September 26

Why We’re Losing the War on Drugs

Singapore’s arrival card. The big red letters leave no doubt as to their policy.

In the past 40 years, we’ve spent trillions of dollars on the War on Drugs in an effort to eliminate supply. Yet drug overdoses are up over 1,200%. We’re losing the war. And not for lack of trying.

We’re losing the war because the very premise of it is flawed.

Trying to solve the drug problem by eliminating the supply presumes, as many conservatives believe, that drug addiction is a choice. Eliminate the supply and people will make better choices.

It’s like those candy displays at the cash register of your local store: you want it because it’s there. It’s tempting. That’s called an impulse buy. And if it didn’t work, they wouldn’t keep doing it.

But drugs are not an impulse buy. Yes, the first time a person uses is clearly a choice, unless it’s given by a medical professional. And that does happen.

But once a person becomes addicted, the drug fills a need that nothing else does. It’s no longer an impulse buy. It’s a requirement.

As I argue in my book, The Soul of an Addict, for an addict the drug provides more than just relief from withdrawals and from past traumas and pains. It provides certain basic human needs which the user has not found anywhere else. These include identity, purpose, meaning for life, structure, and a moral code consistent with these.

Without the drug, in the absence of a suitable alternative, the person is miserable. They’re not waiting for an impulse buy. They are actively looking for relief, and they will do anything and pay anything to get it.

This is a ready-made market, a demand for the substance. And, as anyone who has taken an economics class knows, where there is a demand there will be a supply. Scarcity and risk cause the price to go up. But the person who needs drugs will find a way to pay that price, because they quite literally believe they can’t live without the drug. And that means the methods they use to obtain money may cross the line of legality, from theft to prostitution– and worse.

Is it even possible to stamp out the availability of drugs?

I say no, and here’s why.

Singapore is a small, island nation off the southern tip of Malaysia. It is ideally suited to control what crosses its borders because there are very few ways in or out. And Singapore has one of the toughest drug smuggling laws ion the world. Their arrival card makes it clear: the penalty for smuggling drugs is death. And they’re not kidding: smugglers are executed.

If anyone could eliminate the supply if drugs, it would be Singapore. Yet they had 14 drug overdoses in 2017. Their rate of overdose has more than doubled over the past 30 years. Yes, that’s far better than the U.S. rate of overdoses. Singapore’s is 0.25 per 100,000 people; ours is 18.75. They also have better health care and social services and less wealth inequality than we do, which would tend to drive down the rate of drug abuse and overdose.

But, even with supposedly absolute control and strict penalties, drugs are still available in Singapore. And if they can’t stamp them out with limited access points and draconian penalties, how do we expect to?

The War on Drugs is doomed to fail because it’s impossible to address the problem on the supply side. So long as there is a demand, someone will take the risk to make money by providing a supply. (Singapore’s penalty is death, yet people still risk it!)

And we can’t address it by locking up those who use drugs. We’ve spent trillions of dollars trying. Our prisons are full. Yet the problem keeps getting worse.

There’s got to be a better way.

And there is, but we’re not going to like it.

We’re not going to like it because it calls into question our post-modern ethos of consumerism, the whole premise that life can be fulfilling because of what we buy. That ethos is false, yet that’s what it takes to keep our economy afloat. People have to keep buying. When people start saving money instead, the Federal Reserve gets nervous. They need us to be happy consumers, floating in a sea of debt buying stuff we don’t need (but think we do).

Some of us may be satisfied with this purpose for life some of the time. But the fallacy is revealed in the rise of drug overdoses, alcohol deaths, and suicides. Consumerism doesn’t answer the big questions in life. Like, “What is it all for?”

That’s the realm of religion, not social policy. And religion is something society doesn’t prescribe for us. In fact, it has increasingly fallen out of favor. Over the past 40 years, the number of Americans who identify their religious affiliation as “None” has risen from 7% to 21%.

But even that number may be optimistic. I’ve been to many churches where the point of going to church is to go to church. It’s what we do. Yes, there’s a vague message that we should live good lives, but no specific guidance for doing so.

I’ve been to other churches which focus on what happens after we die. For someone like me, a recovering addict, this fails to answer the burning question of my life: how do I live now? (And if the afterlife is so much better, isn’t that an argument for a sooner death?)

Sociologist Emile Durkheim suggests that a religion provides identity, meaning, structure for life, and a moral code. If that is so, then much of what we experience in church fails to meet the requirements of a religion. It doesn’t provide these basic human needs. No wonder the fastest growing religion in America is “None”! And no wonder deaths of despair are rising.

Doing Something Different

There is an answer to the drug problem. The Twelve Step programs recognize it. Every aspect of those programs is designed to give people identity, purpose, structure, and a sense of belonging. Although most of these programs aren’t religious, they do a better job of practicing a religion, in the sociological sense, than some churches.

Why can’t churches do what the Twelve Step programs do? They could. So could non-religious groups. But that would mean bucking the national religion of consumerism– and potentially being branded un-American, or worse. It would mean pushing back against the long-embraced idea that religion belongs in the private sphere. If your purpose and structure for life comes from your religion, it’s going to show.

Do we really believe that it’s better to spend trillions of dollars on trying to stamp out supply and incarcerate users, no matter the price tag? Is that a necessary “overhead expense” to maintain our consumer economy? Or is that just what we’ve always done?

In either case, it isn’t working. The problem is getting worse.

It’s time to do something  different.

September 9

Praise for Soul of an Addict

“The book elucidates the agony of addiction in a fresh, new way. It emphasizes the role of trauma in setting the stage for debilitating behaviors, and explains the importance of community support in the healing process. With anecdotes of many people who grapple with addiction and have survived, as well as sad stories of addicts who died, this book provides healthy doses of grit and inspiration.” –Christopher Key Chapple, Loyola Marymount University

September 7

The Medical View of Addiction

Medicine has struggled to understand addiction. This may be because it’s not entirely a medical problem. But science doesn’t consider spiritual aspects, and for the purposes of this discussion I’m willing to leave those aside.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the “bible” for diagnosis by professionals. The current version is DSM-V. Not surprisingly, the previous version was DSM-IV. The newer version introduced some major changes to the way substance abuse disorders are diagnosed.

DSM-IV, issued in 1994, generally offered two categories of substance abuse disorders: substance use disorder, and dependence. These corresponded to chronic abuse of a substance, and physical dependency on the substance. There were codes for various substances, distinguishing for example between opioid dependency and alcohol dependency. The DSM-V (2013) combines there and streamlines the diagnosis. As this summary explains, DSM-V

does away with separate “dependence” and “abuse” diagnoses and combines them into “substance use disorder.”

The current version sees substance abuse as a spectrum rather than two separate conditions.

While this does make diagnosis easier, it appears to me to move substance abuse treatment backward by failing to recognize the complexity of factors at play.

For example, let’s consider physical dependence. Anyone who takes opioids (or other physically-addictive medication) over a long period will become physically dependent. It doesn’t matter whether they began using for pleasure, or if they were prescribed the drug by a doctor because of a medical need. They will need the drug to avoid going into withdrawals, which are typically both painful and disorienting. And in the case of alcohol (and certain other drugs), withdrawal can be life-threatening. Someone dependent on alcohol, for example, will crave it. And the cause of this craving is biological: they’ll go into withdrawals if they don’t get it. This is what DSM-IV described as “dependence.”

Yet dependency alone does not indicate whether that person will return to the drug once separated from it. When the physical dependency is relieved through a withdrawal process, medically supervised or not, there is no further need for the drug. Many people, once relieved of their dependence, take what might be described as the sane response: they never touch it again.

On the other hand, let’s consider what is sometimes described as “risky use.” A person who is not dependent on a substance nevertheless seeks it out and abuses it. The cause of this is not physical but psychological. Whether they seek pleasure or to kill the pain of some past trauma, the drug serves a purpose in their lives. They choose to pursue it of their own free will. This is what DSM-IV described as “substance use disorder.”

Interestingly, substance use disorder does seem to be a spectrum. Some people are able to choose to quit of their own volition. Others need help to quit. And some pursue their obsession with the substance, as Alcoholics Anonymous observes, “into the gates of insanity or death.”

These two, very different, facets of substance abuse are combined in DSM-V into a single spectrum. Yet the opioid crisis should show us the fallacy of this “improvement.”

One of the popular news items in the opioid epidemic is the number of people who began using because an opioid was prescribed by their doctor for a medical condition. (Here’s an example.) This theory presumes that chronic physical pain is the cause of opioid use that results in dependence. And this may well be for some people.

Yet many, perhaps most, opioid addicts struggle with a condition I can only describe as “addiction.” Yes, they are physically dependent. Yet once separated from the drug, whether through rehab or incarceration, they return to it despite its adverse effects on their lives. Not because of physical pain, but because of a psychological obsession with what the drug does for them.

At the very least, in these people we can see an overlapping of two distinct conditions: dependency and an obsession to use. These are not the same. One is physical, the other is psychological. Both need to be treated for successful recovery. Yet without recognizing the difference between the two conditions, how can they be treated?

This is true for any drug user. For a successful result, a person who is dependent because of chronic pain must be treated differently from one who is not dependent but seeks the drug by choice. Yet in the case of the addict, who has both conditions, treating one or the other is simply pointless. Not only is it ineffective, but the failure of this approach erodes confidence that recovery is possible.

And recovery is possible! While success with opioid addiction recovery from a medical perspective remains dismally low, tens of thousands have recovered through other, non-medical methods. These include Twelve Step groups like Narcotics Anonymous, religious based programs like The Bridge Ministry, and many others.

Because when withdrawals end, that’s when the real healing begins. Now that we don’t have a physical need, how do we live without the psychological need? Medicine doesn’t do that. Even psychology tends to fall short in offering resources.

Perhaps this is because they don’t really understand what an addict needs, because the vast majority of medical professionals have never experienced it.

But those who have been there and recovered do know. It is to them we should look for answers. Oddly, that seems to be the one place science hasn’t looked. Which may be why their understanding of addiction and recovery sometimes seems to be moving backward.

 

For more on addiction, read my book, The Soul of an Addict, available in Paperback and Kindle editions.

September 3

Getting Out

Whether it’s jail or rehab, how does an addict stay clean when they get out?

I met William in his last week at a program that helped former inmates deal with addiction and prepare for the real world. We talked for almost an hour. I told him my history, and about how I stayed clean. He seemed excited to know someone in recovery. He took my number, and promised to call as soon as he got settled in his new apartment.

I never heard from him.

The are literally hundreds of thousands of men and women incarcerated for drug related offenses, many of them nonviolent. What happens when they get released? Some of these go to halfway houses or rehabilitation programs. Do these improve their chances? Thousands are voluntarily in rehabs. Are their chances any better?

There’s one aspect of addiction that few programs, and few theories of addiction, take into account: Addiction is a way of life. It defines what we do with our time. Conversely, it tells us what to do when we don’t know what to do.

This means the first day or two after getting out, whether from incarceration or from a program, are critical. Structure has been removed. Even if there’s a job to go to, which there often isn’t at that stage, there are still 16 hours in the day to navigate. In an unfamiliar world. With complete freedom of choice. After months or years of complete structure, the person is suddenly expected to know what to do with their time.

That’s not a reasonable expectation. Anyone who has become unemployed, or who has faced a quarantine that disrupts their normal routine (and that’s most of us now), knows that it isn’t easy to find a new routine. And we generally start with what we know, whether that’s exercise or prayer.

What an addict knows is not exercise or prayer. I say this as one who struggled with addiction for many years. The drug becomes the center of our lives, defining our identity and our purpose. And it tells us what to do with our time.

How long will a person wait for something new to happen before returning to their old ways? My experience indicates that it may be as little as 24 hours, and certainly not more than a few weeks.

This is the window of opportunity for the person to develop not only a new routine, but a new circle of friends and support. In the absence of those, he or she is alone and without tools for navigating their new reality.

If you think about how long it takes to find and adopt a new routine, find support, and make friends, this is a nearly impossible task.

So what is the answer?

Those who have relationships with supporters and friends before their release are more likely to succeed. They already have some of the most important pieces in place. If we want to support addicts in staying clean, this should begin while they’re still inside, whether it’s a rehab or a jail.

But secondly, when they get out we shouldn’t expect them to reach out to us. They have been conditioned not to trust, and to believe that those who need help are weak. It takes time for those beliefs to change– time they may not have. There’s also the shame factor. They may be ashamed of their social status, and of their need for help. They also may be afraid of rejection, betrayal, or abandonment– all common occurrences in the world of addiction.

We need to reach out to them! And we need to do so with persistence, but not harassment. They may or may not respond. They may or may not stay clean. Working with addicts always risks heartbreak, including the ultimate heartbreak of funerals. But we do it because there would otherwise be even more funerals.

William, my new friend who disappeared, taught me one thing: not to just give out my number, but to take his. I didn’t do that for him, and he is likely back in the trap of old behaviors. But I have done it for others since then.

For more on addiction, read The Soul of an Addict: Unlocking the Complex Nature of Addiction.
August 30

Now Available: The Soul of an Addict (and a free download)

It’s available! In both paperback and Kindle formats. The Soul of an Addict: Unlocking the Complex Nature of Addiction, by D.J. Mitchell.

Addiction is more complex than it may seem. Written for the non-addict who seeks to understand substance addiction, The Soul of an Addict shows that addiction not just a disease or a choice. Using statistics, anecdotes from the lives of addicts, and the author’s personal experience with addiction and recovery, the book argues that addiction affects all aspects of human existence, including identity, purpose, life structure, and morality. It serves as a religion in the addict’s life, and any approach to recovery must also provide these essential needs. With one in seven Americans struggling with substance abuse, this book brings a timely analysis for anyone concerned about addiction.

“A must-read… As a therapist I will be recommending this book to my clients.” –Milt McLelland, CMHC, Roots Counseling Center

For more information, click here.

Want a free look? Download the Introduction and first chapter here!

August 19

Coming Soon: The Soul of an Addict

Draft cover for The Soul of an Addict

My first non-fiction book is coming soon. The Soul of an Addict: Unlocking the Complex Nature of Addiction argues that addiction is far more complex than most models accept. Is it a disease? A choice? Yes. But it’s also more than either of these. In fact, addiction has the sociological characteristics of a religion.

The book is supported by statistics, anecdotes from my work with addicts, and stories from my own struggle with addiction. It will be available in two weeks.

Here’s an excerpt from Chapter Twelve, “What Is Recovery?”

Jenna was in her fifth round at a treatment facility when I met her. She dropped out before the end of the program and went back to using drugs.

Nate got clean and sober the first time he went to treatment and never used again.

Ben was sentenced to treatment by the court after his fifth conviction for DUI. He went to avoid prison, yet he got clean and stayed clean for many years.

Vivian had a spiritual experience after an alcoholic binge, attended Twelve Step meetings and never drank again.

Dan found sobriety in a church run by a pastor in recovery.

Al got sober through Twelve Step meetings while in prison for vehicular manslaughter.

Vern failed at treatment facilities and methadone clinics for years, but after doing some time in jail and living in his car for a year, he finally got clean in a Twelve Step program.

Treatment takes many forms, and has varying rates of success. But, whether an expensive rehab facility, a publicly funded treatment center, a church-based support group, or a cost-free Twelve Step meeting, some form of support is usually necessary to help us get out and stay out of our addiction. The reason is simple: If we knew how to stay clean and sober without treatment, if we could envision a way of life sufficient to replace addiction, we would have given up drugs already.

Treatment for drug and alcohol addiction is big business in the United States. In 2017, nearly three million people underwent treatment.[1] It’s estimated that Americans spend $30-35 billion a year attending rehabilitation centers for drug and alcohol abuse.

That doesn’t include the nation’s largest single “treatment” system: prison. According to researchers Wendy Sawyer and Peter Wagner, nearly half of all federal prisoners, about 100,000 people, are incarcerated for nonviolent drug offenses.[2] It’s estimated that half a million nonviolent drug offenders are incarcerated in state and local prison systems. [3] At an estimated $30,000 per prisoner per year, that’s another $15 billion expense that falls to the taxpayers.

In 2016, some 168,000 people on parole or probation were returned behind bars not because they committed a new crime but because of technical violations such as staying out past curfew. Sawyer and Wagner argue that the justice system is structured to promote failure, not to reward success.[4]

It’s worth noting that those who go through treatment are more likely to be white (about 80%). Those who go to prison are more likely not to be white (about 70%). The rate of addiction does vary slightly between races, but perhaps not as expected. Of the three most populous races, whites lead in substance abuse problems with 7.7%. Blacks have a rate of 6.8%, and 6.6% of Hispanics struggle with substance abuse.[5] Yet blacks are six times more likely to be incarcerated for drug offenses than whites.[6]

Jacob, a young African-American man, was arrested for drug-related offenses. While represented by a public defender, he was sentenced to four years in prison. Later, he managed to pay an attorney several thousand dollars to have the judge reconsider the sentence. It was reduced to one year followed by a court-ordered drug treatment program. Financial resources clearly make a huge difference in the outcome of drug offenses in the criminal justice system.

There’s another troubling statistic. In 2017, more than 20 million Americans sought treatment for a substance abuse problem. Only 12% of them actually received treatment. That’s a huge improvement over prior years. In 2014, for example, only 7.5% of those seeking treatment actually received it.[7] But still: out of every eight people who seek treatment, seven do not receive it. The most common reason cited, by almost half of those who could not obtain treatment, was lack of insurance coverage.[8] They couldn’t afford the cost.

Footnotes:

[1] Bose, Table 5.10A.

[2]“What America Spends on Drug Addictions,” Addiction-Resources.com, 2005 (https://www.addiction-treatment.com/in-depth/what-america-spends-on-drug-addictions/, accessed August 14, 2019). There are many more recent estimates on what Americans spend on the substances themselves, but I was unable to find a more current estimate of the cost of rehab. Gabrielle Glaser, “The Irrationality of Alcoholics Anonymous,” Atlantic Feb 2015 (https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/, accessed August 15, 2019). “Offenses,” Federal Bureau of Prisons, Aug 9, 2019 (https://www.bop.gov/about/statistics/statistics_inmate_offenses.jsp, accessed August 14, 2019).

[3] Wendy Sawyer and Peter Wagner, “Mass Incarceration: The Whole Pie 2020,” Prison Policy Initiative, March 24, 2020 (https://www.prisonpolicy.org/reports/pie2020.html, accessed May 15, 2020).

[4] Ibid.

[5] Bose, “Results from the 2017 National Survey on Drug Use and Health: Detailed Tables, 2018 (https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf, accessed May 15, 2020).

[6] NAACP, “Criminal Justice Fact Sheet” (https://www.naacp.org/criminal-justice-fact-sheet/, accessed May 15, 2020). Numbers for Hispanics were not included. Also see Alana Rosenburg, et. al., “Comparing Black and White Drug Offenders: Implications for Racial Disparities in Criminal Justice and Reentry Policy and Programming,” J Drug Issues 2017 47(1), 132-142 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614457/, accessed May 15, 2020): Blacks are more likely to be incarcerated for smaller offenses; 49% of Blacks and only 10% of whites in the study were convicted of marijuana possession compared with 7% of Blacks and 50% of whites convicted for heroin possession.

[7] Rachel N. Lipari and Struther L. Van Horn, “Trends in Substance Abuse Disorders among Adults Aged 18 or Older,” The CBHSQ Report, SAMHSA, Jun 29 2017 (https://www.samhsa.gov/data/sites/default/files/report_2790/ShortReport-2790.html, accessed August 15, 2019). Compare Rachel N. Lipari, Eunice Park-Lee, and Struther Van Horn, “America’s Need For and Receipt Of Substance Abuse Treatment in 2015,” The CBHSQ Report, SAMHSA, Sep 16 2016 (https://www.samhsa.gov/data/sites/default/files/report_2716/ShortReport-2716.html, accessed August 15, 2019) reports that 10.6% of those who sought treatment received it in 2015. The percentage receiving treatment has

[8] Bose, Table 5.50A, shows 421 of 1,033 (41%) surveyed either didn’t have health insurance, or had health insurance that didn’t cover treatment.

June 13

Sermon: Misplaced Faith

The second of this two-part series (following “What Can Christians Learn About Devotion from Addicts?“) considers recovery from addiction, and the flawed belief that just quitting drugs and getting a job is enough. Too recover, an addict needs something as life-encompassing as the addiction was. We need a new religion to replace the old, false religion. To rely ion the things of the world to fill the hole we carry is misplaced faith. But we’re not the only ones who fall into that trap!

October 8

What Is Addiction Treatment?

 

How is addiction treated in this country? There’s no single answer. There isn’t even a standard for what makes treatment successful. Some measure years of abstinence. Some seek moderation, but don’t consider abstinence to be part of recovery. Others seek temporary reduction in use through incarceration, or simply a reduction in socially unacceptable behavior.

One reason for this is confusion about the nature of substance abuse. Science recognizes three categories: the risky user, the physically dependent person, and the addict who returns to the substance repeatedly even after being separated from it. Medicine, on the other hand, used to recognize the first two categories. But the DSM-V, the latest version, combines all substance abuse under the single label, “Substance Use Disorder.”

Another reason is the disconnect between science and medicine on the one hand, and public policy on the other. For example, the largest single “treatment” provider for drug users is the prison system. More than half a million nonviolent drug offenders are incarcerated, at a cost to the taxpayers of around $15 billion per year. While there are some drug treatment programs in some prisons, the majority of inmates do not receive drug treatment. The National Institute of Health cites public desire for retribution rather than rehabilitation as a major barrier to drug treatment in prisons.

The amount spent on incarceration pales in comparison to the $30 billion or more spent annually on treatment facilities. In 2017, over 4 million Americans received treatment in a variety of settings. Of these, 2.5 million attended a treatment facility, residential or outpatient. Others may have received help from doctors, psychologists, or Twelve Step programs. Of the treatment facilities, 53% received government funding, meaning they are prohibited from using any spiritual or religious approach, including the Twelve Steps.

A more startling statistic is that of the 20 million Americans who needed treatment in 2017, only 12% received it at a treatment facility. Another 7% received treatment at non-specialty facilities. Still, 81% of those who needed treatment didn’t get it. The most common reason, cited by 41%, was lack of insurance coverage.

Some 10% of treatment facilities provided Medication Assisted Therapy (MAT), in which physical dependence on heroin or other opiods are treated with methadone or buprenorphine– long-acting opioids that are much harder to quit after long-term use. Of these, 95% still offered methadone, while 65% offered a choice between the two substitutes. There was no indication of how many facilities used these replacements for detoxification only, and how many used ongoing maintenance. (I’ll post another time about the nightmare of “methadone maintenance.”)

So what does all this tell us? First, most Americans who need help for substance abuse don’t get it.

Second, there’s a wide variety of approaches to treatment. Some, like prison, embrace the belief that if you punish someone enough, they will somehow magically change. Others, like substitution therapy, seek to reduce the criminal and health effects of addiction, but do not seek to actually treat addiction. Still others seek to return the sufferer to “social” use. Those that do seek abstinence measure it in various ways: abstinence for the duration of the program, or at 90 days, or at a year, or at 5 years.

A study of veterans in Twelve Step programs found that 70% of those who participated for a period of months were still abstinent at 16 years. In contrast, some treatment facilities that don’t use the Steps have abstinence rates around 10% at one year.

The most successful treatment approaches, at least for those who suffer from true addiction, seek total abstinence and a changes way of living. As noted in my previous post, it’s not enough to just get someone off drugs. Addiction is a way of life, a purpose for living, and a moral framework. For treatment to be successful, these old ways of being have to be replaced with new ways of being.

To be successful, treatment does not focus on moving away from drugs, but toward a suitable new way of life.

October 3

The Mystery of Addiction

It’s no secret that addiction is a problem in our society. It’s also no secret that, despite some advances in science, it’s not easy to treat. This is because the nature of addiction remains elusive. We can see this in the argument between those who insist it’s a disease, and those who insist it’s a choice. Some psychologists now argue that it’s both.

I don’t disagree. There are biological factors. And addicts make bad choices. I contend that, while addiction displays characteristics of both disease and choice, neither category is sufficient to explain the phenomenon.

Let me be clear that I’m referring here not to the occasional, risky user, nor to the person who becomes physically dependent on a substance but is able to abstain once separated from it. Addiction refers to those seemingly bizarre cases, now numbering in the millions, in which people return to the substance over and over, even after physical dependence has ceased.

Here’s the issue: if a person is miserable enough to want to quit, and if they have been separated from the biological need to use the substance, it makes absolutely no sense for them to return to the drug that made them miserable– unless there’s something else going on.

Enter Kent Dunnington. In his book, Addiction and Virtue: Beyond the Models of Disease and Choice, he argues that addiction is a habit in the classic sense expressed by Aristotle and Augustine. The behaviors of an addict are preconscious decisions habituated (programmed) by past reward/punishment experiences. I find flaws in Dunnington’s case for addiction as only a habit. But this introduces a third category to consider, and offers another dimension of options for understanding and treatment of addiction. The Twelve Steps, for example, can be described as a method of rehabituation.

Yet Dunnington goes further. We are habituated to our behaviors based on our view of the purpose of life. If, for example, we believe that the goal is to be wealthy, we’ll work hard and accumulate money. If it’s to seek thrills, all our efforts will point toward that goal. If it’s to follow Jesus, we’ll put our efforts into the behaviors that the Gospel describes (none of which include accumulating wealth). Indeed, James K. A. Smith argues that we can tell what we love much more reliably by what we do than by what we say we love.

Dunnington describes how addiction fills a need for transcendental experience, moral certainty, and purpose for life that are lacking in our secular society. In other words, it plays the role of a religion. Dunnington, a Christian, describes addiction as false worship. Yet he recognizes the diligence with which addicts undertake this worship, arguing that the Church could learn something about commitment from the “prophetic challenge” addicts present. Anyone who knows an addicted person can attest that we will sacrifice anything for our god, even our lives. The god may be false, but it’s the one to which we have willingly or unwillingly devoted ourselves.

If addiction is a religion adopted in response to the unsatisfying “spirituality” of secular materialism, this has implications for addiction treatment. To put it simply, the goal of treatment is not to get people off drugs– it is to replace one religion and way of life with another. This is where the disease model fails: medicine is not equipped to address the spiritual and moral nature of addiction.

Obviously, if addiction can play the role of a religion, a replacement is not limited to the Big Five: Christianity, Judaism, Islam, Buddhism, and Hinduism. For example, in the same ways that addiction serves as a religion, the Twelve Step programs do also. But, with thousands of years of practice and tradition, the established religions do have much to recommend them. I’ve found the healing power of Christ to be unique among them, but I do recognize that adherence is a choice.

From an objective perspective, my point is that it’s not enough to get a person off drugs and tell him or her to go get a job. The question that has to be answered in order for an addict to stay clean is this: “What’s the point?” Only when we can provide an answer for that question do we begin to offer hope to those mired in substance addiction.