Jacob Lawrence, "Two People in a Bar" (1941)
Jacob Lawrence, Two People in a Bar (1941)
Can a Game Be Literature?

Mark's Pages

June 1, 2013:

Addiction is a medical, not a moral issue.

Addiction is a brain disease in which neurotransmitters in the dopamine system are compromised or destroyed. As a convenient shorthand you can call it brain damage.

Many are born genetically disposed to the disease, just as others are disposed to hypertension, depression, or cancer. The anecdotal observation that alcoholism runs in families is scientifically correct.

It makes no more sense to castigate addicts than to belittle diabetics.

This is often difficult for addicts and their families to understand. Because the symptoms of dopamine can involve horrific behaviors, it's easy for observers and addicts themselves to interpret these behaviors in moralistic terms. And so the misinformed say: addicts are weak-willed, self-indulgent, rebellious, or more simply, bad people.

In American culture this tendency to blame the victim is reinforced by the lingering legacy of Puritanism. For the Puritans, physical symptoms signified spiritual realities. A cold meant you needed to get right with God. In its way and for different purpose, A.A. has taken this old Puritan idea as its mantra. It's endemic in American culture.

But, it's false. The disease is material, not spiritual. It indicates broken neuropathology in the addict's brain, nothing more.

This means there's real reason for hope.

It's likely that effective treatment will be available soon, in the coming few years. For example, it might become possible to re-regulate the compromised dopamine system analogously to the way SSRIs re-regulate the serotonin system. Something similar to this is already available today for opiate addiction. When effective treatments arrive for alcoholism they'll revolutionize the lives of tens of millions.

Most hopefully of all, science has demonstrated that the brain can recover from the damage of addiction if sobriety can be maintained for a long enough time. The longer you're clean, the more normal your brain becomes. This is a remarkable reason for optimism.

Stay alive.
Keep hope.
Get into treatment.
Be as healthy as you can.

The nightmare will one day be over.