The Proliferation of Addiction and Recovery Theories
“All science is modeling. In all science you are abstracting from nature. The question is: is it a useful abstraction….Does it help solve a problem?” ― Michael Lewis, The Premonition
Imagine realizing that you or a loved one has developed an ever-worsening alcohol or other drug (AOD) problem. Now imagine that everywhere you look to understand or resolve this problem, you encounter a different explanation of its cause and solution, with each source claiming possession of THE TRUTH. That is precisely the confusing circumstances those affected by AOD problems face—a dilemma they share with officials charged with the development of drug policy and related problem-solving resources.
Such confusion reigns whether one seeks guidance from respected scientific and medical journals, conducts random internet searches, seeks pastoral guidance, weighs the marketing hype of public and private helping organizations, or listens to the advice proffered from extended family or friends who draw upon the wisdom of the local barber or beauty shop. Yes, it seems everyone has a pet theory about addiction and addiction recovery, and depth of knowledge is not a requirement for espousing it. The problem with a historically intractable problem is that everyone has a strong opinion about it, all proposed solutions have their rabid defenders and critics, and so-called scientific studies appear to the layperson to checkmate each other. Further complicating this situation is the fact that each major theory of addiction is highly politicized and monetized. The fates of individual careers and whole industries rest on which theory gains cultural prominence.
Addiction, the name commonly used to depict the most serious AOD problems, is an enormously complex entity. In fact, it and the larger spectrum of AOD problems are in my view many entities embraced too simplistically under a single title. Any proposed reductionist theory—one cause and one solution—ignores such complexity. Based on a half century of direct contact with people experiencing and recovering from such problems, I have come to this understanding:
AOD problems, including the most severe of such problems, spring from multiple etiological roots, unfold in diverse patterns, differ markedly in their long-term trajectory, are resolved through diverse pathways and styles of recovery, and are profoundly influenced by cultural context.
AOD problems, and substance use disorders as a distinct subset of such problems, do not rise from a singular cause. For most of us who have experienced it, addiction is a story of intricately intertwined threads of personal and environmental vulnerabilities, including vulnerabilities over which we had no control and were beyond our acts of choice. The most severe, complex, and enduring AOD problems rise not from a singular cause but a collision of multiple vulnerabilities. With pre-addiction stories messy and addiction stories even messier, one can find a seed of support for almost any theory of addiction causation.
Recovery is similarly complex and rarely attributable to a single factor, in spite of the passionate anecdotes of addiction survivors or this or that addiction treatment program swearing possession of the one true path to recovery. In short, no single thought, feeling, action, or environmental condition is sufficient in itself to cause addiction in all people, and no single technique, pathway, or style of recovery support is viable and sustainable for all persons experiencing AOD problems.
There are two ways to test theories of addiction and recovery. First, is it true? Can its central propositions be objectively and independently tested and verified? Second, is it actionable, meaning, does it provide a solution that “works” to reduce harm and enhance personal, interpersonal, and public health?
What all theories and proposed solutions have in common are a scripted storyline that makes sense of experiences that are otherwise inexplicable. The more personally salient ones include catalytic metaphors that can support one through the long-term stages of recovery. Such metaphors invite one into recovery, bolster efforts at recovery initiation, anchor the processes of recovery maintenance, and suggest prescriptions to enhance global health and quality of personal and family life in long-term recovery. What’s interesting is not just that recovery-supporting metaphors and story styles (sense-making explanations of how one entered addiction and then entered and sustained recovery) differ across individuals and cultural contexts, but that they can evolve within the same individual across the stages of recovery and the stages of life.
Resolving AOD problems at a cultural or global level requires disentangling and addressing the multiple causes of such problems and avoiding simplistic notions about such causes. Resolving those problems at a personal level requires not finding some universal truth but assembling that combination of beliefs and actions that facilitates a radical severing or reconstruction of the person-drug relationship with full knowledge that such a remedy may evolve over time.