This is perhaps the most elusive question posed when it comes to addiction. The answer is just as elusive — fleeting, incomprehensible, and illusory, like a ghost amidst shadows in the night. When we ask the question, we are baffled as to why those addicted to particular substances or behaviors continue to use or engage — regardless of the negative physical, psychological, and social effects. We cannot seem to intricately understand why some people decide to walk right off the cantilever of life — falling into a seemingly inescapable abyss. The question is definitely not an easy one to answer — even with advancements in addiction research. The elusive nature of the question is fueled by the complexity of human beings — within sociocultural, psychological, and corporeal contexts — where addiction’s causes and geneses are enshrouded in layers of obscurity and inconclusiveness. Regardless, the question does reveal and unmask how our society conceptualizes and approaches addiction.
Re-examining needs and wants
When we ask the why-can’t-they-stop question, what does that really mean to us and to those with an addiction? Manifestly, we — as loved ones, friends, colleagues, authorities, and community members — want those in the midst of addiction to stop for a variety of reasons: they are hurting themselves, hurting loved ones, compromising their career, etc. Yet, do we ever think that latently, we want them to stop because that is what we want? Yes, that is right — we want them to stop.
When we are pondering why an individual cannot stop their addiction, we are not always thinking about what they want. We cannot always comprehend why they need to use or engage. In a contradictory fashion, we are imposing our own will. We would very much prefer that they stop immediately. In reality, many people who live with addiction cannot stop cold turkey; but, if they do stop, may experience nonlinear occurrences of relapse and remission.
The elusive question blatantly questions the actual drug use and/or destructive, habitual behavior. When we ponder why some people cannot overcome their addiction, a lot of our focus is on the substances used or behaviors displayed such as the use of heroin, cocaine, painkillers, alcohol, or involvement in gambling to name a few. However, this can be problematic as we tend to miss out on what I believe to be the core of addiction: fulfilling a deep, unmet need.
At the epicenter of addiction, this deep, unmet need, which can be a source of pain, frustration, and anxiety cannot be reduced to a single causal factor. Instead, addiction is nourished by an epicenter of pain and anxiety, grounded through underlying biological hardware, intensified along learning and developmental trajectories, and moulded by means of sociocultural forces. Therefore, those with addictions, despite the negative consequences — such as familial/relationship problems, financial risks, physical health issues — continue to use to fulfill their disquieted psyches. This is the oxymoron of addiction: an individual besieged by self-destruction, yet temporarily emancipated and self-fulfilled.
Dr. Stanton Peele, an addiction researcher, analogously uses the word ecology to refer to the idea that a particular drug or behavior becomes part of the person’s immediate physical and psychological environment. Essentially, the person requires the substance or behavior to function and fulfill the unmet need in the same way organisms interact within a particular ecological sphere. Thus, addiction presents itself as the self-sustainability of the person, but also the inevitable self-destruction and implosion of that person.
Further, the conventional, dominant addiction paradigm — the disease theory — asserts that addiction is a chronic brain disease. Addiction becomes a condition which arises from the interplay of the underlying biological structures and the substances/behaviors. Therefore, within this model, addiction becomes a condition to cure — one that can be managed within medicine’s supervision and overcome with persistent advancements in medical interventions.
Contrarily, detractors of the disease model would question its efficacy and ability to fully and wholly address addiction. The model relies heavily on biochemical and physiological processes and changes, but lacks the incorporation of humanistic components of the being (meanings, values, individual attributes, emotions) and the sociocultural forces present. This significantly contributes to its inability to truly understand how to overcome addiction.
As a society, when a condition is labelled as a disease by the scientific community, we expect a cure or at least advancements in the quest for a cure. Unfortunately, for addiction, there is no cure nor effective treatment. This leads me to postulate that the why-can’t-they-stop question is also more than a question: it is a plea for help — mixed with a handful of hope and a dash of optimism, topped off with a generous sprinkling of trepidation. The inability of conventional addiction regimes to effectively manage or cure addiction contributes to this fear.
If addiction can evade medicine and its evidence-based treatment approaches, where do we go from here?
In this piece, it is suggestive that the why-can’t-they-stop question does not prod at the core of addiction as it does not truly focus on the needs of those addicted. Thus, we must ask more direct, probing questions to capture the complex, multifaceted nature of addiction — pondering in a fashion that addresses the following: why the pain? Why the hurt? What does this person need that they are missing? The substance or behavior is a substitute for an unmet need in the psyche. The substance or behavior temporarily fills this void — this intrapsychic imbalance and impoverishment.
Conflict, struggle, and scarcity — in terms of not always having everything we need or desire — are evident throughout our entire lives. Addiction is a reality for millions of people in North America and affects their families and communities. Thus, we must learn to accept and adapt to addiction as a part of life. Acceptance can be mistaken for surrender, submission, and defeat. On the other hand, when I say accept addiction (beyond the submissive connotation), I mean acknowledging and working towards understanding the condition. That does not mean we have to submit to or allow addiction to negatively impact individuals’ lives or our own; instead, it means knowing there will be highs and lows, ups and downs, triumphs and setbacks.
Accepting addiction as part of life also means viewing it on a continuum, where the continuum represents life. The why-can’t-they-just-stop question is a bit naïve as sometimes people think that once an individual stops their addiction, life goes back to normal. However, many times addiction reappears and disappears in the form of relapses and remissions. Recovery and remission can be non-linear lifelong processes filled with curves, twists, turns, clefts, and breaks. Although we want the old person back, they will probably never be the same again. As Professor Marc Lewis, an addiction researcher and neuroscientist, asserts, the brain is not elastic. It does not go back to its original form while recovering from addiction. Instead, the brain’s neuroplasticity allows it to change and mould overtime. Therefore, as the professor points out, addiction is about continuous growth and constant development. Yet, I extrapolate this view and point out that addiction is about growth and constant development not only within those with addictions, but also within ourselves, our institutions, and our society.
Lewis, M. (2015). Recovery (Like Addiction) Relies on Neuroplasticity. Retrieved from https://www.psychologytoday.com/blog/addicted-brains/201512/recovery-addiction-relies-neuroplasticity.