Members of the Alcoholics Anonymous and Addiction communities frequently argue amongst one another over the question of whether addiction is more accurately characterized as a medical disease or as an affliction caused by choices made by those with weak wills and character defects. Such arguments, sometimes heated in nature, remind me of the Nature vs. Nurture arguments I heard in college psychology class.
The 'alcoholism is a disease' camp finds significant footing in the founding principles outlined in AA’s bedrock book, Alcoholics Anonymous. But in truth, the 12-step AA community rather neatly endorses either side of the argument, depending on the ‘objective du jour.’
When diminishing guilt takes center stage, then identifying addiction as a disease is beneficial because surely no one is reasonably responsible for having a disease (never mind cigarette smoking lung cancer victims).
When inspiring recovery is the objective at hand, choice takes center stage, because without choice, without robust devotion to taking the third step in recovery, there can be no meaningful decision to turn one’s will over to that of a higher power, which is the very foundation for 12-step recovery.
When the topic of concern involves appreciating risk factors associated with Alcoholism, for example, then it is useful to pivot back to the disease model; after all, those in the know ought to be concerned by inheritance patterns that emphasize genetic risk factors. Yet the disease model has nothing meaningful to say to recovering alcoholics about the decision they must make regarding making direct amends to those they have harmed if they expect to sustain recovery.
Which camp do you suppose is more likely to compel insurance agencies to expand their coverage and Congress to allocate more funding to the cause? ‘Hey guys, we have more and more people making bad decisions so we need more and more money please,’ verses: ‘Guys, if we just had more money, we’d find that Addiction, like Alzheimer’s, is sure to prove treatable with novel medications.’ On the flip side, which makes more sense: sustained recovery from addiction results in the choice to take 12-steps and get a sponsor, verses, sustained recovery from addiction derives from choosing to take steps and get a sponsor?
It is no surprise that both sides are able to cite facts that support their camp and weaken the opposing view, given the all or none, black verses white thinking that causes the distortion in the first place. Sooner or later, however, as in the case of organism verses environment, observers are forced to concede that both perspectives have something meritorious to contribute toward meaningful understanding.
In truth, there is actually an Incompatibility Principle that applies when considering the interaction between two complex systems, such as organisms and environment, or cognitive processes verses genetic diseases—it tells us that the more precisely one focuses on the merits of one side of the perspective to the exclusion of the other, the less relevant one becomes when drawing conclusions about the whole system.
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