Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

ASAM Definition of Addiction: How Is Addiction a Family Disease?

Wrote a piece for late last night about the American Society for Addiction Medicine’s statement that addiction is a primary, organic illness of the neurological system that distorts addicts’ thinking and drives them into obsession and compulsive use of substances or behaviors.

The physicians I talked to were happy about this development because it meant that addiction, as a problem they treat, is one step closer to being classified as a medical disease whose treatment can be paid for by insurers. Insurers often refuse to pay for treatment for conditions that could be seen as resulting from the patient’s own poor choices. ASAM’s statement makes clear their position that addicts have no choice about their illness.

When I woke around 6 this morning I started to wonder: if addiction is an illness inside the addict’s neurological system, then how can we “adult children of alcoholics” consider ourselves to be affected by addiction? I’ve heard people in Al-Anon meetings say, “I’m the same as the alcoholic—I just don’t drink.” (I can tell you: for my mother, that was true. She WAS a dry-drunk.)

I often think to myself that I have to try as hard as I can in recovery—not just for myself, but also for my son. I don’t, of course, want him to wind up an addict. But is that one of those “things I cannot change”?

The ASAM statement talks about how addiction is largely an illness of twisted thinking and feeling. The neurological dysfunction affects areas of the brain that mediate memory, emotional response to circumstances, pleasure, aggression (anger), and fear. In speaking with Mark Publicker, a garrulous and very interesting doctor who directs the largest rehab in Maine, I listened to him talk about how addiction twists the circuitry evolved to sustain our life on earth. Survival, in other words.

“We’re really talking about the circuitry that provides reward for engaging in behaviors that promote survival,” he said. “Our brains are designed to give us reward and pleasure for eating food, nurturing children, having sex.”

“Huh,” I said, “that’s not too different from what the Big Book says.”

He paused a second, then asked me to explain.

“Well, the Big Book talks about how alcoholism is about excessive engagement in survival behaviors—ambition, sexuality, personal relationships, the things that make you feel secure in the world,” I said. “And how recovery is about looking at our behaviors in those areas and learning to modulate them.”

“I don’t think there’s daylight between AA’s concept of addiction and the neurobiological explanation,” he said. “It’s one of the things I find interesting: Bill Wilson really intuited a lot of what we understand through the science about addiction today.”

Well, my friend Big Daddy might amend that to add that Lois Wilson provided a lot of the “intuition” behind Bill W.’s writing. (“He cheats her of credit every chance he gets,” Big Daddy sometimes says.)

I tend to agree. I’m fond of Lois; she was the driving force behind Al-Anon, the organization that saved my life in the beginning of my recovery. (I was daydreaming about offing myself when I started going to meetings in 1999; when I got a home group that loved me, these thoughts would be countered gently by the idea that, if I did indeed top myself, the folks my home group—my HP at the time—would think this was a bad decision, and that I might have other options.) Apparently Lois gave Bill a lot of ideas that he took credit for himself.

One of the ideas that Lois had was that alcoholism affects other people, not just the alcoholic. She knew that living with Bill had distorted her own thoughts and feelings, her own perception of reality, maybe as much as alcoholism had distorted Bill’s. In other words, she knew she was also sick.

ASAM’s definition of addiction talks about other factors that can lead to the appearance of addiction. These include:

  • Disruptions of healthy social supports
  • Relationship problems
  • Exposure to trauma or overwhelming stress that incapacitates a person’s ability to cope
  • Distortion in meaning, purpose, and values that guide attitudes, thinking and behavior [BINGO]
  • Distortions in a person’s connection with self, others, and with the transcendent (“referred to as God by many, the Higher Power by 12-steps groups, or higher consciousness by others,” the statement says)

So, yeah: alcoholism can run in families not just because of the genetics (which the statement says accounts for about half the chance a person can become an addict), but also because of the (you should pardon my French) shitty social skills that run in addictive families: poor parenting; isolation from friendships; childhood physical, emotional, and sexual abuse; the child making the crappy parent the higher power (which I did for many years, and still tend to do); and freaky, perverted experiences with religion. For example, being taught that God is a (male) judge who hands down decrees from the bench, who bangs his gavel at you every chance He gets.

LOTS of people in The Rooms for addiction and alcoholism are also children of alcoholic and addictive families. Our perceptions of and ideas about the world are severely distorted not just because of The Drinking or The Using, but also because of all the twisted behaviors and thinking that go along with the use, behaviors we observed and absorbed when we were young and our neurology was still forming.

The 12 steps teach us ways to unravel and iron out that twisted thinking, Publicker said. 

And if they work for alcoholics and addicts, why shouldn’t they work for anyone else?

“I have to tell you, as a non-recovering person, I have a lot of envy for recovering people,” Publicker said. “Look—I’m 61 years old. I live in a small town outside Portland, in a house where I can’t see any other houses. I don’t have any natural circumstances where I’m going to develop any intimate friendships. I can’t just go next door and knock and ask somebody to be my friend.

“And the research shows that nurturing intimate friendships correlates with happiness. My patients in recovery have these lovely supportive friendships. They can see everybody every day. It provides a tremendous reward for them.”

“Neurologically, as well as socially and spiritually,” I said.

“Of course,” he said, “because the body and mind ARE one—they can’t be separated.”


  1. I found this development very interesting, as well. The ASAM definition looks pretty good to me, and apparently the medical director at Hazelden likes it, too. I’m glad that it encompasses behavioral as well as substance addictions, and it addresses the neurobiology and environmental factors. Regarding Al-Anons, one of my favorite sayings is that they do the same crazy things alcoholics do only they do them stone cold sober LOL (I’m a double winner, so I’m allowed to poke fun at both sides, I think)

  2. Like how you say that it is not just the addiction, it is the ppor social skill set that goes with it – this makes for a spiral that is not at all positive to have to work with growing up.
    Lucky we can grow through it..

  3. I also think that Lois was important in so many ways with AA. Sad that Bill W. would not let her write To the Wives. I never understood that, other than he had a big ego which later created problems within the fellowship as he had flings with newcomers to AA. Lois stood stoically by him to the end. But I wonder how happy she really was.

  4. Guinevere,

    Wow, love your blog, and the article above is fascinating. I think you should check out a book by David J. Linden, called the Compass of Pleasure-How Our Brains make Fatty Foods, Orgasm, Exercise, Marijuana, Generosity, Vodka, Learning, and Gambling Feel So Good…notice that exercise , generosity, and new learning activate the pleasure circuitry too.
    Juxtapose Linden’s book with the what the brain fitness folks are saying, that we can grow new neurons daily, called neurogenesis, and increase neuronal connections, called plasticity when we take care of the pillars of brain fitness, which are physical exercise, nutrition including omega 3’s and antioxidants, good sleep, stress management, and novel learning experience. Is not the Big Book a novel experience for the early in recovery folks? I worry about my 13 year old boy and seven year old daughter and how they will react to their first experience of drinking or drugs…they have never seen either their mother or I drink or drug, they have the genetics from both sides. And being totally wrapped around my daughters little finger, I takes me a few minuters to realize that of the two of them, she will be the one who is hell on wheels if she goes down the addiction path. The boy is a little more malleable. Will be back. Followed you on Twitter, will go to Facebook now. Mike

  5. Great post.

    This reminded me of something I’d read years ago that described 4 tasks of treatment and recovery:

    Recovery from the other genetic, biochemical, social, psychological, or familial influences which initially contributed to the development and trajectory substance problems
    Recovery from the adverse psychosocial consequences of the substance use
    Recovery from the pharmacologic effects of the substances themselves
    Recovery from an addictive culture

    Note that family are likely to share at least some of the first and second, and possibly, the fourth.

    The more I think about this new definition, the more I like it. It really captures the primary nature of the illness and acknowledges the secondary problems that can result from it. This has important implications for treatment and understanding the constellations of problems that people initiating recovery often experience.

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