When chatting with the kids I work with in treatment about the healthy results recovery affords us, I often joke with them that I have 21 years clean and sober and have not been arrested in, let’s see, 21 years. Must be just an odd coincidence.
All jokes aside I can easily appreciate why folks still have such difficulty understanding Substance Use Disorders as a disease rather than a function of poor choices or even character or morality. Let’s look at a few of the factors that may contribute to this difficulty.
I think one that is glaringly apparent regards our culture’s connection to the idea of personal choice. It makes sense that this American ideal would contradict the loss of control a chemically dependent individual experiences as we do not “drink responsibly” as the ad suggests. So powerful is this notion in fact that many of us with this healthcare condition blame ourselves and struggle with significant guilt over our actions while in active addiction.
Another factor is simply statistical. The majority of folks never develop any difficulty with substance use and cannot imagine how someone would not have the ability to control their own behaviors.
Finally, and let’s be honest, quite early on in the progression of this disease an individual begins violating their own system of values and acts in a manner contradictory to commonly held social and legal standards the majority adhere to. Sadly I am the one ruining a good friend’s wedding, picking the kids up after a few too many, or passing out at the birthday party. I am the one who is “super nice” as long as I am not drinking. The list just goes on and folks whisper “why would he keep doing that?”, yet no one waits for the answer.
Well here it is.
To transcend the common misconceptions related to Substance Use Disorders we have to understand their nature. Some individuals simply have a response to substances that is anomalous or exceptional. Think about a bell curve. No healthcare condition effects everyone. This unique response is usually a function of a genetic predisposition and it subsequently begins the ever increasing compulsion and obsession to use substances in spite of sometimes catastrophic consequences in order to maintain the pleasurable reward response. As time goes on my central nervous system is just unable to keep me in balance neurologically and so continued drug use becomes the only option for general comfort or even survival.
Imagine being hungry, having not eaten for days. What lengths might you go to in order to satisfy this need? Now multiply that by hundreds! This is the “why” if you will. Executive [brain] functions (Prefrontal Cortex) simply do not have the ability to override the primal necessity created in the reward pleasure center (Nucleus Accumbens). Human beings are designed like this. Primitive systems such as pain, or flight/fright are designed to take precedence. As such, I do not “want” to use a substance, I “need” to use. This combined with tissue dependence leaves a biological system that only functions normally in the presence of a drug.
This does not mean I am not accountable for my actions as I am solely responsible for my health in recovery and the amends I need to make. It simply means I am not a bad person needing to get good, but rather an individual with a healthcare condition that needs to be managed into remission.
All jokes aside I can easily appreciate why folks still have such difficulty understanding Substance Use Disorders as a disease rather than a function of poor choices or even character or morality. Let’s look at a few of the factors that may contribute to this difficulty.
I think one that is glaringly apparent regards our culture’s connection to the idea of personal choice. It makes sense that this American ideal would contradict the loss of control a chemically dependent individual experiences as we do not “drink responsibly” as the ad suggests. So powerful is this notion in fact that many of us with this healthcare condition blame ourselves and struggle with significant guilt over our actions while in active addiction.
Another factor is simply statistical. The majority of folks never develop any difficulty with substance use and cannot imagine how someone would not have the ability to control their own behaviors.
Finally, and let’s be honest, quite early on in the progression of this disease an individual begins violating their own system of values and acts in a manner contradictory to commonly held social and legal standards the majority adhere to. Sadly I am the one ruining a good friend’s wedding, picking the kids up after a few too many, or passing out at the birthday party. I am the one who is “super nice” as long as I am not drinking. The list just goes on and folks whisper “why would he keep doing that?”, yet no one waits for the answer.
Well here it is.
To transcend the common misconceptions related to Substance Use Disorders we have to understand their nature. Some individuals simply have a response to substances that is anomalous or exceptional. Think about a bell curve. No healthcare condition effects everyone. This unique response is usually a function of a genetic predisposition and it subsequently begins the ever increasing compulsion and obsession to use substances in spite of sometimes catastrophic consequences in order to maintain the pleasurable reward response. As time goes on my central nervous system is just unable to keep me in balance neurologically and so continued drug use becomes the only option for general comfort or even survival.
Imagine being hungry, having not eaten for days. What lengths might you go to in order to satisfy this need? Now multiply that by hundreds! This is the “why” if you will. Executive [brain] functions (Prefrontal Cortex) simply do not have the ability to override the primal necessity created in the reward pleasure center (Nucleus Accumbens). Human beings are designed like this. Primitive systems such as pain, or flight/fright are designed to take precedence. As such, I do not “want” to use a substance, I “need” to use. This combined with tissue dependence leaves a biological system that only functions normally in the presence of a drug.
This does not mean I am not accountable for my actions as I am solely responsible for my health in recovery and the amends I need to make. It simply means I am not a bad person needing to get good, but rather an individual with a healthcare condition that needs to be managed into remission.