For centuries, humans have been trying to explain why some people lose their way with substances and others don’t.
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At one time, it was widely believed that people with severe drug use problems were simply possessed by evil spirits. Another popular theory put the blame on laziness and a lack of will power, suggesting people with substance use problems in some ways choose to be that way. (Some people still think this way.)
For many decades, harmful substance use has been regarded by some as a disease that requires treatment and careful monitoring, just like diabetes or cancer.
“I have a disease,” writes Patrick Lane in Counting the Bones. “Ten years ago I would have laughed at such a notion. Booze and drugs and tobacco are available everywhere, and I choose to use them. But what do I do when they start using me? What do I do when I’m on my knees puking blood, only to go right back to the bottle?”
The disease model continues to be the foundation of Alcoholics Anonymous and many other programs that see substance use as an illness of the heart that can only be remedied by confessing your behaviours and submitting to a higher power.
“Addiction is no more an illness than are grief, depression, lack of attention, homosexuality, single-motherhood or genius, all of which psychiatry has regarded, at one time or another, as illnesses in need of surgical, electrical, pharmacological, committal and other drastic interventions...We take mood-altering substances to “treat” the human condition, the pain of being.”
Author and physician Gabor Maté agrees to some extent. He argues that excessive and compulsive substance use reflects a need for comfort, from childhood trauma, repressed anger, and a host of other “human” ailments that can result in a variety of illnesses.
But even this more complex theory is not sufficient for psychology professor Alan Marlatt and other researchers who lean toward a “learned behaviour” explanation. Marlatt would argue “addiction” is a human habit that can be unlearned.
Some researchers insist substance use problems reflect the disconnection some people feel. According to retired professor Bruce Alexander, for example, some of the fundamental constructs of our society—industrialization and the free-market economy—have created an environment that fosters problem behaviour in all of us. In other words, we have created a world where substance use problems are understandable coping mechanisms. And if we continue the way we are, we should expect an increase in the number of people with substance use problems.
Perhaps the simplest approach is to recognize that human behaviour—including substance use—is as complex as human beings themselves. That is, each individual’s relationship with substance use is unique, and substance use problems may be a reflection of a wide range of “life” factors, including genetics, lifestyle, culture, habit, environment, and so on.