3 Things Addiction Isn't

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B. Rae Perryman, 2017

September is Recovery Month, and we close it out today. It's a time to celebrate and give thanks for those that battle addiction. We, as people, are almost unanimous in our experience of knowing someone who struggles with addiction, or loving someone who has died from it. September has been a month to honor, and can be a time to mourn. Sometimes, the things we have in common are those that hurt the most.

You can't celebrate recovery without acknowledging its flip side. If you are recovering, something must have hurt you bad enough for you to have something to recover from. In this case, it's addiction.

Addiction is a loaded term, and often controversial — the language surrounding it, the causes of it, how we think of it, and how we reckon with it. I have been in recovery from a 16 year drug addiction for four and a half years, and I write about recovery, drug policy, and harm reduction. I care about it because I am compelled to as an advocate — a guerrilla in the fight against the racist, classist, horribly failed drug war — and a supremely flawed human who has unwittingly survived the horrors of addiction. I write about addiction, however, for a different reason. I write as an attempt to understand it.

There is no understanding it.

I mean this twofold: (1) the pain of addiction itself is mysterious. What makes a person turn to problematic drug use? What gets them hooked? How can we conceptualize and talk about the horrors of addiction without making unwarranted value judgments and unfairly stigmatizing drugs, safe use, and substance users?

And (2), what even is addiction?

When I was first in recovery, I would tell friends, allies, and anyone who'd listen that addiction was a brain disease. Don't stigmatize, I'd beg, to mixed results. Not fully incorrect, but it's not the whole story, either.

Flash forward to the present, and I've spoken about addiction and recovery, written for recovery networks and the Drug Policy Alliance, helped facilitate a Senate briefing about Law Enforcement Assisted Diversion (LEAD) programs, talked to patient groups in rehab, and have been interviewed and profiled for addiction and recovery related causes. Though exceedingly private about my personal life and much of my work, I am a public figure in the recovery movement — specifically in the area of secular, non-12 step recovery. The national conversation on evidence-based drug policy, scientifically rigorous treatment, and the necessity of a philosophical shift to a mindset of harm reduction needs the voices of families, policy wonks, academics, and current and former drug users alike.

I can't tell you what addiction is anymore. I can only tell you what it isn't.

I. Addiction is Not a Moral Failing of the Individual

Drugs aren't bad. To alter one's consciousness for discovery, pleasure, or the spirit bears no need for a value judgement. Drugs and intoxicants will always exist, and people will forever interact with them.

Substance use disorder can be an unfortunate consequence of this reality for many. This consequence is hell enough, and often fatal. There is no need to stigmatize as "bad" the person whose use is or was a compulsion — although the judgement we addicts experience seems inescapable. People struggling with addiction can do bad, dangerous things. But addiction itself is not a moral failing or character defect.

II. Addiction is Not (Only) A Brain Disease

Is addiction a brain disease? Yes. Is that the only factor we should work with as we fight for understanding and overdose prevention? No.

It's neurological, environmental, and genetic. Your mesolimbic pathways get discombobulated and re-routed — the Occam's razor of it all being that addiction is a fundamentally biological process. Your genes, influenced by repeated drug use, express themselves and alter the makeup of your brain. You become unable to control the mechanisms of compulsion without any number of intervention types.

The molecules change. The cells change. And the way your genes express change. There are implications for molecule "memory," whole cell and synaptic plasticity, and the more general adaptions our brains make to their reward systems in those suffering from addiction.

Adhering solely to this model might sound scientific, but it's a function of privilege. If you can pass substance use disorder off as only a brain disease (or, more accurately, a syndrome), it assumes there exists a "cure." And it assumes the causes of addiction can be isolated, silo-ed, and solved. And this is not so without a radical reconceptualization of drug use and its consequences — the drug war.

III. Addiction Does Not Occur in a Vacuum

Problematic substance use is a social disease, symptomatic of problems in society and within. Addiction is a symptom of a much larger problem, that of an unsustainable society.

Addiction happens because of injustice. Addiction happens because of childhood, adult, and culturally inherited trauma. Addiction happens because people care more about what things look like than what they actually are. Addiction happens, in part, because the drug war's goal is to sever connections — to create deep schisms and ingrain suspicion and stigma between societal factions. It serves the insidious parts of our world well to coax us into forgetting we're all interdependent, and that we're fundamentally the same species.

"The opposite of addiction is connection," said Johann Hari, author of Chasing the Scream, in a conversation with Naomi Klein, "And our whole society, the engine of our society, is geared towards making us connect with things. If you are not a good consumer capitalist citizen, if you’re spending your time bonding with the people around you and not buying stuff—in fact, we are trained from a very young age to focus our hopes and our dreams and our ambitions on things we can buy and consume. And drug addiction is really a subset of that."

From Addiction to Recovery

By way of positive definition, all I can tell you is that addiction is a symptom of a much larger problem within an individual, and the world at large. A philosophy of harm reduction is the only pragmatic means of systematically combatting the darkness that addiction can inject into our families and communities.

For me, recovery means sobriety — total abstinence. For the world, recovery means ending the drug war, reframing goals and adherent discourse, and reckoning with these complicated realities as best we can in our communities, personal lives, and national policies.