Seeing the Problem Clearly
“Don’t sit so close to the TV, Greg!” It seemed like my parents said that daily. I think Greg was 2 or 3 at the time. He would start on the couch near the rest of us, but then move closer and closer until he was just inches from the screen. No matter how many times my parents told him to back up, he kept returning to his spot. This went on for months. Advance and retreat. Over and over.
My parents thought it was a straightforward behavioral problem. A matter of conditioning. He was at that age when children begin to assert their independence. Greg simply could not understand that it was bad for his young eyes to sit only inches from the screen. They needed to break him of the habit. It was for his own good.
Thirty some years later, I am still amused that it took my parents several months to figure out the real problem, despite both being doctors. Greg was not trying to establish his freedom through this small act of defiance. He was just trying to see the screen. The problem was Greg’s vision. Once he came home from the optometrist with his arrestingly thick first pair of glasses, he never sat close to the TV again.
I did not really understand addiction before we lost Greg to it. And I know that in some sense I still cannot fully understand the disease because I have never struggled with it myself. But I now appreciate that understanding addiction requires distinguishing the disease from its effects. The effects receive the most attention, and are often confused for the problem. People suffering from addiction disease will lie, steal, and do whatever they can to continue using. Their behavior often hurts and disappoints those who love them the most. Time and time again. The anger, sadness and frustration that naturally follow often obscure the realities that the person is suffering from a complex and unforgiving disease, and that the destructive behaviors are its effects – not moral failings or lapses in judgment. Addiction is a neurochemical hijacking of the brain that rewrites and rewires an individual’s desires, values and impulse control. Expecting people suffering from it to simply summon the “will power” to stop their destructive behaviors is as futile and misdirected as it was for my parents to tell Greg to back away from the TV. Or telling someone suffering from Alzheimer’s to try harder to remember. If we do not understand the real problem, we are certain to fail in our efforts to solve it.
Improving our understanding of addiction disease at a societal level is essential to ensuring that people suffering from it receive the treatment and the support they need. Laws and regulations providing access to effective, evidence-based treatment, medication and mental health care are fueled by public sentiment and support. And improved understanding of addiction disease is urgently needed to reduce – and eventually erase – the stigma and shame that far too often deter people from getting the help they need, or from getting it soon enough. Stigma and shame are the devastating byproducts of misunderstanding, misinformation and ignorance that cause people to view addiction as a behavioral problem instead of a medical disease born of genetic factors and biochemical changes like Alzheimer’s, diabetes or any of the myriad other pathologies that are never confused for moral defects. The sooner we extinguish the baseless, dated and harmful views about addiction and cultivate a sound, evidence-based understanding of the disease in our public discourse and policy, the sooner we will be able to focus resources and attention on solving the right problem. Only then will we achieve the common goals of reducing the destructive behaviors and needless suffering caused by addiction.
DCM
8.22.19