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.