IS IT A BAD HABIT, SIN, DISEASE, OR ADDICTION?
At most big family gatherings, there will be an alcoholic, a nicotine user, or a drug abuser present. The table likely plays host as well to a few non-chemical bad habits that also threaten the family. Nearly every family has folks who have an eating, work, video game, pornography, sex, gambling, hoarding, or spending disorder. Some may also have abusive or violent tempers, infidelity or love addiction, or online screen addictions to their electronic devices.
As damaging as all these chemical and behavioral addictions are, they don’t mess a family up nearly as much as their strongly different views of the addictive behavior. When the house is divided by different narrow-minded solutions, the addict can divide and conquer, and the addiction has free reign. When the family agrees on the causes and cures, they can all grow stronger with each relapsing misbehavior of the addict. Let’s look at six different views one could take about what is wrong and what is needed.
The first view is usually the first approach loved ones take: denial. They look the other way and pretend nothing is really wrong. He just had a rough night. She’s a victim of circumstances. It’s just a phase he’ll outgrow someday. At least she’s not pregnant, and she’s still in school. He’s still got a job. This is the view addicts take of their own misdeeds, and they are good at charming others into agreeing with them. The problem is that this view and this behavior almost always fuel the addiction, and help the addict slide further into gradually more outrageous misbehavior.
Don’t be in denial. A behavior is an addiction if it does most of the following: it hurts people, wastes time and money, becomes an obsession, produces sudden shifts in mood, takes more and more to satisfy over time, and defies the addict’s efforts to quit entirely, or even to set and keep her behavior within limits for a given episode. Most forms of love, encouragement, and support given to an addict just serve to feed his addiction, not his recovery, and this naïve way of loving is called enabling. (If you don’t know how to tell the difference between this and healthy love, ask me for my article on “How Loved Ones Enable Addicts.”)
A second view is that addicts have personal problems they need to solve. Maybe the problem is emotional, mental, or relational, but whatever, they should get better with counseling, because it’s just a bad habit. This is the view of my profession, but our cure rate for addicts who do psychotherapy alone is embarrassingly low.
A third approach is the self- help movement. Its gurus are celebrities with books, CD’s, DVDs, and seminars. Each one has new angles to sell, and new stories to tell. This method is by far the most popular one to combat over-eating. This approach’s Achilles heel is also its curb appeal, that it requires no submission to help from a professional, institution, or organization. Like a good American, you get yourself over your own addiction. The benefits of these cures do not usually hold up well over time.
A fourth view is the medical model: addicts have a disease. They need medicine and the structured environments of first a hospital, and then usually an intensive outpatient treatment program. Doctors and hospital staff bring healing through medicines that reduce the cravings, and treatment programs that are mostly educational. Addictions are like diseases in that they make us sick and can kill us, but they are not diseases. The disease model can excuse addicts by allowing them to blame relapses on a faulty diagnosis or treatment plan. The disease model may hold addicts somewhat responsible for their recovery and compliance with the treatment plan. But it cannot hold them accountable for the selfish and deceitful behavior that invited and grew the addiction, for the effects their behavior has had on others, or for their relapses back into addictive behavior.
A fifth approach comes from religion: addicts are lost children, and like all sinners, they need to give their lives over to God. The medicines they need are prayer, Bible study, worship, forgiveness, and good morals. The healing institution is the church, and its pastors are its healers. The Bible’s favorite models of sin are idolatry, adultery (cheating on God), and foolishness. These metaphors do show how the sin of addictive behavior betrays God, the one-flesh life partner of a spouse, and the addict’s own holistic health and wellbeing. But if the addict’s church is close-minded, if his God is too small and cannot be embodied in other fellowships and traditions, if her faith is too small and immature to use the other four approaches, when life turns up the pressure down the road, my training, research and experience all agree that relapse to the old habit or to a new addiction is likely.
The best approach is twelve-step recovery. It holds the addict fully responsible for his recovery. It educates and heals both her spirit and her flesh (the ego-kingdom, old nature, heart, brain, natural instincts). Going both to church and recovery groups gives both advanced prevention and on-the-spot cure. 12-step recovery is the most effective approach for overcoming denial, and it is the most friendly to all the other views, encouraging the addict to get counseling, education, religion, and when needed, medication that isn’t addictive. Research has shown 12-stepping alone to be clearly the most effective of the five approaches at producing long-term abstinence, bringing serenity, and avoiding new addictions to replace the old one. It is even more effective when it includes the other four approaches, and back to the family, when they also are working a 12-step model for their own recovery from the traumas, losses, and betrayals they have experienced from the addict’s behavior. Elsewhere, I have outlined how to work a good program, and how to tell if a loved one seems to be doing it right (ask me for “How to Work a Good 12-step Program”).
Like religion’s teaching about sin, recovery teaches that addiction is a progressive and fatal disease, and that whatever you put before your recovery you will lose. That’s the bad news, but the good news is that recovery is free, and it will absolutely make everything else in your life go better than you ever could have imagined. When you are delivered from denial of your character flaws and bondage to your bad habits, you are delivered from the fear that anyone can ever again take your sobriety and your serenity away from you. When your higher power is the author of freedom, you have at last found the one healthy dependency.