An “attractor” is really just a description of how a system (e.g. a person, a person’s brain) behaves — how it looks from outside. Here, in the second half of the article (revised), I look at the underlying mechanisms that explain why addiction works as an attractor — why it behaves the way it does.
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Most obviously, addiction is characterized by a strong desire to pursue a substance or behaviour. The substance or activity temporarily relieves the desire, but a negative emotional state is left in its wake. Loss, disappointment and anxiety emerge as soon as the substance or activity is finished or no longer satisfies — e.g., once the drugs or booze are gone. And so desire builds once again. In this way, addiction perpetuates the need it was intended to satisfy. But it also perpetuates the behaviour: the addict learns to satisfy the recurring state of need by getting more, doing more, thus further consolidating the learning — and the neural patterns underlying it. What fires together wires together. The biology of learning locks in the habit, so choosing to stop is not a simple one-step decision. You have to choose to stop repeatedly and continuously until these neural patterns have a chance to reconfigure.
Brian taught in a community college in Cape Town, ran a successful business, and generally used his fine mind to good advantage. But the pileup of obligations and a mild attention-deficit problem saw him begin taking various stimulants to stay awake and clear-headed. Within two years, he was smoking crystal meth several times 
per day. Sleep became sporadic and unpredictable. He could no longer think in straight lines, and fantastical whims soon replaced his customary rationality. His business fell apart, he moved in with his dealer, and his precious relationship with his young daughter turned into a parody of parenting, with him sneaking out to the car every hour or two for another hit. Meth comes on strong and brings with it clarity, optimism and brilliant energy. But Brian’s sleep loss meant that the high was increasingly short-lived. With the first hints of loss, he would grab for his pipe, eager beyond reason for another launch.
Other (interconnected) feedback loops facilitate and consolidate addiction. They include social isolation, reinforced by the addiction, which leaves the addict with fewer opportunities to reconnect with people, or with healthier pleasures. They include the rationalizations that addicts know too well: if I’m such a bad person, or so misunderstood, then I might as well do it again. Brian was a self-reflective guy; he knew how much he had lost. His ongoing self-destruction seemed a punishment for what he perceived as his failure.
Addiction isn’t about rationality or choice; it’s not about character defects or bad parenting, even though childhood adversity is clearly a risk factor. Addiction is about habit formation, brought on through recurring, self-reinforcing feedback loops. And although choice is not obliterated by addiction, it is much harder to break deep habits than shallow ones.
With respect to mental health more generally, addiction can be seen as one member of a family of attractors. Depression, anxiety disorders, post-traumatic stress disorders and other stable conditions are highly resilient despite their unpleasantness. They are identifiable as attractor states — unattractive attractors we might call them — as readily as addiction.
According to classical learning theory, rewarded behaviours proliferate, while behaviours leading to adverse consequences are extinguished. Yet this clearly misses the point when it comes to the development of emotional problems. Rather, it sometimes seems that the most 
unpleasant conditions are the most likely to become entrenched. Mental and emotional states characterized by suffering appear in adolescent development with remarkable frequency, and they continue to dominate the personality for years if not for life. Why would such negative states become attractors, become concretized and stuck?
Perhaps emotional problems like depression and anxiety are diseases. These are indeed the conditions that psychiatry has labelled and pretended to understand — then remained impotent to prevent and treat. Even the medications prescribed for these ‘illnesses’ are notoriously 
ineffective. (Antidepressants simply do not work for most depressed people, except as placebos.) So it’s not surprising that addiction might also be viewed as a psychiatric illness — one that’s hard to treat and therefore “chronic.”
Deep psychological attractors such as addiction, depression and anxiety disorders stabilize for a reason — and it’s not because they make things easier. In general, they stabilize because the interactions that forge them involve strong emotions that call for cognitive compensations that end up making things worse. Depression, for example, involves a sense of loss and rejection that calls up ruminative thoughts whose very character tends to be self-deprecating. The more we examine ourselves, the 
more fault we see; and so rejection, sadness, and shame are amplified. Anxiety draws attention to threat. That is its evolutionary purpose. Thus anxiety disorders arise from a very simple, very pernicious feedback cycle. The more anxiety, the more attention to what could go wrong, to the dangers implicit in the environment. In turn, this thinking amplifies the feeling of anxiety. And so on.
Thankfully, most people pass through their depressions, conquer their fears, and come to terms with their traumas, through some combination of effort, circumstance, skill and luck. With respect to addiction, the news is generally good. With all substances, including heroin, methamphetamine and alcohol, most addicts recover. Depending on the researchers’ claims, methods and definitions, proportions vary roughly from 50 per cent to 90 per cent. The latency to quit or to achieve controlled use varies with the substance, the person and the culture. But experts increasingly agree that development itself drives recovery. While repetition leads to habit-formation, it also leads to boredom, frustration and despair, and these negative emotions impel us to keep on trying something we might have failed at before, as our skills and self-knowledge continue to mature.
Donna stopped taking opiates as soon as she began psychotherapy. She was lucky to find a therapist who not only understood her addiction but understood her, especially the childhood hurts that had sent her searching for chemically induced peace while rationalizing the triumph she’d achieved through deceiving others.
Johnny stopped drinking just before he killed himself. Our interviews took place when he was in his late 60s – an age he’d once seemed unlikely to reach. Johnny used AA, psychiatry, yoga, massage and just about every other trick in the book. His suffering was too great for him to stop trying.
Brian, meanwhile, not only gave up meth; he is now completing a PhD in addiction studies. He holds three international grants for applying addiction-treatment strategies to difficult populations, and he was invited to speak to the United Nations about new directions in drug-policy reform.
Not all addicts grow out of their addictions. Some remain enslaved for life, and some die. But the very stuckness of addiction, the redundancy and stupidity of chasing the same narrow goal each day, constitutes a worthy challenge for all that’s creative and optimistic in the human repertoire.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
I love this post! Such a clear and elucidating description for something so intractable. Deeply learned addiction cannot be erased. It has to be replaced by something positive that is compelling, fulfilling, motivating– and compassionate. That is the reason the notion of service is so powerful in all recovery traditions. It takes us out of ourselves to help another out of the same hole we were languishing in.
I think of the service aspect of recovery as: The Golden Rule of Social Neuroscience: It takes a more organized, integrated brain to help a less organized, less integrated brain. It’s basically what healthy parents, teachers and relatives naturally do for children (emphasis on healthy).
I agree completely — too bad that more dont see the huge benefits to self of helping others…. but maybe not so surprising in the US at least where the idea of Me First and Now has become so predominant .
It seems our culture is a distorted reflection of the human spirit – it’s not surprising that many of us suffer from “god-sized” holes. It’s wonderful that as we learn to become better lovers of each other we begin to nourish the dark emptiness. And maybe that understanding of being of service is a less distorted reflection of who we really are.
Loved the post and the insightful comments following. Thank you. You guys make me less hungry.
Thanks, Nancy. These are beautiful thoughts to help brighten an ugly phenomenon. Indeed, I don’t know anyone, not anyone, who’s been through addiction and hasn’t experienced what you call god-sized holes. Your advice, to care for others as a detour to caring for ourselves, is priceless. And humans have always cared for each other. We wouldn’t have survived otherwise. Why is that so difficult to understand and cultivate?
It has been a while since I visited your website. Part of the reason is the ‘busy’ season for us. Alcohol consumption goes up considerably during November, December and January. The ‘deep’ habit becomes deeper! These patients are clearly cognizant of their problem and attempts to reduce or stop alcohol use failed and these patients sought help.These patients constitute a small minority – 10% or less who could not outgrow or quit on their own.
What is wrong if we offer these patients are offered a comprehensive program that involves medications that mitigate the pain of the withdrawal symptoms, curb the cravings and behavioral therapy that help these patients conquer the deep habit of alcoholism? Yet, this approach is so often denounced on the grounds, the recovery was aided by medications.
The environment plays huge role in the spread of the habit. Unlike depression, or PTSD, the vector contributing to the addiction is cigarettes, drugs, alcohol, casinos, slot machines etc. Greater the access, greater the spread of the addiction and higher relapse rates.
How should society react when so much heroin is coming into the country and more and more people are injecting the drug? The death toll is rising year after year and we have no strategy in place to stem the flow of heroin and help those impacted by the drug. For every Donna who stopped using heroin when she started psychotherapy, there are a lot more who are unable to quit. What should we do for these patients?
Do we just wait for the development to drive recovery or do we intervene with appropriate medications and therapies to give these patients a fighting chance to recover?
I have stated in my earlier comments that my clinics treat in excess of 400 heroin patients a month and they are coming to us because their attempts to quit on their own did not work. These are the hardcore patients coming to us with a constellation of problems involving medical, legal, marital, financial problems and we have offer them treatments that work. For many of these patients, this is the first time they are receiving treatment rather than jail or barely surviving on the streets.
Percy,
Recovery programs play role that is currently overlooked.
Since it is human nature to look under every rock for an answer or solution before letting go of the love of something, Recovery Programs are usually approached before a person lets go of a love for an addiction.
Although Recovery Programs assist a person in recognizing learned habits, support abstinence, etc, a change-of-heart is different.
A change-of-heart is when a person no longer feels emotionally attached to something, such as a sports team, a musical group, film-maker, etc.
There is a spectrum of struggle, but ultimately, a person no longer has to struggle about whether to attend events, purchase tickets, or even plan ahead about avoiding these things if there has been a change-of-heart.
Studying and treating the daily Tragedy and Carnage of Addiction is critical and ongoing, but studying people that have had a change-of-heart regarding an addiction could be of great value, and many of them will have probably have been involved in recovery programs during their recovery.
I think we are coming to a point where a more through understanding of recovery will shed new light on the understanding of addiction.
Carlton
Carlton, this is a really insightful response. To read between the lines, are you saying that recovery programs are sometimes (not always!) premature? That people may very well get to the change-of-heart stage, even though it’s not yet evident? Or are you saying that there are two distinct pathways to recovery: supervised recovery when someone isn’t ready to do it on their own vs. the “development out of addiction” idea that has been widely touted lately? I think there is certainly room for both, and I’m thinking you would agree. Or at the very least, let’s reduce harm until the change-of-heart has a chance to blossom.
Hi Marc, Thanks for the reply.
An individuals change-of-heart seems to occur anytime, even during a persons recovery process.
It does not seem to be part of any specific “stage”, nor does it seemed based on skill, or due to a technique, or method.
It is realized by the individual, and the actual moment can recognized in hindsight, in many cases.
Although this phenomena is not really a part of the current Models of Addiction, It is a fundamental aspect of the evolving description of the DILECTION Model of Addiction.
This model may be more apparent, or in cahoots what that large percentage of people that recovery outside of Recovery Programs experience,
And/or with people that eventually leave recovery programs.
Good to hear from you, Percy. You may be sawing the same old saw as always, but it’s an important one, and we need reminding. Also, new readers come to this blog all the time, so it’s good of you to get them thinking about these matters if they haven’t already.
You know that I would never oppose pharmaceutical aids to recovery….I’m neither opposed to maintenance therapy nor to the use of naltrexone, which I know you favour. Given the discouraging numbers you and others have reported, whatever works is better than whatever doesn’t work. And I don’t think we’d disagree about the value of “harm reduction” either. Which, by the way, may be precisely the same thing as “maintenance.”
Please also see Carlton’s valuable perspective…above. Here we can see that there may be a period when assisted recovery is the only option. Not everyone survives until they’re *ready* to stop.
Marc, You wrote above;
“Please also see Carlton’s valuable perspective…above. Here we can see that there may be a period when assisted recovery is the only option.”
Actually I am saying something quite different. I am saying that for a percentage of people, recovery programs ultimately did not work for them.
The Recovery Programs were one of the many “ Rocks they looked under”, and do not find a solution.
In a positive way, the list of possible solutions became narrower and narrower, and in many cases, constructive realizations ultimately occured
These realization can be profound, horrific and even cathartic realizations, but turning points in life, if you will.
In this type of scenerio, Recovery Programs are not considered “ineffective” or “failures” but as options that were tried along the way, and contributed to narrowing he list of things to try that didnt work for them, yet eventually led to recovery.
Hearing accounts like this may currently be rare, but may turn out to be a big percentage of the people that recover.
I hope this is read and considered in the spirit of discovery, and will shed more light on both Addiction and Recovery.
“You have to choose to stop repeatedly and continuously until these neural patterns have a chance to reconfigure.”
“it is much harder to break deep habits than shallow ones.”
If determination exists, these words bring hope to the addicted.
What makes someone stop their entrenched addictive habit? Well, they have to have the intention to quit, not just the motivation. They have to want it, in order to redirect their desire. They also have to achieve a certain level of honesty about their situation, leading to self-honesty, ending up at that holy grail of recovery Marc often refers to– self-trust. Then they have a sense of agency, of knowing it is possible, of seeing it is possible, of experiencing a salient reward to redirect their desire. Ideally it should be done as intensively as we pursued our addiction.
A guy I’ve been taking around to SMART, 12-Step, all paths meetings made this remark after his first solo outing talking to a rowdy detox: “It was weird afterwards. I all of a sudden felt guilty, because I got so high. I felt like I’d done a speedball! I was scared to tell my wife cuz I thought she’d think I was using again! “ He had faced up to a risk as immediate as sticking a needle in his arm, but with the opposite intention and outcome. To help out others who were still struggling. To connect.
His days now are spent working in a recovery center, facilitating meetings, doing commitments, being a recovery coach. And he doesn’t even have a year sober yet.
Now that’s a moment of clarity
Matt,
Yes, “Seeing it, [freedom from an addiction], is possible”, was a very unique and galvanizing aspect of the SMART recovery program 10-15 years ago.
Some of us proposed a meeting called ” Ex- Addicts as Guest speakers”,
to relate their personal experience about how their feelings changed, what happened to Triggers, etc..to people currently in the recovery process, but paradoxically, If you are a person that feels this could be helpful and valuable ….you are also a person that will probably eventually leave.
It never got picked up or realized, I think because it is does not increase long-term activity or membership..but I would be a thing naturally attractive to people that are at the point where that are actively seeking and desiring freedom from an addiction.
Beautiful anecdote, Matt. Keep em coming.
Hey thanks, Carlton.
Funny you should mention the guest speaker thing. I’ve noticed in SMART, after people are successfully into their recovery, there are some you never see again as with any meeting. There are some who come back, usually around a year to check-in, out of gratitude, but also to show newcomers or those in the throes of early recovery that it’s worth it. They also know it’s there if they need it, and do come back if they’re having a crisis. Some pop in, some stay for life. SMART emphasizes it’s a choice because everything is choice, ultimately. We know that people do much better at something, when they make the choice themselves. And all programs provide a platform to do this. “Recovery” is not a religion. It’s a process.
Some facilitators do extra things when the group seems to want it. For example, some meet before the group to work on cognitive behavioral tools in the SMART handbook, just like 12-Step does to work on their tools. I do mindfulness exercises and meditation. There are 12 Step meditation meetings. Functionally and pragmatically, all successful programs get the same result …for different people. That’s why there needs to be choice.
The person at the end of your first paragraph is one type out of many. People are shy. People have busy lives. People move. The point of recovery is to engage and feel belonging and worthiness in our society– our tribe, our social group, our lives– not to go to meetings for the rest of my life.
Or maybe some are wackjobs like me who do 12 meetings and commitments a week, and drag open-minded people from other programs along with me. It doesn’t matter what meetings we go to. But we have to do something to hold the space in our recovery, till we can figure out what we want to do, and make a plan… what are we going to do to get a foot hold in a new habit.
Sorry, Carlton. I’m not ranting at you. I’m just ranting.
Hopefully, professional research on the phenomena and the underpinnings of leaving recovery groups such as SMART, (and even AA and other recovery programs) will pave the way for the Addiction field and the Public in General, to recognize and consider a different model of addiction other than the Disease model that is currently held.
Matt, you wrote;
“I’ve noticed in SMART, after people are successfully into their recovery, there are some you never see again as with any meeting. ”
As a long time addict, what new in the 1990’s was seeing people leaving recovery groups like St Jude, Cornerstone, and later SMART, and actually witnessing the trajectory of their check-ins over time, which led up to them leaving.
Although people left my AA home group too, there was no way of really knowing why.
After 20+ years as an addict, it had become unimaginable to live without alcohol. Many attempts at abstaining were actually laborious weeks or months, were followed by returning “home” to alcohol.
This is a very familiar story, but in the late 90’s, witnessing the trajectories of the check-ins of people that eventually no longer needed the recovery program or support group. was a new, and very helpful thing.
I would occasionally run across these people in town, and could tell that they were no longer feeling that their addiction was “home”.. in fact they seemed to be free of a “burden” and were not maintaining a controlled life of sobriety.
Recovery had become something witnessed, and no longer un-imaginable.
This was a new thing occurring- perhaps with some of the readers can recall this.
Before the 90’s, being able to witness the trajectory of a persons recovery via check-in’s was not that apparent in recovery groups.
This is an area of Addiction and Recovery that researchers could examine, and it will perhaps lead to new model for Addiction, perhaps incorporating what Marc is describing here too.
A new model would not have to be deterministic and dismiss or undermine the other models, such as the disease model, but could account and allow for all the various beliefs that help people have.
Recovery communities with different beliefs will always be helpful to a large percentage of people with addictions, but having a model that can also account for this scenario that are currently not studied or accounted for.
It could help people that may become addicted in the future, or that are currently struggling.
It could also lead to new strategies and techniques for recovery groups to incorporate into their current programs.
Note;
This following line from above needs to be clarified:
“.. in fact they seemed to be free of a “burden” and were not maintaining a controlled life of sobriety.”
This does not mean people were freely drinking or using as if there was never a problem, this means that the desire and compulsion to return to the addiction appeared to have changed.
The addiction seemed to was no longer be “home”, or a place desired to go, and sobriety was once again the default, not a state needing maintenance.
I believe successful sobriety and recovery eventually become associated with freedom and choice— not control. Addiction is associated with control– being in control, controlling our mood, a situation, another person, our life– our sobriety. When we relinquish that control, it becomes possible to recognize the freedom and logic of letting go.
Yes, Matt, some Ex-addicts may describe it this way:
When addicted, the addiction feels like it is offering freedom and control.
When recovered, the addiction feels it is causing limitation, restriction and confinement.
These feelings, and the freedom from the constant labor of maintaining an addiction, may be key, (and common sence-ical) reasons many ex-addicts no longer feel compelled return to a dependency on an addiction.
This type of information is not a “how…why.. or a “what to do”, but could offer a realistic toe-hold and bolster feelings of hope for a percentage of the current and future addicts that it resonates with… at some point in their recovery process.
And again, It could also lead to new strategies and techniques in the recovery field.
This metaphor you gave really clicked for me, Marc:
“The system, the person, can then be seen as a marble rolling around on this surface of possibilities until it rolls into an attractor well. And then it’s hard for it to roll back out.”
Thanks for that.
Hard to roll out. Not impossible.
As one who has rolled into more than one attractor well over the years – and worked with so many others who have, too – I’m a bit delighted with this way of seeing it. Have found my way out of more than one, too, as have others I’ve witnessed – with support, tools, practices, small steps, learning, clear intention, kindness, empathy, and offering the same for others. We teach what we most want to learn and remember… or, I do. Can’t speak for everyone.
There are probably more things that have helped, though these are the ones that spring to mind first.
Am in another one of those wells currently.
Thankful to be finding all of the above to find my way out… again.
I’ll be sharing this metaphor, this image, and your post, too.
Glad that marbles are round (easier to roll, even if some of have gotten a bit chipped along the way:)…
Glad, too, that we are malleable beings, and interconnected.
– J
What lovely new sprouts you’ve found growing out of the metaphor, Joanna. All these facilitating factors that you mention, “support, tools, practices, small steps, learning, clear intention, kindness, empathy”, can be seen as ridges, troughs, changes in the surface of the plane on which the marble is rolling around.
I’m not kidding. The “state space” metaphor (which is where the attractor idea comes from) can get really elaborate. For example, look at the second “landscape” image from the last post. There you see ravines, branching tributaries, etc. The “tools” you mention can be visualized as fashioning ridges that intervene between the person (the marble) and the addictive attractor, making it harder to roll back in….because you have to go uphill before you start rolling back down and it becomes too difficult to reverse directions.
I guess all I’m saying is that I love this metaphor too, and you can go a long way with it. The take-home message may be that life is a vast, textured, plane of possibilities, and we roll around on that plane, partly through intention and learned control and partly through chance and gravity, en route to ending up wherever we end up.
I agree fully with the notion of addiction as habit – in part because that also normalises addiction. addiction relates to a moral concept but we do not judge elite sports people who are just as addicted as any “junkie” in many cases – and it explains why an entrenched behaviour like chronic drug misuse (the term abuse also has moral implications) is so difficult to change – as Duhhig points out habits need triggers and changing them requires belief, similar to the notion of a higher power but what occurs I think with drug use habits is that multiple triggers are developed to the point that almost anything occurring during a 24 hours period is a trigger, when things are good, when things are bad, when things are neither good nor bad, but also this is where it gets physiological in so far as the blood level of a drug becomes the trigger in chronic use thus the appearance of a physical aspect. of course that is late stage stuff. no addiction is cured, all that ever occurs in my view is that another or other habits take the place including for some addiction to AA or NA. in someone who does the recommended 90 meetings in 90 days a habit to AA is very quickly set up. the problem of course is that by the time a chronic user wants to change alternative new addictions are limited. of course it is always best if one chooses a socially accepted addiction, like work or the stock market or shopping or gaming or sport. then its OK and matters not as much how unmanageable a person becomes, in fact in the cases of shopping for example the more unmanageable the better, as that contributes to economic growth.
Hi Marc,
I have re-visited your essay, The ADDICTION HABIT on AEON and this excerpted version: ADDICTION as a HABIT FORMATION on your Blog a few times, and It is a “clear and elucidating description” as Matt described above.
After reviewing the replies, particularly on the Aeon site, I am curious what your reaction, comments or insights have been.
Also, and this may seem frivilous, but I wonder if people that are, or have experienced addiction problems, (which has been life-threatening to many of us), the word and nature of a “Habit” seems to be, for lack of a better word, an understatement?
Best,
Carlton
Marc,one note to add:
This highly slick 1 hour video production from a few years ago on addiction titled: PLEASURE UNWOVEN portrays some of the things you are describing, but ironically, arguing that addiction IS a disease.
Apon running across it a few years ago I wanted to propose a counter-view video, but alas, there are few people or groups to back a counter-point view at the time.
Addiction: Is addiction really a disease?
https://www.youtube.com/watch?v=wxiKVQR90VM&list=PLA8F89537FD4C3FD1
Carlton
A current Aeon column on drug policy:
https://aeon.co/ideas/want-to-reduce-drug-use-listen-to-women-drug-users
Hi Marc
I am hoping to purchase your Desire book. To get some insites into my addictive behaviours.
I used to drink alcohol but had to give it up 16 years ago because I developed a heart condition.
I still have addictive habits today, in the form of food. I eat chocolate everyday and binge eat. To which I have developed IBS and have teeth issues.
I would like to know if Desire is the same as Wanting.
When i get the urge or craving to eat, it seems to go way deeper than just simple desire. I also can’t feel some emotional reactions except if they are extreme, so I cannot identify when I am having a craving or urge. All I know is I want that item with all my heart and sole. My emotional state is not connected to the negative consequences of my actions and I just indulge because it seems to be right and normal. What I also notice is that my emotions are so subtle that even if I get angry because something upsets me, I don’t actually feel an emotion at all. I can only tell that I am angry for example, if I snap at someone. I also cannot always recognise negative thought patterns, so I try and relate specific actions prior to engaging in an addictive behaviour so I can label them and bring them into conscious awareness. I read Dr Jeffrey Scwhartz’s book called Brain Lock and that has helped somewhat, but it has been a slow process. I seem to be detached from emotions and I think my behavours are driven unconsciously. All I want is to engage in an addictive behaviour. After several years I am learning that a trigger will flash visually into my brain and this I know starts the addiction process. It creates an impulse which I simply act upon without thought. Also I seem to binge regardless of whether I am happy or upset. Sometimes strong excitement causes a binge. Also sometimes strong negative feelings when I have them are actually pleasureble. I am trying another strategy to see if turning away from external stimuli so the first urge of addiction cannot be triggered. Because once it starts, I can’t stop it most of the time.
I have already been to court because of my debt. I don’t want to continue being in debt but at the same time I don’t want to give up my addictions. They are just part of me like an other part of my body. To give up my addictive behaviours, I’d be giving up the essence that is me. So wanting something is different that desiring it.
This response is less about drawing out a structured argument and more about some observations that might be relevant.
1. No one really knows what “recovery rates” are. Substance addiction is on a spectrum (no one thoughtful denies this) and therefore it’s hard to nail down who is really an addict and who is going through a stage…there is no Framingham equivalent for substance abuse…you can make an argument that anyone who just “ages out” of substance abuse was not really addict…
2. Altho the medical benefits of 28 day programs are garbage, is there any information on the efficacy of long term (12 to 18 month) residential programs?
3. AA was never really intended for people who are on the lighter end of the program. The idea that judges can mandate people into AA is AGAINST the very principles of AA. AA says very clearly in the Big Book that its program is for their third category of alcoholic, the one who is “always more or less insanely drunk.” The Big Book also says to anyone who can manage to moderate their drinking, “our hats are off to you.” In fact the three categories of drinkers in the Big Book predates the DSM IV “spectrum” idea by like 50 years…also AA itself is really careful about the term disease…the word malady is used more frequently in the Big Book…I think it’s some kind of hybrid condition…syndrome might be the best term
4. I’m pretty sure that we don’t know exactly how addiction works on the neural level. We have a better idea than we did 15 years ago and Lewis is going (I think) in the right direction…but there are enough mysteries left in the how neural system works that it may well be that substance addiction works in ways that could qualify it as a disease…meaning, it’s not accurate to say with finality that addiction either is or is not a disease….the etiology bears further study…
4. Marc Lewis’ ideas about stopping addiction are not very different from AA ideas. Both call for a change in thinking. The oldest annoying AA cliche is “time takes time.” And every oldtimer at AA knows that after about 90 days of abstinence, a person in recovery doesn’t really have a drinking/drug problem anymore…he/she has a LIVING problem…how to live thru ordinary life without relying on drugs or booze to provide relief…
5. “Habit” is in no way strong enough a word. Obsession is better..
6. I’m only sober 20 months. I drank and did drugs including IV heroin from teen years all the way to 50. I was a high functioning addict til the end when i gave up and lived as semi-homeless criminal for three years. AA and a long term halfway house helped me altho I still don’t believe in the higher power nonsense, and reject the idea of powerlessness. But let me be clear. No one else was available to me. There are not hundreds of thousands of SMART recovery meetings (why does it not catch on as well as AA if it’s so good?)…no one else gave a shit whether I lived or died except a few folks at AA who helped get me some time…and when I disagree with them, they generally say things like “there’s lots of ways to get and stay sober…do what you need to…if it doesn’t work, we’ll be here for you.” …in other words there is a an ALTRUISM component to AA that we don’t see in other addiction treatments…
Yay, Marc!! So happy to see you’re jumping into using complexity and dynamic systems theory as a lens through which to view addiction. I know you’ve studied it a lot and I think that’s why your developing theory as appealed to me so much.
I am using complex adaptive systems as a framework for my dissertation, with a focus on social systems comprised of drug users and their loved ones. I’m currently working on a system dynamics model at the individual-level that will be embedded in an agent-based model. I had a theoretical poster at CPDD last year that I worked on with a PhD in engineering, positing that people move around within certain confined areas of state space based on initial conditions (no simulation or model, just an abstract 2×2 diagram with some vectors). It actually led to some really interesting conversations but I haven’t been able to find the time to follow-up on it. All this is to say, any chance we could talk more about these ideas via email, phone, etc.?
I am not sure that I understand the real difference between labeling addiction as a disease vs. calling it a learned habit. I do understand that most treatment facilities prefer calling it a disease and use the AA model that believes one is never “cured” but can only “contain” with lifelong maintenance.
I think people are wary of anything that might resemble a cure and the danger that idea holds for many alcoholics and drug users. If you can break the habit by forming new ones through repetitive alternative behaviors, then there is in some sense, a cure. However many people who have abstained for long periods quickly find themselves back in their addictions when they have a relapse.
But I do wonder in what sense that just might be a self-fulfilling prophecy for people in AA who think they have no control over their “disease.”
Hi George,
In Brief: one thing the disease label offers, is that people can be seen, and thus treated, as “patients”. For a percentage of people, the disease can account for the troubling, destructive nature of addiction and help alleviate the guilt, shame, etc.
One thing the LEARNED HABIT label offers, is that it allows a person to feel or believe they are a not a “victim” of something like a disease. A percentage of people see this as self-empowerment, freedom, which can be a positive thing for them.
Put this way, it is no longer a; “Disease-vs-Habit” thing, but what a person is naturally drawn to.
A rather new label is that there is a third understanding of Addiction, where addiction is considered a function of life and a naturally, like falling in, and out, of love is.
It is labeled the Dilection model, but it is still being researched and formulated.
If you feel that your son or daughter is a heroin addict, then you should
get in touch with a professional rehab center. They would have experts who
would carefully diagnose the patient and tell you about the course of
action you should take. You don’t worry, your identities would be kept
confidential. If needed, they would admit the patient to their rehab
program to get rid of their addiction. So, get in touch with the leading
drug rehab center and get rid of the addiction with ease and let your loved
one live a healthy life.
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Elina:
I agree with you. My son was in desperate need of help over a year ago and we continuously were looking for the right rehab. Just for purposes of those in need, SLO Recovery Centers (www.slorecoverycenters.com) was the only drug rehab that actually cared enough to 1. Not make insurance the primary factor of whether my son would stay 30-60-90 or more days; 2. Loved my son when we weren’t there; and 3) involve us in his treatment. Our son is sober over a year and we owe this to SLO Recovery Centers.
Dear Tamera,
I am really happy that your son is now much better by the help of SLO Recovery Centers. God bless him..The realities of addiction are painful. It’s hard to hear that a loved one’s life is at risk and you can’t fix it. But once you accept certain realities, you may discover that there’s empowerment beyond the powerlessness. You can read the blog on – how long do xanax stay
in your system
Addiction is seriously a habit and if left long untreated, it goes on to take the shape of a disease or illness that may even lead to death or result in coma. So get treated for you addiction ASAP.
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