Diseasing of America - 6. What Is Addiction, and How Do People Get It? - Are Addicts Disease Victims?

Written by Stanton Peele

Are Addicts Disease Victims?

The development of an addictive lifestyle is an accumulation of patterns in people's lives of which drug use is neither a result nor a cause but another example. Sid Vicious was the consummate drug addict, an exception even among heroin users. Nonetheless, we need to understand the extremes to gain a sense of the shape of the entire phenomenon of addiction. Vicious, rather than being a passive victim of drugs, seemed intent on being and remaining addicted. He avoided opportunities to escape and turned every aspect of his life toward his addictions—booze, Nancy, drugs—while sacrificing anything that might have rescued him—music, business interests, family, friendships, survival instincts. Vicious was pathetic; in a sense, he was a victim of his own life. But his addiction, like his life, was more an active expression of his pathos than a passive victimization.

Addiction theories have been created because it stuns us that people would hurt—perhaps destroy—themselves through drugs, drinking, sex, gambling, and so on. While people get caught up in an addictive dynamic over which they do not have full control, it is at least as accurate to say that people consciously select an addiction as it is to say an addiction has a person under its control. And this is why addiction is so hard to ferret out of the person's life—because it fits the person. The bulimic woman who has found that self-induced vomiting helps her to control her weight and who feels more attractive after throwing up is a hard person to persuade to give up her habit voluntarily. Consider the homeless man who refused to go to one of Mayor Koch's New York City shelters because he couldn't easily drink there and who said, "I don't want to give up drinking; it's the only thing I've got."

The researcher who has done the most to explore the personalities of alcoholics and drug addicts is psychologist Craig MacAndrew. MacAndrew developed the MAC scale, selected from items on the MMPI (a personality scale) that distinguish clinical alcoholics and drug abusers from normal subjects and from other psychiatric patients. This scale identifies antisocial impulsiveness and acting out: "an assertive, aggressive, pleasure-seeking character," in terms of which alcoholics and drug abusers closely "resemble criminals and delinquents."[16] These characteristics are not the results of substance abuse. Several studies have measured these traits in young men prior to becoming alcoholics and in young drug and alcohol abusers.[17] This same kind of antisocial thrill-seeking characterizes most women who become alcoholic. Such women more often have disciplinary problems at school, react to boredom by "stirring up some kind of excitement," engage in more disapproved sexual practices, and have more trouble with the law.[18]

The typical alcoholic, then, fulfills antisocial drives and pursues immediate, sensual, and aggressive rewards while having underdeveloped inhibitions. MacAndrew also found that another, smaller group comprising both men and women alcoholics—but more often women—drank to alleviate internal conflicts and feelings like depression. This group of alcoholics viewed the world, in MacAndrew's words, "primarily in terms of its potentially punishing character." For them, "alcohol functions as a palliation for a chronically fearful, distressful internal state of affairs." While these drinkers also sought specific rewards in drinking, these rewards were defined more by internal states than by external behaviors. Nonetheless, we can see that this group too did not consider normal social strictures in pursuing feelings they desperately desired.

MacAndrew's approach in this research was to identify particular personality types identified by the experiences they looked to alcohol to provide. But even for alcoholics or addicts without such distinct personalities, the purposeful dynamic is at play. For example, in The Lives of John Lennon, Albert Goldman describes how Lennon—who was addicted over his career to a host of drugs—would get drunk when he went out to dinner with Yoko Ono so that he could spill out his resentments of her. In many families, drinking allows alcoholics to express emotions that they are otherwise unable to express. The entire panoply of feelings and behaviors that alcohol may bring about for individual drinkers thus can be motivations for chronic intoxication. While some desire power from drinking, others seek to escape in alcohol; for some drinking is the route to excitement, while others welcome its calming effects.

Alcoholics or addicts may have more emotional problems or more deprived backgrounds than others, but probably they are best characterized as feeling powerless to bring about the feelings they want or to accomplish their goals without drugs, alcohol, or some other involvement. Their sense of powerlessness then translates into the belief that the drug or alcohol is extremely powerful. They see in the substance the ability to accomplish what they need or want but can't do on their own. The double edge to this sword is that the person is easily convinced that he or she cannot function without the substance or addiction, that he or she requires it to survive. This sense of personal powerlessness, on the one hand, and of the extreme power of an involvement or substance, on the other, readily translates into addiction.[19]

People don't manage to become alcoholics over years of drinking simply because their bodies are playing tricks on them—say, by allowing them to imbibe more than is good for them without realizing it until they become dependent on booze. Alcoholics' long drinking careers are motivated by their search for essential experiences they cannot gain in other ways. The odd thing is that—despite a constant parade of newspaper and magazine articles and TV programs trying to convince us otherwise—most people recognize that alcoholics drink for specific purposes. Even alcoholics, however much they spout the party line, know this about themselves. Consider, for example, the quote at the beginning of chapter 4 in which Monica Wright, the head of a New York City treatment center, describes how she drank over the twenty years of her alcoholic marriage to cope with her insecurity and with her inability to deal with her husband and children. It is impossible to find an alcoholic who does not express similar reasons for his or her drinking, once the disease dogma is peeled away.