Disease or Decision – What if the answer does not matter?
The first question most people ask when visiting a doctor is “What’s wrong with me?” As a psychiatrist I usually beat them to the punch by asking them, “Why are you here?” That question itself is diagnostic in nature. It speaks volumes of an individual’s perception and self assessment of their problem. If the patient is presenting with an addiction issue, invariably there are several assumptions they have already made. Most of the time they assume that they have a disease. That it is chronic. That it is incurable. And that after a period of detoxification their disease will be managed by daily doses of 12-step activity. This in spite of overwhelming statistic that traditional 28 day treatment programs have about a 16% success rate.
This has always been a great curiosity to me. If one in six patients who attend these conventional treatment programs remain abstinent for one year post discharge, why would anybody waste the time, money and psychic investment required by these programs. I would not buy a car that started one out of six times. More importantly, I would not buy a car that stopped one out of six times I applied the brakes.
What if we were treating a disease that does not exist? In my profession that is called a misdiagnosis. What if we spent our time, energy and money trying to stop “addiction” rather than trying to understand addiction? An entire industry has developed around causation rather than cessation. If you had a choice of either understanding why you drink or stopping your drinking the decision would be obvious. Even if you are a comprehension junky for whom the process trumps the product, at some point all growth starts with stopping.
Throughout my career I have been employed in various capacities as a medical director for some of the most renowned conventional treatment centers in America. I have observed that the thing that differentiates these facilities is often thread count of their linen, the comfort of their facility, the quality of their food and other such bells and whistles. Philosophically their approach is always the same; you have a chronic disease, it cannot be cured, it can, however, be managed. First we must isolate you, infantilize you and then transition you to the many “fellowships” specifically designed to address your addiction whether it is gambling, alcohol, sexual, drugs or any other of the 123 registered 12-step programs. For a second, I ask you to suspend your disbelief and allow me to take you on a tour of the land I will call “what if”.
What if you weren’t “paralyzed” but actually individually in charge of your addiction? What if the locus of control was internal rather than external, thus, eliminating the need for sponsors, groups, meetings, etc? What if you dealt with a decision not a disease? What if you had to make that decision once instead of one day at a time for the rest of your life? What if your abstinence depended solely on the current version of you rather than the hoped for evolved individual who religiously followed a 12-step blueprint for change? And finally, what if you were in charge of you? By the way, you always have been and you always will be.
Remember, I am a psychiatrist, a trained medical doctor who is an expert on the human brain. As such I am the last one to be accused of oversimplification. I have enormous respect for the complexity of that organ which dictates emotion as well as rationality and everything in between. Because of that in my land of “what if” I would combine every aspect of what makes us who we are as well as what bribes the decision we make. I would take great pains to create an environment that addresses the needs of mind, body and soul during this new decision making process. Sound pretty farfetched? Actually it sounds more reasonable than most of the conventional approaches that are proven to be unsuccessful and yet persist in their proclamations of efficacy.
If you like to hear more about my thoughts on this subject, please contact me.