Is addiction really a lifelong brain disease?

If addiction is a disease, it sure as hell isn't being treated like one.

I was treated for an opioid addiction in May 2012 as a sad and aimless 22-year-old. I listened to emo, read philosophy, and wore skinny black Levi’s, in case you were wondering. The facility I went to was the famous Hazelden Betty-Ford located in Chicago’s fancy Gold Coast neighborhood. The huge red-brick building with a wrought-iron fence in front once housed the Russian Consulate. I used to sit outside and smoke cigarettes, wondering if the Russians knew their mansion was now an expensive rehab.

For us patients, the daily schedule was tiresome and repetitive. Hours of group therapy, followed by educational lectures, followed by more group therapy, then lunch, then more sitting in circles, and by three o’clock all I wanted to do was get on the train and go straight home. That amount of talking turned my brain into scrambled eggs. Maybe that was the point. I was too tired and bored of talking to people about drugs to even think about using drugs.

During this marathon of lectures and group therapy sessions, counselors drilled it into our heads that our use of alcohol, cocaine, marijuana, heroin, some guy was there for huffing obscure chemicals in his parents’ garage, had spun out of control—not because of our own personal moral degeneration, not because we lacked self discipline, but because we had a disease, a disease located in our brains. The counselors told us this brain disease was chronic (it lasts a long time), progressive (it gets worse over time), and relapsing (it could/will come back). Hence the Chronic Relapsing Brain Disease (CRBD) model.

A lot of sayings and slogans were used to help us understand addiction’s brutal physiology. One in particular had to do with the progressive nature of addiction, that even if I’m not using drugs, my addiction is still progressing and getting worse over time. So counselors said stuff like: Your disease is in the parking lot doing push-ups, getting stronger everyday. 

Normal People, the counselors told us, didn’t want to blast off to Mars every chance they got. Normal People could have one glass of wine at dinner and call it a night. But that wasn’t in the cards for us anymore. A line in the sand was drawn and we were on the wrong side of it. After years of doing drugs—in higher doses, and longer binges—we had forever crossed that line. There was another saying for this process: You can change a cucumber into a pickle, but you can't turn a pickle back into a cucumber.

Our excessive consumption of drugs had changed our brains. Drugs altered brain circuits and feedback loops that govern motivation, reward, and pleasure. Drugs had hijacked our brains.

As I write this I’m realizing the words do not quite capture the drama with which all of this was relayed to us. Sipping on my little iced chai from Starbucks during the early morning lectures, the story of addiction I was told reminded me of a possession movie. Only it was Demon Rum. Or for me, since I had barely ever drank legally in my life by the time I went to treatment, the demon was oxycodone.

This line of thinking led to some absurd situations that annoyed the hell out of me. Whenever I began a sentence with the words, “I think,” some counselor, or a Teacher’s Pet patient acting like a counselor, would interrupt me and say, “Zach, can you really trust your own thinking right now? Your own thinking is what got you here, right?” 

All of this felt like a lot. A whole world of new language and concepts and identities was being presented. I struggled to digest it all.

While in treatment, it was customary to identify ourselves either as an “addict” or an “alcoholic.” Some patients called themselves both! But if you didn’t call yourself one or the other, you’d sorta get a look from the staff and your peers. If you weren’t sure what you were, or you didn’t want to call yourself an addict, words like “denial” would get thrown around. People who didn’t get with the program were called “willful” or “selfish.” We needed to practice “acceptance.”

Most of us in this facility were pretty young. Yet every single one of us received the same exact diagnosis and prognosis despite our unique histories. We were “addicts,” and that meant we could never use drugs or smoke or drink anything ever again. The goal set for us by the clinical staff was a life of abstinence. I was 22!

The more I learned about addiction, the more I struggled with the story that I was being told. When I started reading unapproved literature—thanks Google Scholar!—things really stopped making sense. The idea that I was “an addict” for the rest of my life felt oversimplified, flattening a vast range of human experience. The more I wrestled with what addiction was, what it meant to me, the more it seemed that my drug use was as a symptom, not the disease.

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Whether or not addiction is a disease has been the subject of interminable debate. I’ve long been frustrated by this debate for three reasons: