So last week I had the rare opportunity to actually catch a live Dennis Prager show. I got in my truck and happened to turn on the radio (I usually just listen to podcasts) and there was Dennis asking listeners who are themselves addicts or close personal experience with addicts to call in. So I called. Shockingly I got through immediately, the woman on the line asked "Why are you calling?" and I answered simply enough, "Dennis just asked for anyone who is/was an addict or has experience with addicts to call in... so I'm calling as I am a loved one of addicts, who went on to marry an addict, and eventually became an addiction medicine specialist."
Her, "Okay, and what would you like to say?"
Me, "Well hold on, Dennis is asking the question now"
Dennis the proceeds to ask the tough question "Is addiction a disease, or choice, or both?"
Then I quickly explained to her that "...it depends on how you define disease, and that in general it is a behavioral decision based on the basic psychological need to avoid pain and gain pleasure."
Moments later I was on the line with my mentor in-absencia and undocumented rabbi, Dennis Prager.
Here is a clip from the show (from my Pragertopia Subscription. Go get one. It's the best $4.53 a month you may ever spend.)
*The clip is played in the podcast.* Hopefully no copyrights were infringed. There was no intent to do so, rather just to elaborate the background for this topic.
So yeah, I had (have) family who are addicts. And I eventually married an addict. I myself could be called an "addict." Perhaps you are an "addict"?
I understand what the word 'addict' connotes in most of your minds. Alcoholic, drugs addiction, or some sort of deviant behavior which one engages despite their better judgement or sense of propriety is "addictive behavior" right?
But what the heck does that really mean?
Is it an addiction or an obsession or simply a habit?
Where do you draw the line in terms of defining an addiction or labeling someone an addict?
Typically the label of an addict is defined by someone with an addiction.
This tautological definition has troubled me for some time now, as it should you.
What is an addiction? What is addictive behavior?
Well typically it's defined as habitual behavior beyond the subject control which has deleterious effects on his life. Perhaps the effect on one's life are in respect to his family, job, psyche, intelligence, health, or abilities. But in general, people believe that for something to be considered an addiction then it must some how be a denigrating force in someone's life.
So for instance, breathing in smoke on occasion is considered an addictive behavior. But, meditative breathing is not considered addictive behavior. Can one be addicted to smoking? Seems obvious. Can one be addicted to meditation?
What if that person leaves her family and job to go sit in and meditate all day long? This is not an absurd argument. I personally knew people who did this.
What about exercise? At what point does exercise go from being a hobby, to a habit, to an obsession, to an addiction?
Dennis mention that his wife may be addicted to books? I understand that problem, my wife complains about all my books. And now that we are in the process of moving I realize that perhaps I do have a lot of books. I also have a lot of guitars and other musical instruments. But when does something go from a joy to a passion to a collection to an addiction. Who is to determine the severity of the "addictive behavior"?
Well maybe you will answer, when it impedes on your quality of life then its an addiction. But what if you can afford it, and no one else is affected? You simply enjoy yourself, and no one else is bothered and your health is unaffected. Perhaps I could argue that your health benefits because of the joy that you have brought to yourself.
And these leads me to the realization that I mentioned to Dennis.
All people have a deep drive to avoid pain and gain pleasure.
By the way, I believe the drive are in that hierarchical order.
In general, people will fight harder or work harder to avoid pain than they will to gain pleasure.
The best lesson I've heard about this was from Tony Robbins.
To paraphrase his example, he speaks extensively on what he call the "Two Controlling Forces in Life": Pain and Pleasure.
So this leads me to my basic point about the confusion regarding addiction.
Since basically all people have these pain - pleasure forces at play in their lives, and all people act based on these forces. Then anyone's actions could be considered addictive behavior simply if someone else does not operate under the same guidelines.
In other words, Sam likes exercise and feel tremendous pleasure from working out and tremendous shame and discontent from not working out. But Sam's brother Joe likes beer, and takes tremendous pleasure in enjoying a six pack every night and experiences tremendous discomfort and annoyance when he doesn't get to wind down with some cold ones. Meanwhile, Joanne loves to read and has 30,000 ebooks on her kindle. She would very upset if she couldn't read her latest download. And Mandy goes salsa dancing three nights a week for hours, and sometimes misses work the next day from exhaustion. Her boss tells her that if she misses work one more time she'll lose her job. But Mandy is convinced that life would be a nightmare without her salsa nights.
Who is the addict?
Or all they all just human?
I believe humans have free will.
A major purpose of that free will is to be utilized to self determine what we find pleasurable and painful. For some getting high is quite pleasurable and they associate little to no pain with it. Others, like myself, hate losing cognitive function and getting high. Many like myself associate terrible pain to it. Why? Because we choose to.
We are all anchoring beliefs about things constantly. The metaphors we use. The advertisements we watch. The songs we listen to. The company we keep. The memories we experience.
These things are constantly affecting how our minds associate A with B.
I learned this at an early age when I knew two brothers who came from a broken home.
The mother was struggling with drugs and their dad was in prison.
One brother decided that he would get out of that life.
The other decided he couldn't escape it.
These brothers led very different lives and created very different associations for nearly everything.
One saw the police as the enemy and he was a victim.
The other saw the police as people who risked their lives to help.
One brother ended up in prison, while the other ended graduating high school and going to college.
Both blamed their circumstances for their outcomes.
Viktor Frankl's book "Man Search for Meaning" describes similar phenomena regarding human psychology.
We may lose all our liberty, yet we are always free to determine what we choose to believe about any given thing.
You choose your victimhood.
You choose to feel offended.
You choose to act reactionary.
You choose how you represent memories and ideas in your mind.
You choose your behavior.
The more you understand this the clearer many issues regarding humanity become.
So long as you or others believe that they are simply a product of neurotransmitters, chemicals, or hormones who lack any free will then humanity will continue to act horrific.
But once people awaken to the understanding that they determine how they respond to circumstances and that happiness is a decision and that just as advertisers manipulate you into needing what you never wanted before so to you can alter you pain - pleasure associations.
Are there people with real chemical problems or neurological problems for whom this does not apply. Of course! But they are not the vast majority.
In general, peoples neurotransmitters and hormones are as affected by their behavior and consistent actions as those chemicals affect their behavior.
In the words of Anthony Robbins:
Motion Creates Emotion
Act happy and you will start feeling happy.
And in regards to behaviors you want to change...
Figure out your values.
What do you really value most?
How does your behavior fit in with those values?
If you find your behavior conflicting then you must start changing your actions so that they are congruent with what you value. Also, you must change your association with your negative behaviors.
Acknowledge that it was trying to benefit you. And it had the greatest of intentions. But it's had it's turn, and you are not satisfied with the results so you are going to try a different approach.
This new approach is to be rooted in your values and held accountable by someone (i.e. friend, family, God, etc.)
This is to serve as a constant reminder for you of your values and your commitment and the pain you would experience should you deviate from your new identity. A lever by which you can be moved into doing the right thing.
We all need that.
So is addiction a disease or is it a choice or is it some odd combination (a disease of choice)?
Well it all depends on how you want to define "disease." If you want to use a very broad and literal definition "a state of dis-ease", that is to say a state of not feeling well then fine, it is a disease. And though I know people who actually think of health this way, I find it absolutely a worthless definition because then we are all "diseased" much of our life. In fact, you could say that life itself is a disease since it seems to cause so much discomfort and by the way it has a 100% mortality rate.
Or perhaps you define with the mysterious term "abnormal." Yes, disease is an abnormal health condition. Okay, so who's health is "normal"? Is it normal to be addicted, obsessed, or habitual to some degree or another? Who determines where to draw the line in the sand separating normal from abnormal, healthy from diseased?
That brings up another topic that is the other side of the coin. Who is healthy? Who is normal? Who is diseased? Who is an addict?
These are identities that people utilize to define their lives and their behaviors. If a person walks through life identifying himself as diseased do you think he will act different than if he believes he is healthy? How will it affect his choices? What good will the label of disease do for an addict?
This gets to the heart of what Prager was asking, "Is disease a pragmatic description of addiction?" and I answered "Yes."
Yes, because it is only used to convey to people "you have a problem and it needs treatment by professionals." That is it basically. There is no drug or procedure (outside of a dehumanizing lobotomy) that will effectively treat it. There is only a set of behavior skills, philosophy of living, and values that will work to change the addict condition.
Cliches like, "Let go and let God" "It works if you work it" "Fake it till you make it" "One day at a time" "You didn't break it, you can't fix" and the like are more than just hypnotic tools for the addict... they are a necessary part of the treatment plan.
In my experience in working with addict the greatest "medicine" at their disposal is the 12 step program. In fact, I cannot think of an "addict" who has cleaned himself up without working the 12 steps in some form or fashion.
Why? Well lets look at these 12 steps:
THE TWELVE STEPS OF ALCOHOLICS ANONYMOUS
While AA is a non-religious movement, they are fully aware that the most effective treatment plan for an addict is admit they are not in control of what they are addicted to. But is that due to some medical condition or genetic predisposition? Perhaps, but had they never chosen to use the substance then they wouldn't be in this current state.
Yes some drugs are more "addictive" than others. The way they affect the brain and alter peoples perception of pain and pleasure is real. Yet, I also must admit that in general people choose to take that addictive substance believing either they are different, they can handle it, or it's worth it. They create that chemical state in their mind voluntarily. If you want to call it a disease, then recognize that in general it is a disease by choice.
The choice is in regards to values decisions. I don't mean values like honesty versus deception or justice versus compassion. No I mean values in the sense that in general everyone chooses what they value and believe in terms of what will provide them with PAIN and PLEASURE.
Again this was another great insight from Anthony Robbins. I wish they taught this in medical school. Fortunately for me, I learned these principles just prior to going to medical school.
Here's the Robbins' idea in a nutshell:
• We learn to give levels of pleasure and pain to things and those are what we value.
For example if you had to pick only one of the states below, what would you pick?
A) Success
B) Adventure
C) Love
D) Comfort
E) Security
People select different things.
2. Moving away from values- anger, pain, depression or state that you avoid.
How all this ends up working with an addict:
There are six fundamental needs that everyone has in common, and all behavior is simply an attempt to meet those six needs.
Robbins - Madanes Theory of Human Needs Psychology:
1. Certainty: assurance you can avoid pain and gain pleasure
2. Uncertainty/Variety: the need for the unknown, change, new stimuli
3. Significance: feeling unique, important, special or needed
4. Connection/Love: a strong feeling of closeness or union with someone or something
5. Growth: an expansion of capacity, capability or understanding
6. Contribution: a sense of service and focus on helping, giving to and supporting others
"The force of life is the drive for fulfillment; we all have a need to experience a life of meaning. Fulfillment can only be achieved through a pattern of living in which we focus on two spiritual needs: 1) the need to continuously grow; and 2) the need to contribute beyond ourselves in a meaningful way. All dysfunctional behaviors arise from the inability to consistently meet these needs. When our attempts to reach fulfillment fail, we will settle for comfort—or for meeting our needs on a small scale. Look to replace any dis-empowering ways of meeting your needs with things that empower and support you and others.
...Understanding these needs, and which ones you are trying to meet in any given moment, can help you create new patterns that lead to lasting fulfillment." ~Robbins
All people should ask themselves:
1. Which of these six needs do you tend to focus on or value the most?
2. What are the ways (good and bad) you meet these needs? For example, in your relationships, work, eating, exercise, etc.?
3. How can you increase your focus on growth and contribution? What are some things you can do, or new experiences you can participate in?
And for those looking to change negative behavior:
Does it fulfill the need I value most?
How many needs does it fulfill in total?
How strong is it's level of fulfillment?
How certain am I that it (negative behavior) will fulfill my needs?
Virtually anything that strongly fulfills just three of your human needs will become a habit or addiction.
The more needs the behavior fulfills the stronger the addiction.
It is amazingly simple, and amazingly true.
I've had the opportunity to work through hundreds of cases and the Robbins - Madanes theory holds true in a all cases. Nothing I learned in university, grad school, med school, or CEU's have benefited me more than this simple understanding.
So if you want to change your behavior, habit, or addiction you must get clear and acknowledge how it is currently benefiting you by fulfilling your human needs.
Beyond this understanding of human needs psychology you should also understand what Robbins calls the "Crazy 8."
![By Katarrhaktes (www.katarrhaktes.com) [CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons](http://ultimateissues.com/wp-content/uploads/2014/02/Katarrhaktes_ouroboros.jpg)
People trek from one end of the pattern the other only to circle back again, oscillating from one extreme of emotions to the other:
Anger <-> Sadness
Mania <-> Depression
Bored <-> Thrilled
People will stay locked in this crazy eight pattern until they are pushed out. They either descend with use of drugs, alcohol, etc. Or they ascend with the use of prayer, counseling, meditation, etc.
Many people alter their state of mind with the use of chemicals, but unfortunately this often creates a temporary "fix" and creates another pattern problem. Obviously the preferable method would be through an introspective inventory of self and empowering insights and actions to draw a person up and out of the cyclical pattern of destruction.
People can change. We never deny they can change for the worse. So why so much aversion to believe they can change for the better.
Elevate yourself. That is why we are here.
We were created in a holy image, and we are to be holy.
The more holy we try to become the more we elevate ourselves out of the material, animal world we so often find ourselves confined in.
Get out of your secular prison. There is more to life. There is meaning to life.
Shake yourself free, rise from the dust!
That's why I always close by saying...
"STEP UP!
DO GOOD!
LIVE YOUR ULTIMATE LIFE!"
I know I've covered a lot of ideas and topics on the podcast, and that's because this is such an important, complex, and misunderstood topic.
In general everyone deal with addiction issues to one degree or another. But how to define it is not nearly as important as learning how to deal with it.
God willing, I'll cover these topics individually in the future.
