Disease model of Addiction?

October 31, 2012 5:10 PM

Do I have to believe in the disease model of addiction to be successful in my recovery? I go to this counselor and he says in order for me to be happy I need to buy into NA and make friends there to live a happy healthy and normal life. I dont like NA and dont believe in the principles. Why cant I just say I was on drugs and now I am off without having to talk about it all the time? Is this the only way to happiness? He said I am fighting my disease and will never be happy if I dont try it. I have been sober for 5 months and I have real bad days and some good days. I am always overanalyzing things. I started CBT and that has seemed to make me more anxious at the moment. He also says that in my case CBT wont work unless I stop fighting my disease. I dont see how that makes sense.
posted by Truts83 to health & fitness (21 answers total)

I periodically encounter disbelief from people who learn that I quit alcohol without going to AA. Many people are educated to be quite dogmatic about this, it seems. I would suggest to keep doing whatever seems to be working for you. Try to find a therapist who isn't devoted to this weird metaphysical personification of your problems as "the disease".
posted by thelonius at 5:21 PM on October 31, 2012 [5 favorites]

No, you don't need to buy into NA. It is a pseudo-religious organization that provides one of many paths to recovery.

If I were you, I would try and find a new therapist or therapy method, based on your past questions.
posted by empath at 5:22 PM on October 31, 2012 [12 favorites]

No, you don't need to follow the principles of NA to have a successful recovery. You should find what works for you, whether it be another therapist, meditation, non-NA support groups. If possible, you may want to look to see if there is some kind of drug/alcohol council in your area that offers public education or programs for people in all stages of recovery. I volunteer with one of these organizations and can say from experience that they are very firm about there being multiple pathways to recovery (of which the 12 steps are one, but not the end-all be-all).

I would gently suggest not completely shying away from the idea of addiction as disease, however. At least not on a strictly scientific basis. From what people in recovery in my volunteering have told me, understanding how addiction is physically rooted in your brain, and the extent to which it is there and you are compelled by it, can be helpful no matter what path you choose to take. Good luck and congratulations on your five months sober. You have come far already.
posted by houndsoflove at 5:49 PM on October 31, 2012 [3 favorites]

You might be interested in a book called "The truth about addiction and recovery". Followers of AA seem to vehemently dislike this book. I felt it made more sense than the "disease" model.

My father drank heavily when he was younger. He stopped drinking when I was seven. He never attended anything like AA or went to therapy, etc. He fought in the front lines of two wars, in his late teens in WWII and in his forties in Vietnam. He left the army after 26.5 years to avoid a second tour of duty in Vietnam when I was three. I think he drank to suppress nightmares so he could sleep. I think he was able to stop drinking some time after leaving the military because he knew he would never see battle again. Time, distance and sense of safety made the memories bearable without a six pack under his belt.

Whatever the explanation might be, he has essentially never touched alcohol again in 4 decades or so, except for a few sips to teach my brother about the fine points of good beer when he got old enough to drink. So, no, not everyone needs to do AA, etc.
posted by Michele in California at 6:04 PM on October 31, 2012 [1 favorite]

A good counsellor is one who listens to your needs and responds accordingly - you and your counsellor's ways of doing things are opposed, so I would find someone more in line with what you personally need. The onus should be on you getting better, not on you changing your beliefs in order to conform to a concept/model of how things are 'supposed to be done'.
posted by heyjude at 6:09 PM on October 31, 2012 [4 favorites]

Your counselor is not doing you any favors. Addiction is not a disease, exactly, though it can be handy to think of it that way. All you really need to do is stay sober today. And the next today. And so forth. Which it sounds like you are doing. CBT should help with that, if you have a CBT therapist who has good experience with addiction. There is no particular need to stay with NA, though it can be pretty helpful for people who do stay in it.

Best of luck. You're walking a really hard road.
posted by PsychoTherapist at 6:45 PM on October 31, 2012 [1 favorite]

It really is my week to shill for Mindfulness in Plain English.
posted by flabdablet at 6:55 PM on October 31, 2012 [2 favorites]

Is your counselor a former user? If so maybe he is projecting what worked for him onto you.

Whether you use a disease model or a "sin" model or a habit model or whatever, if how you are thinking about it works, well, it works.

I'd get a different counselor, if I were you.
posted by St. Alia of the Bunnies at 7:33 PM on October 31, 2012

(But as far as NA, maybe the particular group you tried was bad and another particular group would help? From what I hear your mileage really varies in these groups.)
posted by St. Alia of the Bunnies at 7:34 PM on October 31, 2012

you might find more use out of something like smart recovery - no "higher power" stuff, more science based.
posted by nadawi at 7:39 PM on October 31, 2012

If NA is not your style because of its adherence to the disease model, you might want to try program such as the previously mention SMART recovery, Rational Recovery or Moderation Management. None of them necessarily follow the disease theory of addiction. Rational Recovery doesn't even have meetings.
posted by Tanizaki at 7:45 PM on October 31, 2012

I have been sober a really long time and don't believe that alcoholism is a disease and I'm a spiritual leaning atheist. I am not the only one floating around 12 step meetings. If you really hate the meetings, either try some new ones or even another 12 step program. But if you really are not into it you should not be brow beat by your therapist to go that route. That is not his job. I would ask him about his willingness to help you find your own way or help you find someone better suited for your needs. Twelve step recovery is not for everybody.
posted by cairnoflore at 7:55 PM on October 31, 2012 [1 favorite]

I went to rehab to get clean two years and three months ago. All I heard, there and since then, is that working a 12 step program is the only way to stay clean. Spirituality has never been a part of my life so I wasn't too sure how this 12 step thing was going to work for me, but I was desperate to quit drugs and alcohol so I figured I'd give it a shot. Whenever I expressed any concern that the 12 step stuff wasn't resonating with me, I was told (always emphatically), "fake it 'til you make it."

So that's what I did, for about 18 months. But "faking it" all that time left me feeling like a disingenuous piece of shit and after a while I realized that all the faking in the world was never going to result in me really believing in the program. A 12 step program isn't like something you do in your spare time, you're supposed to LIVE it. I don't know how constantly trying to live something you don't believe in can possibly be healthy, much less conducive to recovery.

I agree with the others who said you should find a different counselor. But my experience has been that it's really, really difficult to find professionals in the field of recovery who don't try to push a 12 step program. I feel like I hear plenty about other means of recovery, but finding people who actually promote those means has been a different story. Hopefully it's different where you live.

Two years and three months later, I don't have any clear cut and concise way to describe my recovery process. And even though this is what has been working for me, every single one of my friends in NA thinks I will relapse any minute. Nothing will ever convince them you can stay clean without NA, and that's fine, that's their experience. It just hasn't been mine.

TL;DR A 12 step program isn't for everyone. It is not THE ONLY WAY to stay clean. There are other options, but because they're less prevalent, it may take more effort on your part to pursue them. I wish you well in your recovery, however you decide to go about it.
posted by mokujin at 8:09 PM on October 31, 2012 [3 favorites]

Whenever someone says "in order to be happy, you MUST do exactly X thing that I believe in, without deviation, and regardless of your own beliefs, and I won't hear otherwise" you can safely demote their opinion to approximately the status you would give that of a mentally challenged lemur.
posted by parrot_person at 11:49 PM on October 31, 2012 [6 favorites]

Some of the blanket statements in this thread are based on nothing. As an atheist former drunk in AA, I do not buy-in to the Higher Power stuff and I am really skeptical of the disease theory of addiction, but I do attend meetings because I am sure that they really do help keep me sober. If nothing else, they remind me that if I take just one drink, all bets are off and I will probably soon be a raging alcoholic again. The best thing that a 12-step program does, though, is help us to be more than just former addicts. I had quit drinking for 2 years with no rehab or AA and was still fucking crazy. My girlfriend said, "Go to meetings or else", so I tried it. AA has helped me to live a better life, be a better person. Look around for different sorts of NA meetings. If you live where there are a lot, you should be able to find one that feels OK to you. I think you will be better for it.
posted by Hobgoblin at 5:53 AM on November 1, 2012 [1 favorite]

I'm the child of two alcoholic/drug addicts, not a person in recovery myself. So you judge how large a grain of salt you should take this with.

12 steps might not be for you, but there's something important in what your counselor is saying about fighting your recovery. You've only been sober for five months. Your brain is used to having the drugs and it is freaking out right now about not having the drugs. Even though you don't want to take drugs, your addiction is going to try and figure out a way to get you to take drugs again. The upshot is that you don't know how to be sober, and you need to be around people who do know how to be sober, lots of them. And not people who just have never been addicts, but people who have been addicts and know what it's like to be wrestling with these self-sabotaging impulses.

If the disease model doesn't work for you, maybe consider thinking of it as a kind of repetitive stress injury? There's lots of excellent neurological evidence on how different drugs affect your neurotransmitter levels and receptor density over time, not to mention gross anatomical changes. You've got to do various kinds of therapy to heal the damage, and because we really don't know enough about how to heal the brain yet, one of the best places to learn how to heal yourself is with other people who've been there and done it and can help you watch out for the pitfalls.

Maybe your counselor is a jerk, and you should get a new one, but whatever you do, don't try and do your recovery alone. Medical/social work professionals do not count as a social support network. Get some sober friends, whether they're 12-step or some other support group.

For what it's worth, neither of my parents have really liked NA meetings, and both prefer AA.
posted by Made of Star Stuff at 6:53 AM on November 1, 2012 [2 favorites]

You don't need a 12 step program to get and stay clean. They work for some people (although their actual long term success rates are just about on par with any other method - about 5%) but I think those people are of a certain "type," and if you're not that type, you'll never really get into it. I don't believe in the disease mode, in fact there are a lot of scientific arguments on why addiction isn't a disease. I also don't like most of the views of NA/CA/AA, especially the holier-than-thou attitude that almost everyone seems to develop. I was able to get and stay clean. The most important part is coming to truly see that drugs do not make your life better, don't make you feel better, and in fact are the main thing making you miserable. It can take a long time for this to truly click, but once you get there it becomes so much easier.

I think stopping on your own is a lot more likely if you are someone who takes personal responsibility for your drug use. I always viewed my drug use as a conscious decision I had made, so when I wanted to stop, I made another decision, and did stop. Of the many things I disagree with about 12 step programs, is the idea that you can never have another drink, another hit, must be absolutely sober. Some people do need this, but I don't think it's true of everyone. I didn't stop drinking, and for the first year, I used a handful of times, until the urge to use drugs was really out of my system - I could really recognize that they did nothing good for me, and just had no desire to use at all anymore.

One thing that is helpful for pretty much anyone battling addiction is having other people to talk to and share experiences with. That is one thing you can get out of 12 step programs - a kind of free group therapy. It's ok to go to meetings - just occasionally, or very often - to talk and listen, without buying into all of the dogma, or seriously working the 12 steps. And if you do want to try a few meetings, instead of NA you might want to look into CA or even AA, even if cocaine isn't your drug of choice, different programs have different vibes, and I know a lot of people who really don't like NA. My ex was a heroin addict for 18 years, but he chose to go to CA meetings. Another friend preferred AA - although a lot of AA meetings don't allow you to talk about drug use.

My point being, yes, you can get clean without a 12 step, but finding people to talk to somewhere will probably be helpful, and those programs are one place to find people, if you can't find any suitable non-12 step groups. Or you might not need that at all - I pretty much just stopped entirely on my own (most of my 12 step experience is going with other people.) If you are an introspective person you likes to work stuff out on your own, especially if you have and knowledge/interest in psychology, that will really help.
posted by catatethebird at 7:35 AM on November 1, 2012 [2 favorites]

There is no one size fits all solution to anything. Different things work for different people. There is nothing wrong with NA. It works great for some people, but it doesn't work for everyone and doesn't work for you. It's OK to find something that does work better for you.

And good for you for addressing your issues.
posted by cnc at 11:57 AM on November 1, 2012

This is definitely only my idea, and very YMMV, but besides NA and AA being a place where you can be surrounded by other people who are committed to not using and drinking, I think the 12 Step process does retrain your brain, though possibly not for the reasons most participants think it does.

As an example, I'm pretty much atheist (though I hate to claim that because I don't get along with most declared atheists) and so have had to do some convoluting to work with the higher power stuff. And I have convoluted successfully and it has been INVALUABLE. It turned out that the point wasn't so much that I believed in a higher power, but more that I stopped believing I could control the universe, my addictive behavior, my head cold, my broken leg, my friends' and relatives' lives, by force of will. THAT'S the brain pattern that was sabotaging me.

The point wasn't that I needed to find a great bearded guy in the sky. The point was that I needed a more realistic perspective. And I could not logic my way into it. Could. Not.

Of COURSE I am not Jesus! Duh! But my behavior and habits and thought patterns said otherwise. And going through the 12 Step motions and "faking it" (while being very open about faking it, btw) gets me to the more useful place of not only knowing I'm not Jesus, but acting and thinking like it, too.

If you've ever seen Karate Kid, think of "wax on! wax off!" While you're getting pissed off that you're waxing cars instead of getting better, the seemingly-frivolous muscle memory skills you're learning are applicable to a lot of other, real life, useful things.

Some people need the very literal interpretation of the 12 Steps for their whole lives in order not to fuck themselves and their families up. I'm glad it works for them, and I'm not going to argue with them. I'm going to nod and smile and wish them well.

Some of us, like me, need the literal 12 Steps, or as close as I can manage, on and off as stessors come and go. When I need them, they're there like a kata is there for me to get me back on the rails and grounded.

Some people get it after a while and only come back every few years for a touch up.

Personally, I don't know anyone who had a serious addiction problem who was able to jump into the last category without a couple of YEARS minimum in the first category. I'm sure they exist, but if you've been using for a while, your brain is wired to head your thoughts and habits into the wrong ruts for a couple of years at least.

In short, try it. Commit to a year or 18 months or 2 years. There's no written contract. You aren't signing on for the rest of your life, no matter what the extremist 12 steppers tell you.

However, if you ran into a bunch of 12 Step evangelists, try another program. If there's only one NA meeting in town, try AA. Better yet, try another town. There are definitely bullying assholes in a lot of these groups.

That said, as yet another option, I have heard good things about a group called LifeRing.
posted by small_ruminant at 5:32 PM on November 1, 2012 [3 favorites]

I been to aa and have practiced the teps and i just cant get into it. I think it sabotoge people progress by rendering hem powerless and not powerful. It has messed up my head because now i am scared of a relapse thinking I have this incurable disease. Its got my head messed up because i cant buy into it but i am fearful of the negative aspects of it.
posted by Truts83 at 8:40 PM on November 1, 2012

The book I recommended may help with that issue. That is one of the things about AA it criticizes: That it convinces people they are helpless, permanently broken, and can't really change. It makes other related points, such as cultures which blame alcoholism on alcohol have both more tea-totallers and more alcoholics than cultures which put forth the expectation that you can drink socially, in moderation and remain largely responsible for your behavior. (Excusing some inanity while intoxicated is reasonable and healthy.)

AA was founded by people that had been alcoholics for decades and were dying from it and still could not stop. They finally gave it up to god and managed to stop drinking and not die. Good for them. But I see no reason to apply that model to every young person who has been on a bender, which is basically what we do these days even though most people drink less as they get older without ever doing any kind of intervention.
posted by Michele in California at 9:33 AM on November 2, 2012 [1 favorite]