Addiction as a Disease

In the traditional addiction approach, which used by almost all treatment programs and support groups in the United States, addiction is a medical and spiritual problem. Attending Alcoholics Anonymous (AA) or other 12-step groups is seen as necessary for recovery. AA’s 12 steps describe how recovery occurs by turning over one’s will and one’s life to the care of a higher power (God, as understood by each individual).

A Fresh Perspective

But there is an alternative viewpoint, in which addiction in its varying degrees is an extreme version of habit. Overcoming addiction then occurs using the same processes by which one changes other habits. To be sure, severe addiction can result in horrendous consequences, but even severe addiction can be changed using normal human change processes.

Although some individuals become more addicted than others, everyone slips from habit into addiction (broadly defined) at times. Both are part of normal human experience. The ordinary processes that change either include increasing self-awareness, identifying and resolving conflict, discovering and developing alternative behaviors, experiencing support from others, not acting on temptation, and being persistent, among others. Habit change is a psychological problem, and addiction also can be viewed as a psychological problem requiring a psychological solution.

‘To addict’ is derived from a Latin root meaning to assign to, or to surrender. There is no definitive contemporary definition of addiction. I’m presenting here a “working definition” which is consistent with what is known about addiction treatment and with common sense.

Craving. Excessive. Anything.

Addiction is repeated involvement with anything, despite excessive costs, because of craving. The three central concepts here are “anything,” “excessive,” and “craving.” Let’s work backwards.

Craving: Craving can be a complete experience: feelings, thoughts, sensations, images. When craving occurs, you strongly desire a specific substance or activity. You have an urge for it, get jumpy and twitchy, feel you can’t go on without it, start losing interest in everything else, recall a previous “high” and look forward to the next one, and so forth. Craving is a kind of tunnel vision. As it gets stronger, you perceive less and less of everything else, and get increasingly focused on getting back to your addiction. Unless you learn to cope effectively with craving, overcoming addiction is unlikely.

Excessive: All involvements have a cost. If the cost is in proportion to the benefits received, we are satisfied. If the cost is relatively low, it’s a bargain. In addiction, the cost is relatively high. Although there are still benefits in addiction, addiction is the opposite of a bargain. In addiction repeated involvement occurs because the tunnel vision of craving momentarily hinders us from recognizing the discrepancy between cost and benefits. In mild addiction cost clearly but slightly exceeds the benefits. In severe addiction the difference between costs and benefits is dramatic. A habit is repeated involvement when costs and benefits are about equal.

Anything: Although addiction has usually meant substance addiction, in recent years there is recognition of addictions involving gambling, sex, spending, relationships, and other activities. It now appears that any substance or activity (i.e., anything) could lead to addiction, because addiction is a type of relationship between an individual and the substance or activity. The individual is an active contributor to the addictive relationship, and not a passive victim of a substance or activity. If we were at the mercy of certain substances or activities, then everyone sufficiently exposed to them would become addicted, but this does not happen.

Recognizing that there are alternative viewpoints about addiction can be a huge realization to someone struggling with one, and the basis for new-found hope for change.