Who Are We To Judge

Four months have passed since addiction has dominated the majority of my time and brain space. To admit that this has been a surprise to me, who knowingly opted into a job at an organization advancing addiction medicine four months ago, makes me sound like an idiot. That said, I am surprised: by the extent to which addiction seems to undergird and connect inextricably to sociopolitical issues from which I had previously thought distinct, by the almost inevitable revelations I hear from friends and acquaintances about how addiction has touched their lives in ways I didn’t know before whenever I mention my work, by the lack of consensus around a single topic related to addiction, and by the frequency with which I am forced to look inward and recognize the arbitrariness of every mental distinction I’ve ever drawn between me and “addicts”.

There is no specific substance or behavior to which I am addicted, I should clarify – not least because I count relatives and loved ones among my readership (hi!). Rather, the most profound and instructive accounts that I have encountered in my brief journey into this world so far have made a consistent case that addiction is one way of many in which humans respond to suffering. More specifically, it is a response to the feeling of lacking something, which I think few people escape – certainly I don’t.

Here I make no claims to originality. The stories that humans hold on to most tightly are those filled with people overcoming something, or failing to do so, pushing themselves to make up for some lacuna in their lives, perceived or real, and often learning that the lacuna they identified (money, success, fame) was not the real hole in their life (love, purpose, being nice to people). Moreover, even the pursuit of the real things doesn’t fill the hole when that pursuit is motivated by personal desire, and not true selfless focus on the other. Jesus and Buddha both covered this millennia ago.

I’ve recounted Gabor Maté’s explanation of the root of addiction as trauma before in these articles, and people with far greater knowledge than mine have told me that his account is confirmed over and over in their work with people experiencing addiction. This creates an opportunity for a false binary, I think. If you are someone who thinks of yourself as not having experienced trauma, particularly an adverse childhood event, it is easy to think of yourself as someone with “intact” brain circuits that control reward, and thus as someone who is not susceptible to addiction. I think it is clear that many people with trauma do not go on to develop addiction, and I would conjecture that there are certainly people who have addictions not rooted in traumatic events.

My most consistent addiction is to being right - or at least some combination of being viewed as insightful, intuitive, intelligent, and helpful to others as a result. At my mentally strongest, I am confident in my abilities to help others, and I love to do so. Conversely, when I am down or insecure, I jones for the hit of validation and affirmation that comes from someone telling me I’m right, smart, insightful etc, and have overstepped boundaries with loved ones, been vicious in debates, and dug my heels in far past reason or kindness on points of contention in pursuit of hearing those descriptors. Again, none of this is original or unique - that I experience this makes me normal and human. I spell it out this way because my moments of weakness, wanting and need are not the results of trauma, but they are certainly still there, and make me do all kinds of things, positive, harmful, and neutral, to seek comfort and control.

The American Society of Addiction Medicine says the following: “Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.” My meanderings here are borne of grappling with this disease descriptor, that separates “addicts” from the rest of us who also do things, sometimes over and over, sometimes without real self-control, that have predictably negative consequences. Addiction, compulsion, self-sabotage - these all seem to me to be part of the same web of human failings with which we are all inescapably afflicted. While I find the disease descriptor to be important and useful, particularly where physical craving, symptoms and withdrawal need acute attention, I do not want it to absolve the rest of us from reckoning with the closeness between “them” and us.