So what do we disagree on? Without wanting to be facetious, one could say almost everything. From ‘addiction is a disease’ to addiction isn’t a disease. Some people swear by the 12 steps (as the only method of treatment) and just as many who swear at them. There are disagreements about how much choice we have; whether you can deal with several addictions at the same time (my reason for starting All Addictions Anonymous); what substances or behaviors are actually addictions, the differences between addictions and habits, and who is an “addict” at all.
I remember being in 12 step meetings where people were challenging each other about who was a “real” addict. Some would differentiate between moderate drinkers, hard drinkers and true alcoholics. Others took pride in convincing you they were a “real hardcore” alcoholic, or saying things like “You’re not addicted. Let me tell you about addicted!” – and then sharing their worst (or best) stories. So even within fellowships, people were trying to separate one type of addictive behavior from another and making each other right or wrong. Yet this is just a microcosm of what happens throughout this work.
What Is Actually an “Addiction”?
The medical ‘bible’ on addictions, called the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, four edition), includes only a small number of substances – essentially alcohol, drugs and nicotine – in its list. To be factual, it doesn’t even use the word “addictions” at all, but rather refers to substance abuse and substance dependence. The next proposed edition (DSM-5) does use the term addiction, but the list is still quite small. For example, gambling is the only “behaviorial addiction” that will be included; issues like sex and Internet use were considered, but not yet accepted. So the medical way of looking at addictions is a slowly-developing process.
But what about the large number of other ‘addiction-like’ conditions that people are experiencing? For example, consider eating disorders like anorexia and bulimia. Many people I know believe these are addictions; however, the professional community does not. Instead, it calls them “mental health disorders.” Then there is the ‘addiction movement’ itself, where the term addiction is used for a wide range of issues from overeating to codependency to criminal behavior. In fact, if you do an Internet search on 12 step groups, there are more than 65 different types of fellowships. So who is really “right” about what is “actually an addiction”?
What Does “Our Ability to Stop” Mean?
Another key aspect for determining what is an addiction is our ability or inability to stop – something I’ve also used in my definition. But who can really determine that for certain? And when we say “stop”, do we mean “stay stopped”? This concept gets us into all kinds of debates.
For example, if our brain chemistry shows we are dependent on a drug or behavior, does that mean we are unable to stop using it? Experience shows that’s not always the case. Or, if we do find a way to stop a behavior –– how long do we need to stay stopped for it to not be considered an addiction? What is the line between “I can’t stop” and “if I had enough motivation, I would stop”? Or when we do discover new ways to stop – as people continually are – does that mean that they (or we) didn’t have an addiction in the first place? Or are they in denial, headed for relapse because they did not stop the way we think is “The Right Way”.
I think you can see the difficulties – and why there’s so much disagreement among those who have been working for years, if not most of their life, to understand addictions, what causes them and how to treat them.
Now I’m not saying that it’s wrong to disagree. We all see things differently, and this process can help us learn from different perspectives. But the problem comes when we focus most of our energy trying to prove our rightness over others. What’s more, communications among us often get quite heated, even abusive. People like Stanford Peele, for example, were viciously attacked when they came out with new theories that disagreed with the disease model. And today, some people attack anything that IS related to the 12 steps. (I recently bore the brunt of such treatment, when I briefly mentioned on a Website the benefits of the 12 steps.)
So what’s my point? Well, to put it as gently – yet as bluntly – as I can, our obsession with “being right” isn’t working. It’s actually hurting us. It’s confusing people who have “addictions” about what to do. It’s blocking our willingness to the see the value of each other’s perspective. It’s creating conflict, divisions and differences among people working in the same field. And it’s creating fear among those who have problems and want help, as a recent email I received showed all too clearly.
In understanding additions, I often see such differing – and heated – discussions online when looking at weight-loss books, or even listening to the media. Some people say that obese people just eat too much; others say there's psychological or spiritual reasons for weight problems. It hurts when I've struggled so long, and people, very cruelly and judgmentally, say all I need to do is eat less. – Tracey B.
What I’ve come to believe is that our conflicts are now getting in the way of helping people. And that’s why I’ve started to move away from “who’s right and who’s wrong” to “we are all right” - and begin looking for what we have in common.
Suppose we were to put our paradigms aside for a moment, and looked for what’s effective among all approaches? Regardless of how we define addiction or what caused these ‘unwanted habits’ originally, what practices are we using that are actually effective in helping people recover, reduce or prevent them? That’s what I’m committed to find and communicate, so as to bring us together in our shared search for what works. And that's what this book is about.
If that sounds altruistic, maybe it is. But it’s not just to be “nice” or kind to each other (though that certainly wouldn’t hurt). It’s about beginning to see the impact and cost that our conflicts and arguing are having on people. And it’s about finding the common patterns, issues, practices and solutions that can help anyone deal with any, and all, addictive or unwanted behaviors.