People

Module 1A: Disease? Choice? Sin?

FIRST BASIC QUESTION ACQUIRE & APPLY FORMULATION (Level of Information)
#1 WHAT IS IT? 1. Does the Process give a full and accurate description of the Problem?—both what it is, and what it is not.

1A: Disease? Choice? Sin?

“I see no more than you, but I have trained myself to notice what I see.”–Sherlock Holmes in The Adventure of the Blanched Soldier

“…it is my business to know things. Perhaps I have trained myself to see what others overlook.”–Sherlock Holmes in A Case of Mistaken Identity

ABSTRACT

How we define our problems mirror how we define our Selves; how successfully we negotiate the solution to our problems depends on how rigidly we cling to those Self-definitions. To accurately assess any Program of Self-Transformation requires that we unearth its often hidden characterizations of what is the Self—the most popular being the Body – Mind – Spirit model. A fair and balanced application of this model to the Twelve Steps of Alcoholics Anonymous reveals some difficulties when trying to explain problems generated by our own choices. Based on the failure of AA to answer any of our basic questions adequately, we will suggest some ideas upon which to build a more constructive platform.

1A Disease? Choice? Sin? 1B Self & Self-Image 1C The War Within Self
DISEASE: A spiritual illness that manifests in two ways: a mental obsession for the first drink and a physical phenomenon of craving that inevitably develops after taking the first drink. DELUSION: Addiction is a distortion of memory that assigns a permanent identity to an impermanent stream of desires. DUALITY: A pathological inner struggle which traps a person indefinitely in repeating cycles of wanting to quit drinking (Never Again!) and wanting to continue. (I’ll quit tomorrow!)

DISCUSSION

In the landmark 1980 compendium, “Theories on Drug Abuse,” the National Institute on Drug Abuse gave 43(!) explanations of addiction, but popular opinion usually hovers around three main ideas: Disease, Choice, or Sin. To anyone who has accepted the currently entrenched Disease model, the notion that addiction is a Choice probably seems shortsighted and naive. And, of course, to any modern thinker the idea that addiction is a sin is clearly barbaric, a prejudice we left behind long ago. Anyone willing to do the research will be able to verify for themselves that all three ideas are alive and well in the 21st century. Anyone willing to go a little deeper will find that the notion that addiction as Disease, Choice, or Sin grows naturally out of a Body-Mind- Spirit model of Self that has dominated western thinking since Descartes, but whose conscious examination remains relegated to the dustbins of academia.

I clearly remember the last time I debated with someone whether or not addiction was a real disease entity. A testy little Twelve-Stepper made the mistake of beginning his argument with “Science has proven…” and as a Scientist who had spent thousands of hours studying the topic of addiction—but considerably less time learning when not to speak—I laid into him full bore. After just a few minutes, with tears in his eyes, he blurted out, “But it’s the only thing that made sense to me! It’s the only thing that gave me the courage to quit drinking!” Even if you are certain that someone is holding on to an idea that is hurting them, it does little good to point that out until you have something better to offer.

So now, when someone asks me, “Isn’t addiction a disease?” instead of trying to resolve or debate the issue, I propose an alternate path: “Alright, let’s go with that and see where it leads us.” At the end of our Socratic journey, we invariably end at a renewed understanding of what it means to be human, and a reconsideration of the dangers involved in holding on to an unexamined opinion. But most importantly we arrive at our open-ended goal through a dialogue of questions and answers where freedom is at the beginning of the process, not the end. In what will become a recurring theme throughout the cogniventive matrix, the lens of addiction will expose our prejudices and magnify aspects of human suffering that are often too subtle to be seen with a sober eye.

And in the next four Acquire & Apply modules—1A, 2A, 3A, 4A—we will focus that lens by applying a modified version of our Four Basic Questions to the Twelve Step Program of Alcoholics Anonymous (AA). We usefully align our word phrasing with the
recordings from AA’s favorite two man sober side show—the “Joe & Charlie Tapes”:

FOUR BASIC QUESTIONS AA’s ESOTERIC KNOWLEDGE FORMULATION
#1 WHAT IS IT? 1. Knowledge of the Problem
#2 WHAT CAUSES IT? 2. Knowledge of the Cause
#3 WHAT ENDS IT? 3. Knowledge of Solution
#4 WHAT MEANS WILL END IT? 4. Knowledge of the Means to Implement the Solution

At the time of this writing, the “Joe & Charlie Tapes” sit unassailably as the core Treatment Program at one of America’s largest rehabs, and this “Knowledge Formulation” is deeply entrenched within AA’s Esoteric Oral Tradition. Although the simple act of recasting the first four basic questions into this alternate phrasing may fail to interest or inspire, the amount of information that we can Acquire & Apply from such language juggling can literally change the way we think about the world. It is in the very nature of the cogniventive matrix that we are able to easily make huge leaps in perspective—the matrix does much of our work for us. This is not easy to see now, but as we progress this will become more apparent. Now we will look at the AA’ s very best answers (no straw men here!) to our very basic questions and see how the 70-year old Twelve Step institution holds up to first examination.

I. AA’s KNOWLEDGE OF THE PROBLEM: Alcoholism is spiritual illness that manifests as both a mental obsession for the first drink and a physical phenomenon of craving that inevitably develops after taking the first drink.

In the “The Doctor’s Opinion,” which opens the 1939 text of Alcoholics Anonymous, William D. Silkworth, M.D., begins the explanation: alcoholism manifests as a “phenomenon of craving” that invariably develops upon taking the first drink. Once the alcoholic starts drinking they continue to drink to satisfy a physical craving beyond their mental control. Silkworth maintains that the satiation impulse that tells the normal drinker that they have had enough does not exist for the alcoholic.

Simple enough it seems: just don’t take the first drink. And if a physical reaction to alcohol were the only problem, just quitting would be enough. Alcoholics Anonymous continues to explain that after continued drinking an alcoholic develops a “mental obsession” that periodically draws them back towards that first drink no matter what the consequences.

“The alcoholic at certain times has no effective mental defense against the first drink.”

Alcoholics Anonymous, p. 43.

At certain moments, the alcoholic will be unable to choose not to take the first drink, and if that drink is taken then the phenomenon of craving develops and the deadly game is afoot. We can now answer our First Basic Question WHAT IS IT?, in two distinct ways: the inability of the alcoholic to resist the urge to drink, which we will call a mental obsession; and the inability of the alcoholic to control how much they drink once they start, which we will call the phenomenon of craving.

“If when you honestly want to, you find you cannot quit entirely (mental obsession), OR if when drinking, you have little control over the amount you take (phenomenon of craving), then you are probably alcoholic. If that be the case, you may be suffering from an illness that only a spiritual experience will conquer.”

Alcoholics Anonymous, p. 44.

Over a period of time, this dual affliction of Mind & Body takes on a life of its own, creating devastating consequences as the alcoholic’s increasingly disturbing behavior drives a wedge between himself and others, between himself and his God. This completes the physical-mental-spiritual trichotomy of alcoholic dysfunction. Although the spiritual dimension will not become clear until Module 2A, Choice as both Cause and Effect, the more we look, the more we will understand how everything in the AA Program is filtered through a Body-Mind-Spirit model of the Self, an assumption rarely seen, and even more rarely examined.

We will now examine that assumption. One of the first things we see is that, if the problematic “OR” in the above quote was intentional, then Alcoholics Anonymous first defines alcoholism by BOTH a mental obsession AND a phenomenon of craving, and then suggests the contradictory definition of alcoholism by EITHER a mental obsession OR a phenomenon of craving, For those very few in AA who have even noticed this contradiction—only 1 in the ~1000 that I have interviewed—the answer given is “It was just an oversight; Wilson meant ‘and.'” Not acceptable—and AA’s core dogma is rife with these unacceptable contradictions. And this is more than just language parsing: in our EITHER-OR explanation knowing whether a particular alcoholic is suffering from a mental obsession or a phenomenon of craving—or both—will determine how we approach their recovery. Treatment centers claim addiction is a primary disease of Body and Mind and then stake the long range results for their outpatients in a religious, cultish, Fellowship that believes God grants the sufferer a “daily reprieve based on the maintenance of their spiritual condition.” We have barely begun to answer our first basic question and we are in some deep, dark, dangerous metaphysical woods.

Daily Experience Label
A phenomenon of craving demands a body that can crave Alcoholism is a Disease
A mental obsession implies a mind that can be obsessed Alcoholism is a Choice
A spiritual illness requires a spirit that can be corrupted Alcoholism is a Sin

These definitions of alcoholism—better to call them labels—are all rooted in daily experience that tells us that we have a Body that exists in space, a Mind that appears to change through time, and something else that we can’t perceive with our senses—this last usually gets thrown into the catch-all “Spirit,” or “Soul.” And here is where it gets dangerous: when we call addiction a disease, choice, or sin, rather than examining the daily experience that gives rise to the label, we unknowingly pick up and carry the baggage associated with the label. Nowhere is that more clear than with the idea that alcoholism is a “Sin.” Rather than examining how our behavior may have “missed the mark,” the word itself can provoke so many bad childhood memories that any useful properties that the very notion of sin may carry with it are abandoned. Suspension of moral judgment was one reason that alcoholism as a disease first gained ground over alcoholism as a sin in popular opinion; however, the Body-Mind-Spirit model of the Self penetrates deeply in our consciousness: in trading “Sin” for “Disease” we continue to judge the alcoholic who, in trading one label for another, has simply traded one shame for another. Tony Soprano goes to therapy for the Mind and Carmella is happy, but knows it doesn’t “address the Soul.”

We could go on and on for dozens of pages, but my goal is simply to suggest some of the difficulties in just understanding what alcoholism is and how we can use these difficulties as a springboard to a greater understanding of who we all are as human beings. Our goal is illumination not argumentation.

ACQUIRE & APPLY SUMMARY:

Do the Twelve Steps of Alcoholics Anonymous give a full and accurate description of alcoholism—both what it is and what it is not?

    • Our proposed definition does not include the “strange mental blank spot” which in Alcoholics Anonymous is the key operator when an alcoholic relapses after an extended period of sobriety. This peculiar phenomenon of getting “struck down drunk”—which is neither mental obsession nor physical phenomenon of craving will be covered in the future Module 7A: When it Stops Working.
“Not only had I been caught off guard, I had made no fight whatever against the first drink. This time I had not thought of the
consequences at all.”
Alcoholics Anonymous, p. 41.
    • Although Alcoholics Anonymous attempts a qualitative description of different types of drinkers to more clearly define what alcoholism is not, it adds a circular definition of alcoholism that would frustrate any critical thinker: an alcoholic is someone who needs a spiritual experience to recover; if they can recover on their own they are not an alcoholic.

“If that be the case, you may be suffering from an illness that only a spiritual experience will conquer.”

Alcoholics Anonymous, p. 44.
    • AA fails distinguish between mental obsession and a physical phenomenon of craving, just as some of history’s greatest thinkers have struggled to untie the World-Knot of subjective & objective experience.

“If when you honestly want to, you find you cannot quit entirely (mental obsession), OR if when drinking, you have little control over the amount you take (phenomenon of craving), then you are probably alcoholic.

Alcoholics Anonymous, p. 44.
Therefore, the main problem of the alcoholic centers in his mind, rather than in his body.
Alcoholics Anonymous, p. 23.
In our belief, any picture of the alcoholic which leaves out this physical factor is incomplete.
Alcoholics Anonymous, xxiv.

CONCLUSION:

Towards a More Motivating Description of what is Addiction

To define what addiction is and what addiction is not seems to be getting increasingly more difficult. How much easier it would be if we could find an unambiguous physical cause and an attending silver bullet cure. How much easier it would be if addiction were a choice and the addict could free themselves by simply trying harder. But as the “addiction is a disease” and the “addiction is a choice” proponents square off against each other, what do either of them have to offer an addict for the confusion that they feel at that moment of decision? Listen to the agony in this voice:

“I sit in my living room with a beer in my hand. I do not want to drink it and yet I know that I will, and I know how disastrous the outcome will be. You may tell me I have a disease; you may tell me that I have a choice. Yet nothing you can tell me will change what will happen, because nothing that I can tell myself will change what will happen. It matters little whether I arrived at this point through defective genes or poor toilet training. It does me no good to tell me that my brain chemistry has been compromised and then expect me to make the right choice with my compromised brain. What do you have to offer me at this one defining moment when I am divided within and feel compelled to do what I do not want to do?”

Anonymous

A framework for discovering a complete solution to any aspect of human suffering must define and describe the range of suffering in a manner that engages the individual deeply enough to awaken the desire to seek out the source of that suffering. We must acknowledge the precious opportunity given to us by our suffering, accepting it as a challenge rather than a curse. The addict must not be allowed to indulge in self- pity or cling to notions that they are forever recovering from their addiction—that is not the reality of their situation, or the situation of countless others that have been liberated from addiction. We must offer the afflicted an oasis of truth, an opportunity to look past their addiction at the underlying cause of their dissatisfaction with life. Freedom comes at the beginning of the process as well as the end.

And at the beginning of the process I suggest that we compassionately give the sufferer the freedom to choose their own understanding of their addiction—particularly when their self-definition moves them closer to a practical realization of the difficulties they are in and a resolve to do something about it. This is not just theoretical. A friend of mine was hospitalized for alcoholism in the relapse center of one of the premiere rehab sites in the United States. He wanted to get sober and was willing to do the work necessary with one caveat: he did not believe that addiction was a disease. Rather than taking advantage of his willingness, the hospital staff spent most of their time trying to browbeat him into accepting the disease model—even made it a condition of his continued treatment. Beyond this barbaric lack of compassion, such bullying unearths a lack of understanding of one of the core ideas of this module: How we define Addiction mirrors how we define our Selves; how successfully we negotiate our Recovery from Addiction depends on how rigidly we cling to those Self-definitions. To ask someone to accept a self-definition of alcoholism that conflicts with their deepest convictions and values will make their Recovery even crueler than the Addiction itself.

For some, the disease model allows a momentary release from the cyclic, crippling guilt that keeps driving them back to their drug, and a chance to make new choices. For others, the disease model just trades one shame for another and gives the user an excuse to use again. For those whose personal or cultural history includes systematic abuse, AA’s First Step doctrine of personal powerlessness over alcohol can be emotionally debilitating. And surprisingly, an intelligently articulated model of addiction as “sin”—not the emotional, liturgical, blackmail that many of us were subjected to in our childhood experience of religion—can be just what it takes for someone to “go and sin no more.”

But the freedom to choose one’s own interpretation requires a responsibility to fully commitment to that decision until it no longer works as a motivating description. If you want to believe that addiction is a disease, then be willing to explain how a spiritual experience can end an addiction immediately and spontaneously. Does a spiritual realization rewrite defective A1 alleles, change the number of dopamine receptors, and dry up excess acetaldehyde? If you want better answers, you need to start asking better questions.

MEDITATIONAL EXERCISE

1A: WHEN DO YOU FIRST REMEMBER BEING YOU?—Not necessarily your first memory, but the earliest Image from your past that arouses a smile of recognition as certain as looking in a mirror today. Can you point to a childhood photo and not only recall what was happening that day, but also know, and feel, that it was you? In that snapshot moment you were no longer just a bundle of perceptions or a passive recipient of experience, but instead a conscious, active agent in your little world, your thoughts and feelings part of a unique individual with a style, an attitude, and an awareness of that individuality. And now, years later, you look back at an Image that does not sleep in the past, but reaches out to you with a continuity that can only be called “Self.” …Continued in Gods Little Warrior

NEXT CHOICES:

STAY ON CHALLENGE-BASED PATHWAY (continue on Level A): 2. What Causes It?

STAY ON RESPONSE-BASED PATHWAY (move to level B): 1. Observe The Problem & Explain It

©2012 Michael V. Cossette
cossettem@earthlink.net
609-306-4123

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