The biomechanical disease folks are right that there is a there there, that when people with addiction say they feel powerless, we should take them (us) seriously. The choice folks are right that even in severe cases of addiction, we are not choiceless zombies but retain some human agency.
Indeed the third way is vital. Middle path, transcending the limits of language (which in itself is an object of craving to maintain ourselves in the limitations of the ego). It was courageous from you to write that op-ed about the term "disease". One thing I know for sure is that when we get curious about our processes, we help our recovery because we become more at "-ease". And your shares here helps me nurture my curiosity for my own process. Thank you for this.
I think this is why 12-step did not jive with me. I interpreted the "give it all to the higher power" thing as totally relinquishing any possibility of me having a choice in continuing my addiction. I believe in god and a higher power, but I don't believe that god has control over me and my life.
Deep down, way way down, I knew I had the ability to choose to remain sober. It was extremely taxing and tiring at first to make that choice over and over, but it has gotten easier with time. It is both liberating and sad to realize I have choice and agency in this.
Personally, some of the most disempowering things I heard were when I went to (a very traditional) rehab. I hear you. Glad you found a way to get in touch with your self determination and put it to good use!
I agree with Ms Dorval, it takes courage to write about ideas we are yet to understand fully. Thank you for that.
The Center for Motivation and Change NYC helps people understand change through comparing and contrasting problematic behavior and the rewards of self respect (living our values) and connection with others. Perhaps, rather than self-control, we look to the science of motivation.
Also SMART Recovery is a personalized approach for people seeking recovery and the family and friends, who are in a powerful position to promote healthier choices.
Neither subscribe to addiction as a disease. Both focus on letting the person suffering with compulsive behaviors and the concerned significant others to identify their values and let those be their guide. I hope you’ll check them out.
I value your writing, Dr. Fisher, precisely because you are willing to spend time in the gray areas.
I don't have a formal education in addiction/recovery, AND I did not participate in 12-Step. Still, I've inserted myself into this field by creating a local community for sober women centered on positive psychology, mindfulness, and social health.
Your inquisitive voice has given me permission to keep digging into and sharing my investigation into my own journey of recovery/flourishing (sober almost 7 years).
It's challenging to be willing to stay in this curious, flexible, open space when I can feel a strong pull towards rigidity and FACTS. It feels vulnerable to be in this place of AND instead of OR.
But the former is a place of possibility and potential, and the latter is what turns some people away from benefitting from the joys of a thriving, sober lifestyle.
beautifully said. my own experience, and after reading a lot of quit lit, is that the experience for everyone is different, and that issues w whatever drug of choice are on a spectrum. Having agency is empowering, while keeping in mind that this is a high stakes game. thanks for writing.
Thanks Laurie! People have told me not to write about things like moderate drinking or agency too much, because its a high stakes game, but I think we have to be honest about where these things get messy. I try to strike a good balance.
which you did. I also appreciate that you are upfront about going through something yourself, which I recently did too. I read that the choice is part of a triangle, much like fire, which needs heat, fuel and oxygen. To give in to a craving you need opportunity, desire, and permission. and if you don't grant permission, the triangle collapses, much as a fire goes out when you remove one leg.
I like this perspective, as I have grappled with the "responsibility" (guilt?) my husband has had for his choices in addiction (now clean and sober for a year following double organ failure). I rail against people who blame him, but I am challenged in my own thinking by the fact that he did, finally, "decide" to change
But nuance is important: few people undrstand or appreciate it; and treatment methods that require nuanced assessment and lack a firm paradigm (so are harder to classify as "successful," for one thing).
The prevailing ethos of personal responsibility is also more complicated when a person considers the "reality" of choice vs. the impression of choice. Even you believe that you "chose" to walk to the liquor store. But we aren't aware of our subconscious-conscious interactions that fight battles we never get to see. (That is, if my very basic understanding of neurological function is, in fact, roughly correct. ) What other interactions, both internal and external, are moving your legs in the direction of a plastic gallon bottle of vodka? I don't know. And neither does anyone.
Finally, and connected, there is the subtext of free will. I dont mean the argument about predetermination or overarching intelligence or collective "soul." (Although, arguably, one could determine behaviors for a lifetime if s/he understood the gazillions of elemental "pings" that concur conflict, confine everything we think were deciding. What ping ping pinging is going on in our brains and bodies, nevermind outside ourselves?)
I am simply pointing out the likelihood that none of us has any idea if or how much our conscious selves decide. Or the mechanism by which we would sort out influence vs self. Nebulous at best, incomprehensible by most.
That said, I am also eager to find better ways of understanding addiction and applying treatment. The notion of a shift in beliefs seems like a fine place to start.
Thanks Tara, I'm glad the nuance is helpful in this case. To your point, I am interested in nuance to the extent it helps with real world problems.
I entirely agree that "choice" can be epiphenomenal and we can delude ourselves into thinking we have it (or exercise it) when we really don't. (And, vice versa)
You may be interested in the work of Hannah Pickard, a philosopher now at Johns Hopkins, who has written a bit on "responsibility without blame". I found it's really helpful for some people who are struggling to make sense of the extent of their own responsibility for addictive behavior, or loved ones.
It's definitely fascinating to think about, though I always wish I didn't have to. I'm the sister of someone who reached end-stage alcoholism. At that stage, there are so many medical things (not to mention falls that cause brain injury) that could be affecting their agency. But there's no one out there helping family members get a grasp on that, especially if the person is an adult. (My issue with SMART recovery, which I do like, is that it assumes a much less intense level of addiction, and not someone on the verge of homelessness or death.)
So sorry to hear that Joy. I wonder if Carrie Wilkens and her ITC model could be helpful here. It is still very SMART based but as I understand it there's a fair amount of focus on the self-care aspects of things. Overall though I agree there are not enough resources for people whose loved ones are really struggling with high-severity issues.
Indeed the third way is vital. Middle path, transcending the limits of language (which in itself is an object of craving to maintain ourselves in the limitations of the ego). It was courageous from you to write that op-ed about the term "disease". One thing I know for sure is that when we get curious about our processes, we help our recovery because we become more at "-ease". And your shares here helps me nurture my curiosity for my own process. Thank you for this.
This is very kind of you to say, thanks for writing, I'm really glad it resonated!
Beautiful comment. Curiosity is so often underrated. Thanks for the reminder.
I think this is why 12-step did not jive with me. I interpreted the "give it all to the higher power" thing as totally relinquishing any possibility of me having a choice in continuing my addiction. I believe in god and a higher power, but I don't believe that god has control over me and my life.
Deep down, way way down, I knew I had the ability to choose to remain sober. It was extremely taxing and tiring at first to make that choice over and over, but it has gotten easier with time. It is both liberating and sad to realize I have choice and agency in this.
Personally, some of the most disempowering things I heard were when I went to (a very traditional) rehab. I hear you. Glad you found a way to get in touch with your self determination and put it to good use!
I agree with Ms Dorval, it takes courage to write about ideas we are yet to understand fully. Thank you for that.
The Center for Motivation and Change NYC helps people understand change through comparing and contrasting problematic behavior and the rewards of self respect (living our values) and connection with others. Perhaps, rather than self-control, we look to the science of motivation.
Also SMART Recovery is a personalized approach for people seeking recovery and the family and friends, who are in a powerful position to promote healthier choices.
Neither subscribe to addiction as a disease. Both focus on letting the person suffering with compulsive behaviors and the concerned significant others to identify their values and let those be their guide. I hope you’ll check them out.
Wonderful suggestions. I interviewed Carrie Wilkens of CMC on this substack not too long ago, precisely so she could describe her model for loved ones. https://carlerikfisher.substack.com/p/how-to-help-people-change-with-dr
SMART recovery is also wonderful https://smartrecovery.org/
I should have Tom Horvath (SMART'S president for many years) on the podcast as well.
I value your writing, Dr. Fisher, precisely because you are willing to spend time in the gray areas.
I don't have a formal education in addiction/recovery, AND I did not participate in 12-Step. Still, I've inserted myself into this field by creating a local community for sober women centered on positive psychology, mindfulness, and social health.
Your inquisitive voice has given me permission to keep digging into and sharing my investigation into my own journey of recovery/flourishing (sober almost 7 years).
It's challenging to be willing to stay in this curious, flexible, open space when I can feel a strong pull towards rigidity and FACTS. It feels vulnerable to be in this place of AND instead of OR.
But the former is a place of possibility and potential, and the latter is what turns some people away from benefitting from the joys of a thriving, sober lifestyle.
Thank you for generously sharing your thoughts!
Thanks so much for the note! Very glad you are here and working on this important field.
beautifully said. my own experience, and after reading a lot of quit lit, is that the experience for everyone is different, and that issues w whatever drug of choice are on a spectrum. Having agency is empowering, while keeping in mind that this is a high stakes game. thanks for writing.
Thanks Laurie! People have told me not to write about things like moderate drinking or agency too much, because its a high stakes game, but I think we have to be honest about where these things get messy. I try to strike a good balance.
which you did. I also appreciate that you are upfront about going through something yourself, which I recently did too. I read that the choice is part of a triangle, much like fire, which needs heat, fuel and oxygen. To give in to a craving you need opportunity, desire, and permission. and if you don't grant permission, the triangle collapses, much as a fire goes out when you remove one leg.
I like this perspective, as I have grappled with the "responsibility" (guilt?) my husband has had for his choices in addiction (now clean and sober for a year following double organ failure). I rail against people who blame him, but I am challenged in my own thinking by the fact that he did, finally, "decide" to change
But nuance is important: few people undrstand or appreciate it; and treatment methods that require nuanced assessment and lack a firm paradigm (so are harder to classify as "successful," for one thing).
The prevailing ethos of personal responsibility is also more complicated when a person considers the "reality" of choice vs. the impression of choice. Even you believe that you "chose" to walk to the liquor store. But we aren't aware of our subconscious-conscious interactions that fight battles we never get to see. (That is, if my very basic understanding of neurological function is, in fact, roughly correct. ) What other interactions, both internal and external, are moving your legs in the direction of a plastic gallon bottle of vodka? I don't know. And neither does anyone.
Finally, and connected, there is the subtext of free will. I dont mean the argument about predetermination or overarching intelligence or collective "soul." (Although, arguably, one could determine behaviors for a lifetime if s/he understood the gazillions of elemental "pings" that concur conflict, confine everything we think were deciding. What ping ping pinging is going on in our brains and bodies, nevermind outside ourselves?)
I am simply pointing out the likelihood that none of us has any idea if or how much our conscious selves decide. Or the mechanism by which we would sort out influence vs self. Nebulous at best, incomprehensible by most.
That said, I am also eager to find better ways of understanding addiction and applying treatment. The notion of a shift in beliefs seems like a fine place to start.
Thanks Tara, I'm glad the nuance is helpful in this case. To your point, I am interested in nuance to the extent it helps with real world problems.
I entirely agree that "choice" can be epiphenomenal and we can delude ourselves into thinking we have it (or exercise it) when we really don't. (And, vice versa)
You may be interested in the work of Hannah Pickard, a philosopher now at Johns Hopkins, who has written a bit on "responsibility without blame". I found it's really helpful for some people who are struggling to make sense of the extent of their own responsibility for addictive behavior, or loved ones.
It's definitely fascinating to think about, though I always wish I didn't have to. I'm the sister of someone who reached end-stage alcoholism. At that stage, there are so many medical things (not to mention falls that cause brain injury) that could be affecting their agency. But there's no one out there helping family members get a grasp on that, especially if the person is an adult. (My issue with SMART recovery, which I do like, is that it assumes a much less intense level of addiction, and not someone on the verge of homelessness or death.)
So sorry to hear that Joy. I wonder if Carrie Wilkens and her ITC model could be helpful here. It is still very SMART based but as I understand it there's a fair amount of focus on the self-care aspects of things. Overall though I agree there are not enough resources for people whose loved ones are really struggling with high-severity issues.
Thank you I’ll look into it. H