Replies to '*Dr. Phil Prime Time Special: Escaping Addiction, Part 2'

The Indian wrote to Princess1: 

You mentioned people who go back to "the same situation".   In one sense, this may be true.  But  a big part of rehab is learning how to avoid situations that are risky, and also what to do when those cravings start to hit.  If someone chooses to ignore this, then  yes, they have made a bad choice.  But it's on them, not the rehab.  

Prschuster: 

One problem I have had with "relapse prevention" is that the emphasis is on constant avoidance of risky situations. This can lead to consigning yourself to living life in a protective bubble. People cannot grow if they always avoid risks in life. One thing that helped me was to get myself used to ordinary situations and to deal with those cravings by dissociating your inner feelings from your surroundings. In other words, one must recognize that the real "relapse trigger" is the associations you make in your mind. And NO, I don't spend all my free time hanging out at bars. That would be stupid. But, by the same token, I don't flee from every alcohol-related event as if it were the plague. I can go to parties with friends who drink moderately, and learn to get along just fine sipping on my glass of soda. However, I have dropped my former problem-drinking friends. That's just common sense. The disease model puts too much emphasis upon "denial" and "cravings", as if these things can never be fully overcome (hence: progressive, chronic disease). 

The Indian: 

Also -- and this is the biggest misconception -- the disease model does NOT give people a free pass to blame their actions on addiction!  In fact, a big part of recovery relates to taking full responsibility for all choices that have harmed others, and then making amends.    

Prschuster: 

The disease model puts too much emphasis on the role of brain chemistry, or "self will run riot", or some other condition which compels us to drink. As a result, the person in "recovery" wastes a lot of energy with diversions. They obsess over character defects that are said to cause the alcoholism, and go through endless inventories, while they ignore the main defect - the act of drinking itself. That is where the primary responsibility should go. I mean, the people I have harmed when drinking, were harmed because I took that drink. The drinking was the cause. The thoughtless actions of a drunk, or the irritability of a person who is hung over, are just spin offs of the drinking itself. I am more responsible for having taken that first drink than I am for the things I did when I was too wasted to know what I did, or too hung over to react appropriately. Also, brain chemistry does not make a person act a certain way. It only predisposes one to drink in order to medicate themselves because their serotonin or dopamine levels are out of wack. Again, it is the drinking which causes the problems - rather than a disease which causes the drinking. 

The Indian: 

The reason the disease model is important is because alcoholism isn't caused by drinking too much.  And the difference between an alcoholic and a non-alcoholic has nothing to do with how much they consume.  It has to do with what happens to them when they consume.  For an alcoholic, the body begins adapting to the alcohol from the very first sip.  

Prschuster: 

I am not all that sure that anyone is immune to becoming alcoholic just because they don't have the metabolism or brain chemistry of an alcoholic. I could go on & on about serotonin, dopamine, GABA, liver enzymes etc.. But anyone who drinks alcoholically long enough will get the DTs. Anyone can get into the habit of using booze to deal with their problems. Just because some folks are more susceptible to the effects of alcohol, it doesn't hold that others can't destroy their lives by drinking, if they do it often enough for the wrong reasons. Again, the disease model is too limited, with all this talk of biogenetic factors. Even the reports of structural changes in the brain of an alcoholic haven't been shown to cause permanent cravings. We all know that it "gets better", something that flies in the face of notions about "chronic, progressive disease" models.