Wrote a piece for TheFix.com 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.”