Addiction Debate: Disease or Decision?

by Steven Gledhill for FREEdom from MEdom Project

“(This) is right on. You did a lot of work and your study was directed by God’s eternal truth from the Bible.” —Randal Ross, Pastor

Pages related to Disease Debate are:

• Brain Problem
• Distorted Defensive Thinking
• Role of Family and Genetics

The video clips are from Dr. Kevin McCauley of The Institute for Addiction Study.

Question: What icon from the Bible wrote the following about himself?

My guilt overwhelms me—it is a burden too heavy to bear.
My wounds fester and stink because of my foolish sins.
I am bent over and racked with pain. All day long I walk around filled with grief.
A raging fever burns within me, and my health is broken.
I am exhausted and completely crushed. My groans come from an anguished heart…
My heart beats wildly, my strength fails, and I am going blind.
My loved ones and friends stay away, fearing my disease. Even my own family stands at a distance.

Is addictive thinking and behavior a matter of cognitive choice bearing responsibility, or is it a disease of the brain and body? Particularly in religious and church circles there is a debate that rages on concerning the issue of addiction as a disease. There is a philosophy in such circles suggesting that if addicts are delivered from the powerful control of sin that they will experience deliverance from their addiction. But what happens when delivered addicts behave selfishly and sin again? Is it possible that the selfish sin is a trigger for addictive thinking and behavior?

But afterward Jesus found him in the Temple and told him, “Now you are well; so stop sinning, or something even worse may happen to you.” John 5:14

Addiction is in fact manifest in human behavior, but is also manifest in the brain and mind, as well as being a matter of the soul, which makes it spiritual. Then there is the obvious physiological impact of addiction. Perhaps this is not a question to be answered as “either/or” but rather to be answered as “both/and”.

“My head is filled with disease; My skin is begging you please; I’m on my hands and knees; I want so much to believe.” —Trent Reznor, musician

Answer: “My loved ones and friends stay away, fearing my disease. Even my own family stands at a distance” and the rest are the words of King David concerning his overwhelming guilt, his physical, psychological, and spiritual well being; his exhausted body, his crushed spirit, and anguished heart. It was David’s (infamous?) rant from Psalm 38, written years and perhaps a couple of decades after his famous words in Psalm 51.

Jesus said that we are to love (worship) the Lord (meaning authority) our God with our heart (the driving force of behavior), our mind (cognitive thought and emotion), our soul (the spiritual component to human life) and our body (the mechanism for actions and reactions). There is a direct parallel between the clinical disease component of addiction and the Biblical disease component of our selfish sin nature. Mental disorders are what we used to call mental illness until it crossed the lines of political correctness.

If we can agree that when we refer to mental health disorders as impairment of, and damage to, the brain, then we have to accept that brains and central nervous systems damaged and impaired by addictive lifestyle behavior result in mental illness. Addictions are recognized by the DSM (Diagnostic Statistical Manual) as mental health disorders. The DSM is the manual of the American Psychiatric Association. The World Health Organization has also contributed to the characterization of addiction as a disease.

Addiction’s Primary Characteristics

• Tolerance. Has your use of drugs or alcohol increased over time?
• Withdrawal. When you stop using, have you ever experienced physical or emotional withdrawal? Have you had any of the following symptoms: irritability, anxiety, shakes, sweats, nausea, or vomiting?
• Difficulty controlling your use. Do you sometimes use more, and/or, for a longer period of time than you would like? Do you sometimes drink to get drunk? Do you stop after a few drink usually, or does one drink lead to more drinks?
• Negative consequences. You continued to use even though there have been negative consequences to your mood, self-esteem, health, job, or family?
• Neglecting or postponing activities. Have you ever put off or reduced social, recreational, work, or household activities because of your use?
• Spending significant time or emotional energy. Have you spent a significant amount of time obtaining, using, concealing, planning, or recovering from your use? Have you spent a lot of time thinking about using? Have you ever concealed or minimized your use? Have you ever thought of schemes to avoid getting caught?
• Desire to cut down. Have you sometimes thought about cutting down or controlling your use? Have you ever made unsuccessful attempts to cut down or control your use?

Addiction is also quite clearly a matter of individual choice, personal responsibility and   accountability. Our society does not excuse the person who kills someone who was driving under the influence of alcohol or drugs. Someone harms another person under the influence of a drug (i.e., steroid rage) or themselves become afflicted by symptoms of disease as a result of the use of drugs or food addictions, they pay a price of some kind.

There is often times this prevailing notion in religious and church circles that only the root problem of sin be treated when the perception is that addiction is merely a peripheral problem hiding the real sin problem. If the sin problem is resolved then the addictive behavior will exterminate now that the sinner has been delivered. The problem with that is that even though the sinner has been set free from eternal consequences, the sinner will relapse into some form of sin everyday. Are we to assume that he will not relapse back into that sin; that being addictive behavior? Of course, the issue of selfish sin must be treated; but so must the sinner’s addictive thinking and habits.

What if we only treated the root symptoms of a disease and did not treat the resultant factors of that disease?

What about the issue of heart disease?

While there may very likely be genetic factors, diet and exercise play a critical role in the onset and degree of heart disease. Stress can be a contributing factor. Also, the choice to use alcohol and drugs, or to indulge in unhealthy eating habits can lead to heart disease and death. Is heart disease any less a disease because the person’s choices and behaviors increased its risks and incurred consequences? Should heart attacks and stroke not be treated as an illness if they are traced back to lifestyle choices and behavior?

What about diabetes?

In particular, Type-II diabetes is often the result of a person’s lifestyle of unhealthy diet and lack of exercise. The degree to which a diabetic suffers consequences of diabetes (i.e., kidney disease) can be a result of poorly managing the condition with appropriate care. Should diabetics be challenged about their dietary and exercise habits before being treated for their disease?

What about cancer?

Lung disease, emphysema, and other cancers can be connected quite easily to the use of tobacco products—smoking and chewing. Alcohol and drug addiction impact the rate of production and function of blood cells. Reduced white blood cells impair the function of the immune system and increase the likelihood of bacterial infection of cancer. About half of all pancreatic cancer is tied to alcohol-related problems. There are the connections of alcohol and drugs to all sorts of cancers. Should cancer not be treated as a disease if its roots are traced back to a lifestyle of addictive behavior?

What about liver disease?

This is the most obvious disease linked to addictive behavior. If so, is liver disease disqualified?

What about brain disease?

Alright… so you get where this is going. What about choices to risk everything for one’s addiction?

• Bodily harm and physical health
• Personal well-being
• Spouse’s well-being
• Children’s well-being
• Degradation of values and morality
• Emotional health
• Spiritual health
• Professional life
• Economic survival
• Conversion to morally deviant lifestyle

How does Scripture approach addiction? As a disease?

Look at the words of King David of the Old Testament in Psalm 38:1-11, when he speaks of his sin problem that was likely related to addictive behavior, including intoxicating substances, sexual addictions, and some serious issues with power and control (check out 2 Samuel):

1 O Lord, don’t rebuke me in your anger or discipline me in your rage!
2 Your arrows have struck deep, and your blows are crushing me.
3 Because of your anger, my whole body is sick; my health is broken because of my sins.
4 My guilt overwhelms me—it is a burden too heavy to bear.
5 My wounds fester and stink because of my foolish sins.
6 I am bent over and racked with pain. All day long I walk around filled with grief.
7 A raging fever burns within me, and my health is broken.
8 I am exhausted and completely crushed. My groans come from an anguished heart.
9 You know what I long for, Lord; you hear my every sigh.
10 My heart beats wildly, my strength fails, and I am going blind.
11 My loved ones and friends stay away, fearing my disease. Even my own family stands at a distance.

The Old Testament accounts of King David appear to reveal an addictive personality and character. David became physically ill with possibly heart palpitations, fever, muscle aches, and even episodes of blindness. He may have been experiencing withdrawal from an alcoholic or opiate drug experience. He also struggled with severe guilt and shame, as well as tremendous stress and feelings of despair. His weakness made him vulnerable in his personal and family life, his spiritual life, along with his professional life as one governing so many people under the threat of attack from both outside and inside the kingdom. Throw in the issue of irrational thoughts, feelings, and beliefs, and you have a troubled, sick man.

The Need for a Physician

If we are not willing to accept addiction as a disease, accepting only that addiction is a matter of selfish sin that requires repentance and mercy; then under that premise, according to Scripture, the addict is in need of a physician; one with the ability to deliver the addict from his sin disease. Jesus spoke of sinners as being sick, in need of a doctor.

“Those who are well have no need for a physician, but those who are sick have need; for I did not come to call the righteous, but sinners to repentance.” Matthew 9:12-13 (NKJV)

Scripture appears to indicate that the infected selfish sin nature is beyond our control; and that it in fact controls us. We are enslaved by sin, according to Scripture, and the selfish sin nature is the master. Our brains have been altered so that selfish human desire takes control.

“For what I am doing I don’t understand. What I will to do, I do not practice; but what I hate, that I do. But now it is no longer I that do it, but the sin that dwells in me. For I know that in me nothing good dwells; for to will is present with me, but how to practice what is good I do not find. For the good I will to do, I do not do, but the evil I will (intend) not to do, that I practice. Now if I do what I will not to do, it is no longer I who do it, but the sin that dwells in me.” Romans 7:15-20 (NKJV)

They themselves are slaves of destructive habits. For a man is a slave of anything that has conquered him. 2 Peter 2:19 (NKJV)

“Jesus said to the people who believed in him, “You are truly my disciples if you remain faithful to my teachings. And you will know the truth, and the truth will set you free. But we are descendants of Abraham,” they said. “We have never been slaves to anyone. What do you mean, ‘You will be set free’?” Jesus replied, “I tell you the truth, everyone who sins is a slave of sin.” John 8:33-34 (NLT)

Conclusion

There really is no debate. Addiction is both a disease and a matter of responsibility. There will continue to be those who refuse to accept this but it is what it is. The choices addicts make to support their addiction are often quite sick. One’s addiction never justifies addictive behavior and its impact; it only helps to explain and understand it. Addicts will always need to be held accountable for their actions. However, the disease of addiction must be acknowledged and treated. It is necessary for the well-being of us all.
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From the National Institute on Drug Abuse

Drugs and the Brain

Introducing the Human Brain

The human brain is the most complex organ in the body. This three-pound mass of gray and white matter sits at the center of all human activity – you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities. In brief, the brain regulates your basic body functions; enables you to interpret and respond to everything you experience; and shapes your thoughts, emotions, and behavior. The brain is made up of many parts that all work together as a team. Different parts of the brain are responsible for coordinating and performing specific functions. Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug abuse that marks addiction. Brain areas affected by drug abuse –

• • • The brain stem controls basic functions critical to life, such as heart rate, breathing, and sleeping.
    • The limbic system contains the brain’s reward circuit – it links together a number of brain structures that control and regulate our ability to feel pleasure. Feeling pleasure motivates us to repeat behaviors such as eating – actions that are critical to our existence. The limbic system is activated when we perform these activities – and also by drugs of abuse. In addition, the limbic system is responsible for our perception of other emotions, both positive and negative, which explains the mood-altering properties of many drugs.

The cerebral cortex

is divided into areas that control specific functions. Different areas process information from our senses, enabling us to see, feel, hear, and taste. The front part of the cortex, the frontal cortex or forebrain, is the thinking center of the brain; it powers our ability to think, plan, solve problems, and make decisions.

How does the brain communicate?

The brain is a communications center consisting of billions of neurons, or nerve cells. Networks of neurons pass messages back and forth to different structures within the brain, the spinal column, and the peripheral nervous system. These nerve networks coordinate and regulate everything we feel, think, and do.

• Neuron to Neuron  Each nerve cell in the brain sends and receives messages in the form of electrical impulses. Once a cell receives and processes a message, it sends it on to other neurons.
• Neurotransmitters—The Brain’s Chemical Messengers  The messages are carried between neurons by chemicals called neurotransmitters. (They transmit messages between neurons.)
• Receptors—The Brain’s Chemical Receivers  The neurotransmitter attaches to a specialized site on the receiving cell called a receptor. A neurotransmitter and its receptor operate like a “key and lock,” an exquisitely specific mechanism that ensures that each receptor will forward the appropriate message only after interacting with the right kind of neurotransmitter.
• Transporters—The Brain’s Chemical Recyclers  Located on the cell that releases the neurotransmitter, transporters recycle these neurotransmitters (i.e., bringing them back into the cell that released them), thereby shutting off the signal between neurons.

To send a message a brain cell releases a chemical (neurotransmitter) into the space separating two cells called the synapse. The neurotransmitter crosses the synapse and attaches to proteins (receptors) on the receiving brain cell. This causes changes in the receiving brain cell and the message is delivered. Most drugs of abuse target the brain’s reward system by flooding the circuit with dopamine.

How do drugs work in the brain?

Drugs are chemicals. They work in the brain by tapping into the brain’s communication system and interfering with the way nerve cells normally send, receive, and process information. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter. This similarity in structure “fools” receptors and allows the drugs to lock onto and activate the nerve cells. Although these drugs mimic brain chemicals, they don’t activate nerve cells in the same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network.

Other drugs, such as amphetamine or cocaine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals. This disruption produces a greatly amplified message, ultimately disrupting communication channels. The difference in effect can be described as the difference between someone whispering into your ear and someone shouting into a microphone.

How do drugs work in the brain to produce pleasure?

Most drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The over-stimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.

How does stimulation of the brain’s pleasure circuit teach us to keep taking drugs?

Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.

Why are drugs more addictive than natural rewards?

When some drugs of abuse are taken, they can release 2 to 10 times the amount of dopamine that natural rewards do.¹⁵ In some cases, this occurs almost immediately (as when drugs are smoked or injected), and the effects can last much longer than those produced by natural rewards. The resulting effects on the brain’s pleasure circuit dwarfs those produced by naturally rewarding behaviors such as eating and sex.^16,17 The effect of such a powerful reward strongly motivates people to take drugs again and again. This is why scientists sometimes say that drug abuse is something we learn to do very, very well. Long-term drug abuse impairs brain functioning.

What happens to your brain if you keep taking drugs?

Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive signals. As a result, dopamine’s impact on the reward circuit of a drug abuser’s brain can become abnormally low, and the ability to experience any pleasure is reduced. This is why the abuser eventually feels flat, lifeless, and depressed, and is unable to enjoy things that previously brought them pleasure. Now, they need to take drugs just to bring their dopamine function back up to normal. And, they must take larger amounts of the drug than they first did to create the dopamine high – an effect known as tolerance.

How does long-term drug taking affect brain circuits?

We know that the same sort of mechanisms involved in the development of tolerance can eventually lead to profound changes in neurons and brain circuits, with the potential to severely compromise the long-term health of the brain. For example, glutamate is another neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate for this change, which can cause impairment in cognitive function. Similarly, long-term drug abuse can trigger adaptations in habit or non-conscious memory systems. Conditioning is one example of this type of learning, whereby environmental cues become associated with the drug experience and can trigger uncontrollable cravings if the individual is later exposed to these cues, even without the drug itself being available. This learned “reflex” is extremely robust and can emerge even after many years of abstinence.

What other brain changes occur with abuse?

Chronic exposure to drugs of abuse disrupts the way critical brain structures interact to control and inhibit behaviors related to drug abuse. Just as continued abuse may lead to tolerance or the need for higher drug dosages to produce an effect, it may also lead to addiction, which can drive an abuser to seek out and take drugs compulsively. Drug addiction erodes a person’s self-control and ability to make sound decisions, while sending intense impulses to take drugs.

Source Reference: National Institute on Drug Abuse, NIDA

For more information on drugs and the brain, order NIDA’s Teaching Packets CD-ROM series or the Mind Over Matter series at www.drugabuse.gov/parent- teacher.html. These items and others are available to the public free of charge.