PART III: The Nature of the Illness

Thus far we have looked at the general makings of a health crisis as well as a lead cause of the opioid epidemic. In this third part of the series, the intention is to briefly explore the nature of the disease: to explore the states of mind that are predictable and consistent across all sufferers, as well as what similarities are observed in cases that have successfully recovered.

Drug and alcohol addiction are social problems that feed into parallel issues of crime, poverty, and welfare. These concerns have proved intractable and thus far not well understood beyond basic descriptions.  By the term “addiction” we mean clinical addiction using the classic definition where there is a continued dependence on drugs or alcohol despite serious consequences.  Traditionally, societies throughout history have “treated” social problems by issuing legislative and corrective action, waging wars, passing laws, and demanding prohibitions, only to see the problems persist, recur, or worsen despite the attention and action. With careful attention and knowledge of historical outcomes, it becomes obvious that conditions of social conflict do not improve until the underlying etiology has been identified, exposed, and “healed.”

A lot has been written about this subject, particularly in recent years.  However, a considerable amount of it may be misguided, leading to ill-advised actions by the misinformed. This can create more problems than the efforts (or lack thereof) of the uninformed. There is a theory known as the law of sensitive dependence on initial conditions, meaning that a slight variation, if continued over thousands of iterations, will lead to major changes in outcome. For example, a ship with a bearing just one degree off compass will eventually find itself very far off course. This analogy could be applied to the current day efforts to identify, fix, and even prevent the development and consequences of chemical addictions. Strong public efforts and political policy changes are required to correct the problem, however, well intentioned as they may be, if the bearing is off compass, we would expect to find ourselves over time very far off course.  

Addiction is a progressively fatal and devastating disease.  It is the respecter of no one. But why have medical efforts evoked virtually no improvement in prognosis?  What is it that makes this area of behavioral health so complex and unresponsive to heavily researched and highly funded efforts?

Prior to the 1930’s, recovery from alcoholism or drug addiction was effectively nonexistent.  It is considered one of very few progressive illnesses that made virtually no progress over thousands of years and continued to baffle science and religion. In the early-mid 20th century, the most acclaimed and well-respected psychiatrist was the Swiss physician, Dr. Carl Jung. Jung focused a great deal of effort and study into this area but eventually famously admitted that apart from a few seemingly spontaneous and dramatic “religious conversions” he had read about, he had never in his own experience witnessed a true recovery. Shortly after that time, however, when groups of sufferers began coming together to help one another, many have recovered. Through witnessing recovery in another, a vision could now be implanted in the man still suffering.  If one sees his own condition as hopeless, and is provided no evidence in the world to suggest otherwise, it is very difficult to rise above this belief in one’s mind.  And as is suggested by the law of attraction and other universal edicts, if one is convinced a situation is hopeless, he is usually right. 

 For example, before 1954, it was generally accepted that a human being would never break the four minute mile mark; human beings were simply not designed to run any faster than that. For centuries many attempted, and many failed. In 1954, Roger Bannister became the first man to eclipse this milestone and in doing so, breaking through the paradigm that it could not be done. Surely this would be a record that would hold up forever.  Less than three weeks later, his time was broken by another runner. 

Once the belief that it could not be done had been shattered, this mental obstacle was pushed aside, permitting many more to accomplish the same.  A very similar phenomenon was seen after the first successful ascent of Mount Everest. This is also why it is pointless to compare athletic greatness across eras.  We can compare talent or ability, but Roger Bannister’s greatness was not just in breaking the record, but in shattering the current paradigm of human possibility. There are hardly, if any, individual human accomplishments in sports history that are not shortly thereafter eclipsed.  Contrast this to athletic performance in animal competition. What Secretariat accomplished in 1973 has stood up for nearly half a century. In fact, no horse has been even close. If horses were influenced by the mind to the degree that a human runner is, the track time would likely have been beaten a short time later. 

From a pragmatic viewpoint, the effect that a successful recovery will have on a social organization or the society as a whole is immense. It can be measured not merely in the relief of suffering, but economically in the savings of billions of dollars. Hospital admissions, healthcare costs, absenteeism, car accidents, auto insurance rates, welfare, etc. are all unbelievable collective expenses and are hugely ameliorated by the successful recovery of the individual.

Generally speaking, mental and physical health depend upon the positive attitudes of the individual, whereas poor health - both physical and mental - is often associated with negative attitudes like resentment, jealousy, self-pity, anxiety, etc. Even treatment - which is the single most costly aspect of the addiction epidemic - is destined to fail unless the basic attitude that is causing the dysfunction is corrected. This explains why treatment facilities are so averse to releasing a patient right back into his previous environment. Whether or not one is living with or among others who have addictive tendencies of their own makes little difference.  A household which harbors such negative attitudes as listed above is an unbelievably difficult environment for one to begin recovery.  One does not get beyond pessimism by associating with cynics; the age-old truism that you are defined by the company you keep has some clinical basis.  

The term “family illness” is widely accepted by professionals who work in the field and deeply understood by family and loved ones with enough honesty and courage to see how they themselves fit into the clinical picture.  The energy and attitudes one gives off can be thought of as an invisible element which becomes a constituent of the very air one breathes.  Therefore, just as one breathes in hydrogen, nitrogen, and oxygen, the energy from an individual becomes a part of the very life force that permeates and sweeps through the body. Everyone has known individuals who seem to be floating in a bubble of toxic energy; they simply attract conflict at every turn. These are individuals who will inevitably destroy every close relationship around them while being completely unaware of the pattern. Through every form of rationalization and self-justification, even if made aware of the trend, will be entirely convinced that he/she has not once been at fault. A discussion into the neuroses that are at play here is well beyond the scope of this article, however its identification is an important one. Many recovering substance abusers were once themselves and/or closely associated with individuals of this type.  The discipline and courage required to identify and distance oneself from these types of relationships can prove paramount to the prognosis of recovery. 

Before we continue on, let’s expand on the belief in the power of the mind, and how it might relate to the field of behavioral health. It is generally held by traditional medicine that stress is the cause of many human disorders and illnesses. The problem with this diagnosis is that it does not accurately address the source of the stress. It looks to blame external circumstances, without realizing that all stress is internally generated by one’s attitudes.  It is not the events of one’s life, but the manner in which one reacts to them that triggers the symptoms of stress. For example, one might consider divorce to be one of the most stressful events one could experience. However, what might be an agonizingly traumatic experience for one, could be a liberating blessing for another. So it is not the event itself, rather one’s reaction to the event that is of consequence. It is the persistence and repetition of the stimulus (a thought) that, through the law of sensitive dependence on initial conditions, results in the observable disease process once the pernicious thought is repeated over and over and over again.

The mind’s very nature is to convince us that its unique view of experience is the genuine thing. Most individuals secretly feel that their experience of the world is the one true, accurate, and reliable one. To displace this long accepted belief is of course very difficult. Every mind will instinctively do everything in its power to guard its supposed “correctness”. This explains the unbelievable resistance to change that prevents the average individual from evolving much during the course of a lifetime. A great leap in consciousness is typically preceded by surrendering the illusory belief that “I know.” Often this willingness to change is only accomplished by “hitting bottom”, which as its name suggests is an incredibly uncomfortable and deflating process. If these painful lessons of life are not transformed into entryways for growth and progression, the experience may have been wasted. Ironically, with some humility and grace, this place that seems wrought with complete despair can often be the springboard towards a new life.

It is said in the recovery world that there is no recovery until one experiences an essential change of personality. This transformation in belief systems can also be defined as a significant leap in overall consciousness. One of the first documented women to successfully recover from alcoholism occurred in New England during the early part of the 20th century. The American psychiatrist, Harry Tiebout, witnessed a profound change in his patient that he was unable to attribute to any known therapeutic intervention. She changed from an intolerant, angry woman full of self-pity and intolerance into a kind, loving, and forgiving one. Dr. Tiebout wrote his famous paper, “The Power of Surrender” , about his observations.  In other words, recovery from chemical addiction must be accomplished by ‘choosing’ sobriety, rather than ‘fighting’ addiction.  Support of this idea can be illustrated no better than the utter failure from the ‘war on drugs.’ Just the name alone suggests that it is destined to fail. Force begets force. Mother Theresa once said:

I have no desire to attend an anti-war rally. Invite me to a peace summit, however, and I will gratefully attend.

This can help explain how elusive recovery tends to be for so many sufferers. Conversely, it also helps explain the feelings of complete liberation and renewal espoused by the select few who do seem to be recovering to good purpose. However, a very important point needs to be driven home here. This experience of liberation and freedom occurs at two distinct phases of recovery and are often times unfortunately misinterpreted by those closest to the sufferer. For many former drug users – particularly those chemically dependent upon opioids – the last months and years of this dependency can only be accurately described as literal hell. Therefore, after completing a successful detox (often in a safe and protected environment), a feeling of liberation and intense gratitude is often experienced by the individual, and he typically is very eager to tell everyone about it. Those closest to him who have been hoping and praying for this moment for a long time, are filled with encouragement and relief as they are witnessing what understandably appears to be the successful rehabilitation and recovery of their loved one. But this does not necessarily reflect a true psychic change. In fact, often times this is simply the extreme relief from no longer experiencing chemical withdrawal. That feeling is much different than the authentic one being described above. The true freedom that follows genuine humility is usually described as being infinitely more than the mere release from a physical addiction; it is the release from a bondage of the mind that had ruled and ruined the individual’s life up to that point.

Recovery from a complex disease process depends on the willingness to begin exploring new ways of considering one’s own self and life. This will include the capability of enduring the inner fears that surface when long-held belief systems are disrupted. People have a tendency to relish and desperately hang on to their hates and grievances, but these can literally anchor the individual in a state of perpetual sickness.

A disease process is evidence that something is awry in the workings of the mind. Treating an illness only as a physical process (i.e. “a pill for any ill”) does not address the root of the dysfunction, and is palliative rather than curative. The critical point in a complex system is the site at which the least power is required to alter the entire system. A move of even one pawn in a chess match changes the possibilities of that game. Each detail of a belief system that we hold will have consequences for better or for worse. This is the reason no condition is ever considered absolutely hopeless or incurable; somewhere, sometime, somebody has recovered from it. And although not discussed in this article, having compassion for oneself during this uncomfortable process is pivotal to its success and absolutely necessary if the healed are to one day become the healers. 

Magnetic imaging of the brain’s frontal cortex region in opioid abusers- responsible for the prioritization of life-sustaining impulses— consistently shows drastically altered activity. The substance leaps even food, shelter and family as the most important daily need to satisfy. According to a Sep 2015 article in Journal of Neuroscience Research, it typically takes three years of continued abstinence for the measured brain scans of former heroin dependents to resemble the brain images of the control subjects. This is still more reason to adopt patience in the process and have compassion for oneself during the long road ahead.

When an individual seeks out treatment for his addiction, he is typically consumed by feelings of self-hatred, despair, regret, and despondency.  This position of apathy and hopelessness is a state of mind whereby the sufferer is incapable of helping themselves. It often expresses itself as, “My case is different. You may have recovered from your addiction, but my situation is worse.”  This is a place where treatment centers are particularly designed to help and can be life-saving. The sufferers are admitted into a facility where they are surrounded night and day by individuals who are pouring energy into them. The entire treatment process has been carefully designed to confront patient denial and redirect negativity towards a place of hope and optimism. This is the first level of integrity, and and acts as a springboard to now face, cope, and handle things, and for the first time, to react appropriately to the world.

The entire recovery process is to provide a new context within which to view one’s life. So that sobriety is no longer so intolerable that the individual needs to anesthetize the world simply to stand it. Therefore, ultimately the alcohol or drugs have required that a person become more awake and aware in order to survive.   Paradoxically, the sufferer’s greatness weakness is transformed into his greatest strength. These diseases are progressively fatal, and the only way to recover from them is to become progressively more awake, more conscious, and more responsible. It is moving away from a life of irresponsibility, repeatedly acting out the role of the tragic and helpless victim at the mercy of a cruel and unjust universe, to owning ourselves as being spiritually responsible for the fulfillment within our life. Although one can and should initially feel a sense of healthy regret for things done during the course of active addition, there is no longer debilitating remorse and shame regarding the process.  Guilt for what one has done becomes replaced by gratitude for who one has become.  The entire journey of experience becomes the individual’s greatest asset. Through these experiences, he is uniquely positioned to help others find the same road of recovery.  Out of this shift in perspective, the dark clouds of drug addiction can part to reveal the bright, infinite beauty of life.