by Joshua Hoe
When people hear that addiction is a disease they often assume that addicts will get treatment and be healed.
In other words, they assume that like with Cancer or Malaria, the addict will get some Chemo or take some Antibiotics and be healed. In “addiction-land,” the treatment everyone expects addicts to take before being healed is called Rehab.
This plays out pretty much the same way in the press over and over again, usually with celebrities or sports figures.
Most recently, talking heads on every sports channel in the world spend hours bemoaning how “stupid” Josh Gordon (formerly of the Cleveland Browns) is for failing a drug test after being suspended for a year.
Didn’t he learn anything in rehab (it must be his fault since he got treatment) and how could he be so stupid as to relapse RIGHT before his reinstatement by the NFL was once again possible.
What an idiot!
Except, addicts know that it is exactly times like sobriety anniversaries or major new opportunities that people relapse. Sometimes, often times even, the stress created by these looming events is a trigger.
Addicts don’t relapse because they are “idiots” they relapse because they are addicts.
The “Chronic” Disease Metaphor
I have long suggested that what is needed, for a cleaner understanding of what addicts go through, is not a disease metaphor for addiction. Instead, I have suggested that what is needed is a “Chronic Disease” metaphor for addiction.
(I do understand that proponents of the disease model use disease literally, but I am talking about how people translate that and create a parallel between addiction as a disease and other diseases that they already understand).
Basically, Addiction is more like Diabetes than like Malaria.
Like with people with diabetes need insulin, addicts need daily maintenance (calls, HALT inventories, meetings, therapy, medidation, exercise etc.).
At any time, any addict who messes up their maintenance program can relapse (just like messing up insulin maintenance can send any diabetic into shock).
How we conceptualize addiction matters, in the political discussions on the subject of addiction during this election cycle multiple candidates have referred to giving addicts second-chances before applying criminal sanctions for use of substances.
But, if an addict isn’t ready to recover and/or doesn’t have a good maintenance program (we call it a program of recovery) that addict is almost guaranteed to face relapse (and Rehab is not a method for continual maintenance although it can be very helpful to addicts in getting clean and creating a good maintenance plan).
Not because they are stupid, or because they are morally bankrupt, because they are doing a poor job of maintenance (just like a diabetic forgetting to take insulin).
Perhaps more important, even if an addict has been sober for years (sometimes even decades) they will always be at risk of a relapse if their maintenance program fails. It is a chronic disease.
The sooner people understand that relapse is not a moral failing and that addiction is a chronic condition, the sooner the treatment of addicts will improve.
I have not heard many people call people in diabetic shock “idiots.”
Do you disagree with the idea of addiction as a chronic disease? Let me know what you think, leave a comment!