We’ve all found ourselves in circumstances, I suspect, when we’ve been told to “pull yourself together”. It might have been a wake-up call when we were overreacting, perhaps, to some situation or other. No doubt, in that particular regard, it may have served some useful purpose. But it’s certainly not going to be helpful if you are suffering in some way and it’s not going to encourage those who are trying to turn their lives around from addiction.
Some criticise the notion of portraying alcoholism as a “disease”. This is surely correct in the following rather narrow sense. You can’t walk into a crowded stuffy room and pick-up alcoholism in the same way that you may catch Covid, for example. You don’t become an alcoholic through coming into physical contact with a fellow sufferer, though you may come to share their traits.
I’m not a medical expert in any sense of the term. But it seems to me we do talk about disease in a more general sense, however. We develop cancers or disease of the heart, for example. Although our lifestyles, poor diet, or whatever, might contribute in some way to these cases, they sometimes just happen to us because of some genetic defect.
Some go further and make the claim that the idea of “addiction” itself is false. They argue that this is a lazy descriptor or a cop-out for a certain form of behaviour. In support of this claim, they note that many people smoke, drink, and take drugs without becoming “addicted”. Indeed, opiates are used when we undergo surgery and most of us don’t typically suffer problems later. Not only that, many so-called “substance-abusers” do stop and remain clean and sober.
This much is certainly true. The central claim here, however, is that what we commonly call addiction is just “weakness of will”. This, it seems to me, is overly simplistic. We might note the following:
First, there may be a genetic predisposition for “substance use disorder”. I’m not a neuroscientist but I’ve read enough to know that brain chemistry may play a part in things like depression. Those who take mind-altering substances, including alcohol, may enjoy the relief they find, at least initially, before they find that more significant intake is required to have the same effect.
Second, there may be a psychological disposition. Trauma is commonly at root of a tendency to self-medicate.
Third, many sufferers from pain can only obtain relief from long-term medication. It is easy to understand how this can lead to over-reliance and significant withdrawal symptoms. The latter push people back to using drugs again.
The point here is that although it might technically be correct to say that alcoholism is not a disease and that it is perfectly possible for the addict to stop, there may be reinforcing factors contributing to the behaviour, including the impact on neurotransmitters in the brain, that still deserve to be described as a sickness.
This all suggests that we need a varied approach to tackling the problems of addiction – using a combination of medication, therapy and behavioural approaches, as required. This should include, based on my own experience and those I’ve known over the years, an approach to help the sufferer find new meaning and purpose in his or her life.
With this in mind, we might say that addiction manifests itself as “dis-ease” or a “sickness of the spirit”. The Danish philosopher Kierkegaard says that “loss of self is despair”. He says that when we lose something, we instantly feel the loss. But when we suffer something infinitely more concerning, such as loss of self, we are never properly aware:
“The greatest hazard of all, losing one’s self, can occur very quietly in the world, as if it were nothing at all. No other loss can occur so quietly; any other loss – an arm, a leg, five dollars, a wife, etc. – is sure to be noticed”, The Sickness Unto Death, 1849.
What does he mean? In short, he is saying that we find ourselves so wrapped up in the world, struggling to survive, that we fail to pay enough attention to the basics. We care more about getting the job done and pleasing others than we do to our own well-being. We are fully aware when something bad happens, often quite trivial, but not sufficiently self-aware that we are suffering for other more deep-seated reasons.
In these circumstances, we surely need to get to the bottom of the problem. Telling somebody that they are weak-willed and need to “pull yourself together” is hardly going to work. Instead, we need a comprehensive strategy to address all of the components and part of the strategy may involve helping the person to rebuild a sense of purpose, identity and self-worth.
Another aspect of a related attack on the way of thinking about alcoholism and addiction follows from the discussion about our personal responsibility. Saying that alcoholism just happened to me, as if entirely outside of my control, is a denial of free will and responsibility. But accepting that you are responsible for your own fall does not mean that you can also recover on your own.
Augustine says that we do have free will but we use it wrongly. We make wrong choices for whatever reason – self-pleasure, self-medication, the pleasing of others – and this becomes habit. Without our realising it, the habit becomes necessity or compulsion and we find ourselves stuck in a damaging pattern of behaviour. Put simply, once fallen we find that we can’t get back and we need help to get on the path to recovery.
Fundamentally, I’m not really interested in whether we call it “substance use disorder” or “addiction”. I’m also not agitated about whether it’s a disease or not. Instead of getting worked up over the terms alcoholic or addict, why not focus on what really matters? Somebody is suffering, causing great harm to self and to others. Why not get to the bottom of it and see what we can do to help?