15 September 2021
In the preceding blog, two arguments were presented against exiting the Cycle of Change (CoC). This blog looks at the neuroplasticity implicated in addictive behaviour and thus in leaving the CoC.
From my recent training in psychology, from independent reading, and from working with groups of people coming to terms with addiction, two strains of thought emerge, separated by their views on how brains change. The less prevalent strain conceptualizes addiction as a set of adaptively learned behaviours. The more prevalent strain conceptualizes addiction as a disease. The latter is the modal model in academia and medicine and has held sway since the mid-twentieth century. And I’m not buying it. Here’s why.
Per Gabor Maté, (2018) Marc Lewis (2017) and Maia Szalavitz (2017), a simple description of the argument beneath the disease model is as follows:
The National Institute on Drug Abuse (NIDA), an American Federal agency with an annual budget of just over $1,000,000,000, defines addiction as “...a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences” (Lewis, 2017).
One of the theories beneath the disease model is the opponent-process theory. That theory states that emotions act in opposite pairs. Concerning addiction, the pleasure of the high is soon opposed by the pain of withdrawal. To decrease that pain, a user will increase her dosage to achieve an equal or more intense high (Barhum, 2017). The predicted outcome is death through overdose or systemic failure, resulting from chronic addictive behaviours. The problem with this theory is that most drug users don’t die and many recover living decades of healthy life.
What Lewis (2017) counterargues is that, in fact, all healthy developing brains do change as we move through the stages of life. There is little dispute about the truth of this. If you accept this premise, the first premise in the argument above (p1) is untrue and its conclusion false.
Lewis (2017) argues that “The disease model provides a knowledge base and research agenda for developing pharmaceuticals that can be useful for reducing craving and easing withdrawal symptoms.” A further problem for the disease model is that “…most alcoholics and addicts recover (Lopez-Quintero et al., 2011), and most of those do so without treatment of any kind” (Dawson et al., 2006). Further, those recovered users never felt they were either sick or cured, per the disease model.
A crucial premise of Lewis (2017) is that the way we experience life changes the way our brains are wired. That new wiring then affects the way we experience things from that point forward. And here’s the kicker: cells that fire together wire together (per Hebb, 1940s) which means that, “once formed, habits—even minor habits—remain in place, sometimes for the rest of our lives.” Lewis goes on to explain that addictive habits are amongst the hardest to extinguish. Enough theory.
If Dick and Jane have been in group recovery meetings for a couple of years together, who is more likely to have that reward circuit kick back into high gear, Dick, or Jane? Dick keeps coming back to the meetings, keeps seeing the danger faced by newcomers, entering the stage of contemplation, and develops a healthy fear of backsliding. Jane lives with the boredom of the meetings for two years and yearns to be gone. She feels she has mastered this stuff and can easily exit the cycle of change living happily ever after. You tell me, whose hard-to-extinguish habits are more likely to arise? That’s why I am not in favour of exiting the stages of change.
Dan Chalykoff is working toward an M.Ed. in Counselling Psychology and accreditation in Professional Addiction Studies. He writes these blogs to increase (and share) his own evolving understandings of ideas. Since 2017, he has facilitated two voluntary weekly group meetings of SMART Recovery.
Addiction is the only ‘disease’ that, once the DOC is discontinued, the patient recovers.
Mental status may be altered for both better AND worse but the same occurs in other stages of stress that affects health and wellness.
Never bought into addiction as a disease process….
If we understand addiction as having three causal factors: a susceptible organism (person!), an addictive drug or activity, and stress/trauma then I would argue with a twist. The patient recovers when consumption of the addictive drug or activity is ceased AND when the patient learns healthier approaches to reducing and/or living with the stress/trauma. You don’t have to agree, Nancy, but, either way, I appreciate you taking the time to read and comment.
Why can’t it be both? Adaptively learned behaviour that is considered a mental illness… One causes the other and creates a vicious circle. What makes it a disease in my opinion is that it creates a mental illness that prevents you from logical perception. That could be used to describe many if not all mental illnesses. Avoid the learned behaviour and create healthier ones, and more accurate perfection of reality comes back. Yes, learned behaviour can be permanently anchored in your brain just like a childhood memory. The new, healthier behaviour can be reinforced and replace the old one. This new patterned becomes the new learned behaviour. The fact is that every single human being on the planet, and even on the space station, is vulnerable to addiction should their mental health and habits take a wrong turn. Someone aware of this, such as a person that has thoroughly recovered from past addictive behaviour is aware of this and, therefore, more likely to take his/her mental health maintenance more seriously than someone who doesn’t understand their vulnerability.
I don’t believe it can be both, Charlie, because the symptoms don’t meet the criteria for both. Cancerous growths are not learned coping mechanisms that disappear with the cessation of an addictive substance/behaviour alongside understanding the stress/trauma that led one to suffering from cancer. I’m also not convinced that every person is equally susceptible to addictive behaviours. Those few fortunate enough to grow up with secure attachments and loving, supportive, and stimulating environments don’t feel setbacks are about them. As such they don’t have stress-based reactions invoking previous trauma and inducing a cycle of panic, negative self-talk etc. I encourage you to keep asking questions and to keep disagreeing if that’s the way you see it, Charlie. As always, thanks for reading and commenting.
Sometimes, ok most of the time, I wish our group could all take a few years of our lives and have these discussions as a full time career. These disagreements/debates are the best way to learn as much as possible about addiction and mental illness.
Copy that, Charlie!