One of the most harmful and pervasive myths about the disease of addiction is that it isn’t a disease at all; instead, people see it as a moral failing, or a weakness of character. Often people see the addictive behaviors of their loved ones as only a bad habit, or maybe even as willful rebellion. In either case, they see the addictive behavior as being under the addicted person’s control. Maybe the addicted person is too “weak” or “lazy” to stop, but if they really wanted to stop, they could. It’s within their power, they’re just not exercising that power for whatever reason. They’re just not trying hard enough. They need to really try.
It’s an attractive myth. For one thing, American culture has been built around the idea that anyone can do anything if they just try hard enough. Individual power and responsibility are very familiar and comforting concepts to us, and we tend to apply them even where they are out of place. For another thing, this “myth of personality” can give a certain level of control to someone in the grip of a terrifying disease. It can be more comforting to think that the addictive behaviors could be stopped with trying than to think that these behaviors are mere symptoms of a disease that has biological roots and cannot be controlled without costly inpatient treatment or medication. For these reasons, and because they hear it from everyone around them, the people suffering from addiction come to believe this myth too. It’s easy for them to see themselves as “weak”, “lazy”, “cowardly”, etc. It’s easy for them to blame their own symptoms and relapses on a failure to “try” with the required passion. It’s also wrong. No amount of “trying” can reverse a behavior when that behavior is the result of a pathological biological process. The confusion comes about because opposite is sometimes true; in a condition like high blood pressure, willpower can change behavior (like diet or exercise), which can change the biological process of high blood pressure. But in addiction, the behaviors are a symptom of the underlying brain chemistry imbalances. Willpower does not have any affect on the underlying disease, so it is not generally useful for alleviating the symptoms.
This is not to say that people can’t curtail their addiction by sheer willpower; clearly, many people have done so in the past. The point I’m trying to make is that while we can applaud and support such efforts, it is cruel and viciously unfair to expect them. Yet in addiction treatment today, that is often exactly what we do; we expect patients to cure themselves by sheer willpower, with maybe a little assistance from some form of counseling, and then when they relapse they are told that they just didn’t try hard enough. They didn’t want sobriety enough. Our treatment was never insufficient; all problems are the patient’s fault.
This is sheer, unrepentant victim-blaming, and I have seen cases where this constant battle between patients and their loved ones or physicians has bordered on emotional abuse. It is the duty of physicians to provide support and help to those who are sick, not to attempt to shame and frighten them into health — especially when those shaming and frightening tactics have a success rate well below 10%.
Possibly the worst thing about this entire complex issue is its element of self-fulfilling prophecy. A person with addiction, having been told that they can get better if they just “try”, then tries as hard as they possibly can, and relapses. Well, that means they must not have been trying hard enough! So they try harder and harder, and relapse again. And again. And again. Eventually they become convinced that the moral failure just runs too deep, they’re not capable of the level of “trying” that everyone else expects of them, and they give up. That may be the point where they genuinely do stop trying to even seek treatment, and lose hope that they can ever be helped.
If there is one thing I want to do in the field of addiction medicine, it is to wipe out this pernicious myth of moral failure. Addiction is a disease, and if we are to have any hope of helping the majority of our patients, we must treat it as one.