The Disease Concept

Dave was an obnoxious, muscular, prescription benzo addict. They gave him a Valium taper for his first 7 days in treatment. And on day 8, when he didn’t get any more Valium, he threatened to leave, punched a hole in the wall, and called the nurse “a cunt”.

I was speaking to him in my office after this latest outburst. He had his head in his hands. He was hysterical.

Why do I want Valium so much??

Because it feels good.

Why do I act like this??

To try to get more Valium.

It’s this fucking disease! I hate it!

What disease?

……

At the rehab we’re constantly told addiction is a disease. I’ve sat through countless training videos where some neuroscientist gives a lecture or some drug expert shows diagrams of the brain and explains the physiology of pleasure centers, dopamine receptors and the frontal cortex. No one understands a fucking thing. But I look around me and see everybody nodding in agreement.

The part of these videos that’s easiest to follow is when they show sections of the brain light up when drugs are ingested. Well, I could’ve told you that. When I would shoot a speedball my whole body would light up. The entire world lit up!

After these trainings I walk the floor and hear staff eagerly trying to explain what they’ve just learned to the patients. They stutter, stammer, and mumble their way through scientific explanations with lots of “ums” and “likes” and a couple of complicated words thrown in and the clients swallow it whole as if it was another detox medication.

Their behavior and the destruction it’s caused suddenly has an explanation. They’re sick! They’ve contracted a disease, through no fault of their own, like lupus. They’ve gone from predators to victims in the time it takes to watch a video on YouTube.

This certainly makes them feel better. And more eager to take medicine. After all, diseases are cured or managed with medicine. It also makes them more comfortable with continuing their behavior. It’s this insidious disease that makes me do this while the real me lays buried underneath somewhere, deep down inside, helpless to get out. Shame, guilt, and responsibility have lessened or vanished all together.

And I’ve noticed there never seems to be any excuses for good behavior. When I see a patient do something kind and generous and I commend them on it, no one has ever turned to me and said, “Well my father was a kind generous person. I just inherited it. I had no choice”. No, the good actions they take full credit for while the bad actions are the fault of some force not seen.

Excusing one’s own rotten behavior may be a practice older than getting high. And I don’t see either going away anytime soon.

I don’t mention the disease concept when talking to clients. First of all, I don’t know what the hell I’m talking about and secondly I don’t really believe it. I don’t actively tell them I don’t believe it but when pushed I relate my own experience…

I tell them I have shame and guilt about my past because my past was shameful and my behavior guilty. I tell them it’s painful to look at your character honestly and take full responsibility for your actions. But when you do you will no longer be a victim or slave to some mysterious illness or disease. The excuses you hear for your behavior whether they be from family, the medical community, society at large, or yourself will suddenly sound like meaningless gibberish. And you’ll be free. Free to become the person you wish to be.

Hardly anyone listens. And even less agree.

In my 8 years at the rehab, I don’t know if I’ve done any good or honestly helped a soul. I’m told I have. But I don’t know. I’ve watched over a hundred people die. Thousands ruin their lives and mutilate the ones they love. I’ve spent over ten thousand hours talking to these people. I’m not sure one minute of it has made a bit of difference. It’s quite possible that all of it has fallen on deaf ears.

The one thing I can stand on, that makes it bearable to look in the mirror, is that I’ve told them the truth.

…….

Dave finally calmed down. The following day he punched a client he thought was staring at him. Before he was administratively discharged he told me he couldn’t wait to get home to take “a fistful of Xanax”. When I dropped him off at the bus station he spit on my car and told me to go fuck myself.

It’s some disease.