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Is Addiction a Disease or a Choice? The Different Models That Explain Addiction · Recovering Out Loud

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  For decades, people have debated the question, is addiction,
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  alcoholism a disease or is it a choice?
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  What's going on here? Some people say addiction is a
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  brain disease, others say it is learned behavior, some say it's
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  trauma, coping, or even spiritual disconnection.
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  Depending which model you believe, it completely changes
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  how you think about recovery. So today I'm going to break down
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  the disease model of addiction, other major models used in
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  psychology and treatment, and why understanding these
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  perspectives actually matters in recovery.
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  Disclaimer here, I'm not a doctor or a scientist.
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  This is all personal experience in the 10 years, 11 years I've
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  been in addiction recovery and education.
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  So first the disease model, probably the most widely known.
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  It became especially especially influential through Alcoholics
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  Anonymous medical research and addiction treatment programs.
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  The basic idea is simple. Addiction is a chronic brain
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  disease, just like diabetes or asthma, and it affects how the
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  body functions. So in something like Alcoholics
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  Anonymous and 12 step programs, they believe that addiction is a
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  disease of the mind and body. So it's an allergy of the body
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  and obsession of the mind. When I take that first drink, I
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  can't stop. I need another one to satisfy
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  the urge, the craving. Men and women essentially drink
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  because they like the effect produced by alcohol and drugs,
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  and they'll chase it into the depths of hell.
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  They will go to any lengths to get that next drink or drug
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  because it provides some sort of relief, ease and comfort for
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  them that once I start, I can't stop.
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  And when I'm stopped, I can't stay stopped.
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  I'm constantly obsessing over the next drink or drug.
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  So the disease model focuses on brain changes.
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  Substances alter brain systems involved in reward.
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  So it feels good when I when I get that dopamine hit.
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  Motivation, memory, decision making, and impulse control,
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  these are all factors that contribute to the fact that I
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  have no choice in the matter. Repeated use changes the brain's
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  wiring so that the substance becomes prioritized over
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  everything else. Nothing else matters except for
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  that first drink, that next drug.
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  I will do whatever it takes to get money to achieve that.
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  I will lie, cheat, manipulate, and steal so that I can get that
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  ease and comfort with a few drinks.
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  This is why addiction often involves cravings, compulsive
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  behavior, and relapse when someone wants to stop.
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  So we see people on the streets, for example, that don't have a
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  choice in the matter. They're not enjoying themselves
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  out there, a lot of them. I know for myself, I wasn't
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  enjoying the depths towards the end of my addiction.
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  It was fun in the beginning, and then it becomes about chasing
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  relief. It becomes about just survival,
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  really, my medicine. One important idea in the
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  disease model is this loss of control.
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  People with addiction may sincerely want to stop, but the
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  brain's reward system has been altered.
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  That's why addiction is described as chronic and
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  relapsing. So it's progressive.
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  You'll hear people say it's a progressive disease and it's
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  getting worse, not better over time.
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  That was evidenced in my life when I relapsed after 7 1/2
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  years, I picked up way worse than I left off.
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  I I really couldn't control it. I had no say in the matter and I
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  felt like I needed to drink. So some strengths of the disease
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  model. And again, there's no one way to
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  look at this. This is a multi layered solution
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  to a multi layered problem. There is a lot of different
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  beliefs out there. There's not just one way.
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  So whichever 1 you agree with you confide in, you resonate
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  with, go with that one. So the strength of the disease
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  model is there's big benefits to understanding addiction.
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  First, it reduces stigma. Instead of seeing addiction as
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  moral failure or weakness, it frames it as a medical
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  condition. So it, it doesn't, the way I
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  like to look at it, it doesn't shift blame.
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  It reduces shame, right? We're not shifting blame and
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  saying, oh, it's not up to me. So I'm gonna just do whatever I
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  want. There's no point in all of this.
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  No, it's not about that. It's about reducing shame so
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  that I know that I am not just fucking up and I'm not just a,
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  a, a failure in life. There's more to it than that.
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  It's bigger than me. It's bigger than you.
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  Second, it encourages people to seek treatment so that there is
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  a, a treatment to it. There's not a, there is a
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  solution, but there's not a, a cure.
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  And in my experience, it's a daily reprieve contingent on the
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  maintenance of my spiritual condition.
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  That's me. And 3rd, it emphasizes long term
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  management rather than quick fixes.
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  So this is something that I'm going to be battling with,
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  dealing with and it can lay dormant.
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  It is not going to run my life, not going to drive the bus, but
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  I do have to work on it every single day.
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  It doesn't just go away. It doesn't just disappear when I
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  stop taking substances. Just like other chronic
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  conditions, recovery may involve ongoing support.
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  So it's looking at people as being sick rather than being
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  flawed or broken or beyond repair.
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  They're just stupid, they're just having fun.
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  They're just selfish. They're just making decisions
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  and choices to do that. Some criticisms of the disease
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  model 'cause there are criticisms for sure.
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  There's a lot of scientists and neurologists that believe
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  differently, and it's important to understand all of the
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  perspectives here. That's what I'm trying to do in
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  this episode. So at the same time, the disease
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  model isn't perfect. Some critics say it makes people
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  feel powerless. If addiction is purely a
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  disease, some people interpret that as I have no control over
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  this. Others argue that addiction is
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  more complicated than just brain chemistry.
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  It's multifaceted. Because addiction is also deeply
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  connected to environment, trauma, social conditions,
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  learning and behavior, there's more going on beneath the
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  surface. I talked about that at length in
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  the last episode. So while the disease model
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  explains parts of the picture, many experts believe it doesn't
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  explain the whole story. Next model.
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  So the addiction being a behavioral and learning model,
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  this is another major way of understanding addiction.
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  It's called the learning model. Perspective says addiction
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  develops through conditioning and reinforcement.
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  So it happens over time, reinforced behavior, repeated
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  behavior, repeated patterns or conditioning the brain.
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  In simple terms, your brain learns the substances produce
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  relief or pleasure from whatever you're dealing with.
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  For example, I get stressed at work, I drink alcohol, I feel
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  relief. I can relate to this one as well
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  because for a long time, alcohol and drugs quieted the noise in
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  my head. I always say that made me feel a
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  part of it, made me feel connected.
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  It made me feel like nothing else mattered in the world and I
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  could escape reality for a moment.
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  That illusory freedom. I didn't have to be an adult.
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  So over time, the brain records that pattern and the next time
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  stress appears, the brain says, use that thing that worked
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  before. I know what'll work.
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  Over time, this becomes a habit loop.
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  Triggers start activating cravings automatically, so
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  you're not even thinking about it.
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  Subconscious. You're picking up the drink and
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  you don't even realize you're picking up the drink.
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  How did I get here? How did I get 7 deep already?
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  Your brain has learned a predictable reward pattern.
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  Predictable and deadly. The next model we have is the
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  trauma or self medication model. So this this model focuses on
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  emotional pain and trauma. You often hear Gabe or Mattei,
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  the famous doctor on addiction. He goes on a lot of podcasts, he
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  talks about trauma. This is all addiction is all
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  about trauma and pain. So it's often called the self
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  medication model. According to this view,
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  substances are used to regulate difficult emotional states like
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  anxiety, depression, trauma, shame, loneliness.
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  I am regulated when I am on substances, so people aren't
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  necessarily seeking pleasure, they're trying to reduce pain.
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  I'm in so much pain from whatever happened in the past or
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  whatever, it's usually in the past that this is my solution to
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  that pain. For example, someone with severe
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  anxiety might discover alcohol quite their nervous system.
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  You hear that a lot. It calms me.
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  Someone with trauma might use substances to numb intrusive
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  memories. PTSD is another one.
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  Over time the brain learns substance equals emotional
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  regulation. This is why emotional sobriety
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  is so important and regulating your emotions naturally,
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  healthily, without substance, without mind altering drug.
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  This model helps explain why addiction is so common among
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  people who have experienced childhood trauma, chronic
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  stress, emotional neglect, abandonment issues.
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  The next model is the bio psychosocial model.
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  This one is is probably one of the more popular ones in the
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  science community. Scientific community is called
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  the biosocial biosocial model. This approach combines multi
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  multiple perspectives. It reduces it recognizes that
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  addiction is influenced by three major factors, biological
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  factors. So genetics and brain chemistry,
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  which I talked about in the last episode.
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  It can increase vulnerability. Some people are more
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  biologically susceptible to addiction.
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  I talked about this at length in Why Why do some people get
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  addicted and others don't in that episode?
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  Check it out. Two, we have psychological
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  factors. So things like trauma, mental
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  health conditions, personality traits, coping skills all
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  influence how someone responds to substances.
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  So you are predisposed to these things.
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  You have more likely a chance to get addicted. 3 social factors.
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  So environment, things like peer groups, family dynamic, the
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  culture you grew up with, stress, access to substances, is
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  it around? Are you hanging out with people
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  that are using more often? They all shape the risk of
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  addiction. The biosocial, biopsychosocial,
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  I said that wrong in the beginning.
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  Biopsychosocial model basically says addiction isn't caused by
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  one thing, it's the interaction of many factors.
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  Why these models matter in recovery.
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  So why should we care? These models aren't just
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  theoretical, they influence how treatment works.
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  So how do we treat the illness the the problem at hand?
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  For example, if you follow the disease model, treatment might
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  emphasize abstinence. So completely going off
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  substances, all minded, mood altering substances.
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  Because just because I like the alcohol doesn't mean that I can
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  safely use marijuana because I'm always the the pattern below it
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  is deeper. I'm escaping something instead
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  of coping with it in a healthy way.
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  So the disease model might emphasize abstinence, ongoing
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  recovery programs like 12 step model or SMART Recovery.
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  I need to constantly work at this daily, like I said off the
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  top, and then medical support, if you focus on the learning
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  model, treatments may focus breaking habit loops,
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  identifying triggers, right? These more practical approaches,
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  building new coping strategies, actually writing out what my
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  triggers are and how to combat them.
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  CBT and DBTS, cognitive behavioral therapy and
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  dialectical behavioral therapy. These are methods that are used
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  to treat this sort of breaking these negative thought loops.
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  If you focus on trauma model, treatment may involve therapy,
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  trauma processing, and emotional regulation.
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  So digging up that stuff and dealing with it, not just
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  ignoring it. In reality, effective recovery
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  often involves elements of all three.
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  So it's a multi layered approach.
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  Addiction is one of the most complex human conditions.
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  A lot of people don't really understand it fully and that's
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  why it's such a personal recovery, such a personal
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  journey. It's not one single model
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  explains everything. I used to think that abstinence
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  was the only way to recovery, but I once heard somebody in
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  harm reduction. The other day we were getting
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  naloxone training at school. They talked about recovery being
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  just progress, just wins, small wins, incremental.
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  So if I was drinking 6 beers a day and now drinking three, that
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  is recovery. That is a win.
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  Some people believe that and I am more open minded to that.
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  I do not believe one way my recovery is my recovery.
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  However you practice your recovery is going to be
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  different than the way I practice it and that is fine.
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  It is accepted as long as we are moving towards a goal.
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  What is the goal here? Do I want to get abstinent?
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  Do I want to fix my life or do I want to just moderate?
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  Do I want to control my drinking?
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  In my experience, control is never an option.
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  Moderation was never an option. I could never just take one and
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  take it as prescribed. I never had benefits with that.
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  That is evidenced by my reaction to nicotine.
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  I got back on these damn zin pouches that I just, I, I can't
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  just moderate it. I'm always thinking about it.
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  And it's not something I, I'm proud of.
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  It's not something that I, I want to do for the rest of my
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  life. But you know, these are things
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  that I just need to understand more about myself that I can't
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  have one of anything. And that is OK.
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  There's ways to live around that and to cope with that and to
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  live successfully and happily and whole and be happy, joyous
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  and free while also recognizing that there is work to be done.
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  I'm always in progress. I am always moving toward this
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  power greater than myself, this connection with what I choose to
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  call God. So no single model explains
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  everything like I said. But most modern research will
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  agree on this, that addiction involves changes in the brain,
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  patterns of learning, emotional coping, and life circumstances.
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  This it all involves. It's all-encompassing, and in
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  order to recover, we need to focus on all of these areas.
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  Understanding these models helps us move away from blame and
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  toward compassion and effective recovery.
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  So the better we understand addiction, the better we can
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  help people heal. And this is all about empathy to
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  me. The next time you see someone
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  struggling with addiction in your life or on the street or
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  whatever scenario you might run into, cause addiction is
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  everywhere, Let's place it. If you don't think you have an
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  addiction, rethink how your relationship is with your phone,
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  your social media, your coffee. That is addiction.
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  It's just not. The circumstances may not be
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  harming you in the way they're harming other people.
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  If we can understand and empathize with people instead of
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  saying what's wrong with them, say what happened to them, what
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  are they going through? Everybody is facing a battle
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  that you know nothing about. Try to understand it from
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  everything that is LED up. What happened to that person to
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  make them need to escape it, to look for relief, to look for
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  ease and comfort? What is driving that behavior?
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  What is driving the need to seek pleasure or to whatever it is
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  for that person? Understanding it can help us
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  treat it can help us empathize with people more instead of
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  sympathize and look down on people and realize that at the
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  end of the day, this is not a choice.
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  That that is the one thing that upsets me is when I hear people
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  say, well, they're just choosing to to do that.
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  They're choosing to live this way.
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  They're choosing to separate themselves from society and
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  isolate. I have spent a lot of time
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  around recovering addicts and new people and new guys and
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  worked with them one-on-one. If it was a choice, a lot of us
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  wouldn't need recovery. We would just choose to change
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  our life. And for some people, they can
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  just do that. They can just change small
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  things in their life and work out more and read more books and
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  go to retreats and see a psychologist and they're fine.
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  Go on a certain medication and they're OK.
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  But at the end of the day, think of recovery like this.
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  It is simply just improvements, progress, not perfection.
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  We are moving toward a goal, and any small win is a win.
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  If I stop doing heroin and I'm smoking weed now, that is a win.
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  That is recovery. If I am California sober, which
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  a lot of people disagree with, and I did for a long time, Try
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  to open your mind to that concept that maybe that person
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  doesn't need abstinence, maybe they don't want it ever.
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  And I know certainly I was practicing harm reduction when I
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  was in my relapse. I was looking for ways to safely
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  use drugs. And I just found that I could
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  never come to a happy, useful incorporation of drugs in my
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  life, even ADHD medication. There was no benefit to me.
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  It was just providing relief, providing illusory freedom.
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  I didn't want to be an adult. I wanted to escape the moment.
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  I had such a hard time, still have such a hard time being in
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  the now and just being in my skin, being here and now.
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  So meditation helps with that. All these other things help with
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  that. But at the end of the day, try
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  to open your mind to more different concepts.
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  And there's not one way to recover.
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  There's not one way to get this thing.
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  It is multilayered, multifaceted.
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  Have compassion towards those people because at the end of the
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  day, I think we're all just trying to do better.
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  And when I see the world that way, there are, I have no
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  problems. There are no issues in the
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  world. There are no discrepancies.
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  I'm I'm seeing the world through a lens of acceptance through
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  compassion, tolerance, love and tolerance of others is our code
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  patience. I just need to accept that if I
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  see somebody living in a way that I disagree with, I can
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  simply say to myself, that person is simply not living in a
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  way in which I would prefer. And when they see me, I am not
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  living in a way I in which they would prefer.
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  And that's OK. We can all coexist.
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  I can be of service to those people.
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  So is addiction a disease? I don't know.
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  I believe today that there I just my brain is wired
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  differently than other people and that it provides me with
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  enough solace to work my recovery program that I know
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  that I can never moderate anything.
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  I could never just have one of anything, anything mood or mind
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  altering. Even gambling, shopping.
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  These are all things that I used to escape the present moment.
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  I to escape myself. Thank you for listening today.
• 17:54
  Please like subscribe, follow the podcast.
• 17:57
  Recovery is simple, not easy.