Joel Littlefield

Drug and alcohol addiction are a serious problem worth deep consideration for the well-being of our society, our families, and our souls. In my research I make no claim of superiority, I lay no condemnation on those who struggle with addiction, or guilt any who have close friends ravaged by substances. I only seek to bring into view an understanding that addiction is not what much of the world says it is today.

MY THESIS: Contrary to popular opinion, substance addiction is not a chronic disease for which there is no cure. It is a sin problem for which Jesus is the cure.

The Christian worldview makes sense of life. It sheds the best light on the social disorders that plague humanity. One of those plagues is addiction to chemical substances like drugs and alcohol. The Bible is not silent on the issue. It provides answers to why the world is broken, why people struggle in marriage, why natural disasters happen, why people hate and murder others, and believe it or not, why millions of men and women are addicted to drugs and alcohol to the point of slavery and ruin.

At the core of all human struggle is a three-letter word called sin. Sin is rebellion against God. Sin is willfulness. Ultimately, sin is a choice to serve someone or something other than the God who made us and can truly satisfy us. In Genesis Chapter 3 a scene unfolds that gives us a foundation for the topic of addiction, and why so many are gripped by it. There, we find Adam and Eve in the Garden of Eden with the Serpent. The Serpent lied and twisted God’s clear command, a command that, if followed, would have continued a harmonious relationship of eternal satisfaction between God and man. The consequence for disobeying God and eating the fruit from that tree was death and spiritual separation from God. Eve made the choice to listen to the Serpent instead. She gave the fruit to her husband, and both died. Every human since then has inherited their sin nature. This nature motivates and influences the thoughts and actions of every person not submitted to Christ. The Serpent’s lie to Eve, “You shall not surely die”, was designed to plant doubt of God in the heart and turn man’s attention to cheap substitutes that cannot fulfill. All sin can be boiled down to a cheap replacement of what God alone can provide for the human soul.

Not everyone sees the addiction issue in the same way. One popular view on the topic is called the disease model. I want to emphasize again that this view, though popular among many professionals and medical practitioners, is not the only view.  I do concede that drug and alcohol addiction in many cases manifests like a disease, but I believe there is a better response that simply calling it such. Alan Leshner is the director of the National Institute on Drug Abuse at the National Institutes of Health and is a leading voice for the disease model. In an article written for Issues In Science and Technology, Leshner writes:

A core concept that has been evolving with scientific advances over the past decade is that drug addiction is a brain disease that develops over time as a result of the initially voluntary behavior of using drugs. The consequence is virtually uncontrollable compulsive drug craving, seeking, and use that interferes with, if not destroys, an individual’s functioning in the family and in society. This medical condition demands formal treatment.

The idea that addiction begins with an initial voluntary behavior is one I agree with. Leshner goes on to say, “Over time the addict loses substantial control over his or her initially voluntary behavior, and it becomes compulsive. For many people, these behaviors are truly uncontrollable, just like the behavioral expression of any other brain disease.” Uncontrollable behavior is certainly a characteristic of addicts. But does that mean that it must be a disease? Leshner and others who hold to this model argue that the use of drugs for an addict can even be compared to the tremors of a Parkinson’s patient, or the mood changes of the clinically depressed. If this is an accurate comparison, then an addict cannot be responsible for his or her decisions to use drugs. This is the crux of the argument. People with diseases inevitably become patients. Patients need doctors. Doctors give medicine and treatments. Patients must listen to the professionals. If addiction is a brain disease like Parkinson’s, Alzheimer’s and other chronic conditions, then an addict should not expect a cure.

In His book, A Disorder of Choice, Harvard PHd, Gene Heyman explains how opponents to the choice model of addiction (the view I am arguing for) leave addicts little to no way out of their plight. He says that the majority of clinicians doom addicts to a lifetime of medical treatment, while calling any sort of cure an unrealistic hope. Heyman helps us to understand the hopelessness behind the disease model. Most proponents of this model probably do have good intentions, and want to help, but is it helping? Is it doing more harm than good? Perhaps this is a surprise to many, but statistics show that most addicts do quit, eventually. This a massive challenge to the popular view that addiction is a chronic disease.

One reason why the disease model has so much traction today is because the brain does undergo physical change under the influence of drugs and alcohol. The human brain learns through repetition. When a person uses a drug or drinks alcohol for the first time the brain responds by learning that the pleasure, the relief of pain, the ecstasy, or the numbing it was seeking can be found in an instant. The craving that was there is now satisfied, but only temporarily. Thus, the unending cycle of an addict seeking his or her “fix”. As time goes on, the brain physically changes. Mark Lewis, a neuroscientist, and author of, The Biology of Desire, explains the disease model this way. “In its present-day form, the disease model of addiction asserts that addiction is a chronic, relapsing brain disease. This disease is evidenced by changes in the brain, especially alterations in the striatum, brought about by the repeated uptake of dopamine in response to drugs and other substances.” Dopamine is the chemical sent to the brain every time we experience something pleasurable. Drugs trick the brain to believe that the experience is worth remembering, and the user is consequently rewired to seek out that experience repeatedly.

Lewis goes on to explain that many call addiction a disease because of, “changes in the prefrontal cortex, where regions responsible for cognitive control become partially disconnected from the striatum and sometimes lose a portion of their synapses as the addiction progresses. These are big changes. They can’t be brushed aside.” But I make no attempt to brush this aside. Neither does Lewis. The changes are real. And these changes are the entire basis for which scientists and doctors hold to the disease model. This is an important distinction between the two views. Does brain change, though, equal disease when research has shown that literally everything changes the brain? From the time the brain is developed in the womb the brain begins to learn, and thus, to change. Any experience that we are motivated to pursue is a literal dopamine inducer. When you visit your favorite vacation destination, fall in love, or cheer for your winning team, your brain is learning, and changing. But these are not diseases. Again, the disease model is based primarily on this reasoning, that the brain undergoes change. 

Lewis claims, and I agree, that the disease model is only useful in helping addicts escape the stigma of the lifestyle, as well as having some way of explaining the difficulty of quitting. But as we can see, a person can repeatedly pursue any number of attractive things and undergo similar brain changes. Studies also show that when an addict quits and then begins to make better decisions over a long period of time, the brain changes back to normal. A typical brain disease produces physiological malfunction, something we do not see with addiction. We see brain change, but I believe that is not proof enough to call it a disease.  

As Christians we have a higher authority and a clearer lens through which to look at life and its problems; the Word of God. Scripture is the only system that will never need improvement, which means that when we look to the Bible to understand the brokenness that addiction is, we can expect answers from God that are both helpful and applicable. The choice model of addiction that I am arguing for is based on the biblical doctrine of sin, that all humans are prone to self-destructive choices because we are born, in a sense, with chains on. Sin is a word that is despised in our culture, even by some professing believers. We do not want our choices attached to a word that brings grave consequences with it, especially if those consequences are directly from God.

Family members and friends of addicts have seen so many disastrous decisions made, decisions that have cost people their lives, consequences that do not seem to sway the user from abusing, that calling it a sin seems insensitive and harsh. The alternative, though, to call it a disease of the brain for which there is no cure at all, is a damning alternative. The choice model (or sin model) is not saying that drug addicts and alcoholics are worse that everyone else. Addiction is only one manifestation of the broken world we live in, and the stigma that follows those who are bound to it is real. I am not a proponent of shaming. But I do believe that avoiding the truth will not do anyone any good. Sin is the root cause of all destructive human behavior. If addicts are to find freedom, we should not look primarily to a model that is self-admittedly unable to offer that freedom.

The choice model is a better alternative to the disease model and brings us much closer to a biblical world view. What is assumed about the disease model is that humans do not make self-destructive choices, and because addicts do exactly that, it must be a disease. Drug users and alcoholics are told that in their addictive state their choices are compulsive and involuntary, and because brain diseases like Parkinson’s and others have compulsive and involuntary symptoms, they, too, must have a disease. Alan Leshner argues that “we are going to have to rise above moral outrage that addicts have ‘done it to themselves’ and develop strategies that are as sophisticated and as complex as the problem itself. Whether addicts are “victims” or not, once addicted they must be seen as ‘brain disease patients.’” Leshner seems to believe that the solution to addiction is to ignore the core problem that causes a person to enter a life of drugs in the first place, then prescribe them treatment.

Ed Welch, author of Addiction: A Banquet in the Grave, argues that “Even among Christians, sin is not always seen as our deepest or primary problem.” He continues, “If sin is not our core problem, the gospel itself – the thing of first importance – is marginalized.” Welch would wholeheartedly disagree with Leshner and others on the disease model. He points out that many well-meaning Christians who would generally hold to the authority of Scripture have abandoned this conviction. This is due partly because these same people believe that Scripture misses the modern diagnoses on drug and alcohol users. After all, the disease-model data was not available in biblical times, so we must listen to modern science, right? Wrong. Drunkenness dates all the way back to Genesis when Noah came off the Ark and drank so much wine that he ended up naked in his tent, having done who knows what. Throughout Scripture, drunkenness is never associated with disease, but always sin. It is always a moral failure for which the person is fully culpable. Proverbs 29 contains a surprising description of a drunkard. Solomon describes a person that “lingers over wine”. He has blood-shot eyes, needless bruises, sorrow and woe. The picture is painted so clearly with this verse, “When will I wake up so I can find another drink?” Is the Bible unfamiliar with drunkenness? Clearly not.

Still, one might argue that this is not the same as alcoholism, the modern “disease” we know today, but there is no reason to conclude there is any difference between what we call an alcoholic, and what many throughout history referred to as a drunkard. “Is there a difference between a drunkard and an alcoholic? Scientifically, no. There are no medical tests or brain scans that distinguish them, and their behaviors are identical”, confirms Welsh. The New Testament goes on in 1 Corinthians 5:11 to list drunkenness (the sin of the drunkard) along with the sexually immoral and greedy. The Bible does not call these diseases, but sins. If the Bible cannot speak sufficiently on this issue because that data was not available to Moses, Jesus or Paul, then where do we draw the line? Can the bible speak accurately into our culture on issues of sexuality, gluttony, and depression, even though the “science” has produced more data since then? The answer is yes. All immorality is a result of the sinful human nature. Until a person comes into a loving relationship with God, he or she will seek to fill the void with all manner of unworthy substitutes. This leads to what Scripture calls, slavery to sin, and is where we finally begin to find a lasting answer for the problem of addiction.

This disease model claims to give addicts the only real answer for uncontrollable and compulsive choice. These are false claims. Scriptures teaches that destructive behaviors such as sexual immorality, lust, greed, and drunkenness begin in the heart. Everyone is born with the capacity for these behaviors. Sin is so comprehensively a part fallen humanity, and yet the secular world, and even some Christians, refuse to associate addictive behaviors with the notion of sin. The Apostle Paul, in Romans 7:18-20 says, For I know that nothing good dwells in me, that is, in my flesh. For I have the desire to do what is right, but not the ability to carry it out. For I do not do the good I want, but the evil I do not want is what I keep on doing. Now if I do what I do not want, it is no longer I who do it, but sin that dwells within me. Paul’s sinful nature was waging war against him. It seemed uncontrollable at times. This is not far from the nature of addiction itself. In Chapter 6 of Romans Paul tells us that sin reigns in the mortal bodies of men and women. It is like a slave master ordering its subject around wherever it wishes, and the only way out is to be set free. For just as you once presented your members as slaves to impurity and to lawlessness leading to more lawlessness, so now present your members as slaves to righteousness leading to sanctification.

Not every drink is an act of lawlessness. Drug users do not usually plan on becoming enslaved. Depending on the person, the motives and other social influences, the first use can turn into a second, a third, a fourth, and then eventually on to habitual using and a chemical addiction that cannot be shaken by shear willpower. This is when the disease model takes its full swing. The user cannot say no to drugs anymore, so they sat it must be a disease. The proper recourse may very well be to medically treat a person through detoxification in order to break chemical dependence, but as soon as that is broken, then what?

There are some ways in which sin is like a disease. It ruins. It rots. It creates dependency. It seems beyond our control. But the most significant way that it is not like a disease is that, though it affects the physical body we live in, it is first a matter of the heart: a spiritual problem. The slavery of addiction is one manifestation of humanity’s longing for God and his eternal love. The cravings, the desperation, the need for fulfillment and satisfaction…they are all part of what make us human. God has designed us for relationship with Him. The addict who quits after years of ruin to himself and his surroundings usually does so because the damage becomes too much. Too many lost jobs. Too many broken relationships. Too many months away from the kids he loves. Eventually the bottom is hit and there is only up. This is precisely why faith-based programs are the among the most successful for full recovery and freedom because it is at this place of rock bottom that one is introduced to Jesus Christ. The desperately sinful person who surrenders to Jesus Christ as Lord is given a brand-new heart. With this new heart comes new desires and affections. Instead of idols and worthless substitutions for God, the truth is realized, and freedom found. Instead of unrighteousness being the slave-master, the Master is Christ, who came to earth in the form of a man to suffer and die for the enslaved and reconcile them to God forever. Uncontrollable desire does not get the final word in God’s economy, but people need to be reeducated as to where the battle line needs to be drawn. Welch puts it so eloquently. “The only possible attitude toward out-of-control desire is a declaration of all-out war.” The war on drugs is not won by studying the brain and diagnosing patient after patient with chronic illness. It is won when the faith of the addict is made alive, and new life is given, and sins are forgiven, and Jesus takes becomes a forever-resident in the heart.

CONCLUSION

As you can see from the product of my research this is a vast issue. I admit have merely scratched the surface. I am sure I have not answered all the questions. I have simply sought to adequately show you that calling addiction a disease is largely unhelpful to the cause. Proponents of the disease model of addiction spend millions of dollars a year on researching the brain, hospitalizing and institutionalizing patients, all the while admitting that there is no cure or end. I believe Christ offers hope, and the Bible rejects the notion that addicts cannot become free; completely free. Though brain-change is a real result of drug use, there was an initial choice of the heart to take the drug. Research shows that better choices can be made, and the brain can reform. In conclusion, I am convinced that the most helpful approach is to concede that addiction may look like a disease at times, may need medical intervention in very serious cases, but freedom can be found through a relationship with God who gives a new heart and new desires to those who worship Him over every substitute this world has to offer.