The fact is that addiction, by definition, is a psychiatric, psychological or mental disorder first, and a biological or physiological illness second. The recovery movement and "Dr. Drew's" own dogmatic conceptualization of addiction as a primarily biologically-based disease, is a significant part of the problem he and others have in effectively treating such patients. Addiction, be it to alcohol, cannabis, sex or porno, is not a biological disease like diabetes or leukemia. Patients may, in some cases, inherit a genetic, temperamental predisposition to the tendencies that make one susceptible to addiction. But that is not what makes them an addict. More than anything else, addiction is about denial of reality. It is, like depression, nonetheless a debilitating and potentially deadly psychiatric syndrome. People do suffer and die from addiction. And that these patients are severely ill, especially in the advanced stages of addiction and during withdrawal, cannot be denied. But that does not make addiction a biological "disease" per se. For, as AA has long rightly recognized thanks to psychiatrist Carl Jung's influence on its founder, alcoholism and other addictions are at least as much sicknesses of the soul, psyche or spirit as of the physical body and brain.
Psychologically speaking, addiction is all about escapism. Avoidance. Denial. Addicts run from reality, and, in some cases, have been running all their lives. The addict cannot tolerate reality and its vicissitudes. Neither internal reality nor external reality. They find reality repugnant, uncomfortable, overwhelming, and prefer, like the psychotic, withdrawal into fantasy, bliss or oblivion over reality. They seek constantly to alter subjective and objective reality to their own liking. For one thing, reality--the existential facts of life--can be both painful and anxiety-provoking. Like all of us, addicts don't like confronting pain or feeling anxiety. That's human nature and comports with Freud's "pleasure principle": we all tend, whenever possible, to avoid pain and seek pleasure. Addicts prefer the pleasure of intoxication, the bliss of oblivion to the suffering, banality, ordinariness and difficulty of mundane day to day reality. Of course. Reality inevitably includes suffering, pain, loss. Reality entails consciously acknowledging, not just intellectually but emotionally, both what was hurtfully done to us in the past (by parents, peers or others) and what we have hurtfully done to others. Who wants to experience (or re-experience) that? But the problem is that to avoid this reality the addict has to keep getting high, because these "demons" never go away. They're always there, lurking, waiting to bite them in the ass as soon as they start coming down. And what goes up must always come down. So this is the psychological problem of addiction. And when it (consciousness) comes crashing back to earth, reality and withdrawal from fantasy painfully set in. The psychological and emotional demons and demands of reality return with a vengeance. Reality cannot be run from indefinitely. A major part of addiction treatment entails acknowledging, confronting and experiencing reality. In most cases, the addiction has permitted the patient to keep outer reality and his or her inner demons at bay. Sobriety forces the addict to face reality, motivating the addict to want to find some way to avoid or alter it again. Breaking this vicious, sometimes fatal cycle of avoidance of inner and outer reality is the key to treatment. This holds true not only for the addicted patient, but, to some extent, for allpsychotherapy patients. [And, I would add, for all sinners - see my comments below.]
So many addicts (likely including some of Dr. Pinsky's patients) suffer from undiagnosed major mental disorders and serious personality disorders. Their chronic substance abuse and addictive behavior is symptomatic of these masked mental health issues--while at the same time, obviously contributing to and exacerbating them. The majority of such patients belong in and could probably benefit from what is called a"dual diagnosis" program, which is specially designed to address both their serious mental health issues and the co-occurring substance abuse or dependence simultaneously. To his credit, Dr. Pinsky seems to acknowledge this fact, often focusing in his televised sessions with patients on any history of trauma, especially physical, emotional and sexual abuse during childhood. And he occasionally brings in psychiatrists, psychologists and other mental health professionals to work with his patients. While it is clinically true in general that, in most cases, the severe substance abuse itself must first be addressed, detoxification completed, and sobriety established before meaningful psychotherapy for such childhood or other trauma can proceed in earnest, the reality is that without the proper therapeutic structure and support, this simply won't happen. The patient, as soon as he or she starts feeling stressed, sad, lonely, angry or anxious, will simply return to the only way they know to cope and comfort themselves: by doing drugs or engaging in compulsive, self-destructive, "acting-out" behavior designed to avoid becoming more conscious of reality. Unconsciousness is the primary culprit in addiction. This is why intensive, ongoing, real psychotherapy needs to be an integral part of any effective treatment process for addiction.
The antidote to addiction is learning to tolerate reality. Little by little. That is what sobriety really is. This is what the recovering addict needs the most assistance with: soberly dealing with inner and outer reality. And part of existential reality involves personal responsibility. We are responsible for consciously facing and dealing with our inner demons as constructively as possible. And we are responsible for dealing maturely with the outer world. It is clear that, especially for so-called celebrities sheltered from reality by fame and money, sobriety ( be it from alcohol or other substance abuse or compulsive sexual behavior) demands accepting the same reality we all deal with every day: being responsible for ourselves; making choices that are in our own best interest; tolerating tedium, frustration, anxiety and life's inevitable physical and emotional suffering. Addiction is the habitual avoidance of reality. What the addict needs to discover is that reality is bigger than we are. [The second of the Twelve Steps: Came to believe that a Power greater than ourselves could restore us to sanity.] A devastating blow to one's narcissistic grandiosity, to be sure. But the beginning of healing wisdom and willingness to accept and embrace reality-including both its negative and positive aspects--on its own terms.
Now if God is the ultimate Reality and the source of all that is real, then our addictions and our sins are motivated, psychologically speaking, in an attempt to play God, to create a substitute controllable reality that we can manage. The motivation, as I wrote a few days ago, is Assuaging Worldly Fears by Means of Egotistical Control. This is a fancy way of saying we prefer our own Unreality to God's Reality.
While this sounds a bit overblown, realize for a moment that we see this in ourselves and others all over, all the time. Bad liturgical music and suburban Masses that frustrate any true worship? That's sinners creating an Unreality that denies God. Sex that's deliberately sterile, or even homosexual or solo-sexual? That's another example of elevating a controlled and contrived Unreal over a frightening and challenging Real - of putting man's sick agenda above God's healthy and ever-living one. Any "-aholism" that enslaves us - workaholism, alcoholism, control-freak-aholism - all of these are our attempts to shy away from God the Real in favor of Me the Unreal.
And as a friend of mine who was a recovering addict used to say of any such behavior, "How's that workin' for you?"
If we answer, "Terribly," we're on the road to Repentance, Reform and Recovery.