No matter who you are, the question you should ask is not, am I addicted? The question should be, how addicted am I? And to what? Addiction, in the broadest sense, is universal because we’re all guilty, some of the time, of mindless inflexibility. We can all admit to avoiding negative thoughts and feelings by disappearing into compulsive mindlessness, as well as chemicals. We all have our ineffective, but persistent reactions to fear, loss, and pain. We don't usually think of addiction this broadly. Instead, we select certain addictions to be our scapegoats and merrily go on with the rest. We've divided the world into marginalized people we call addicts, and those whose addictions we favor. We've been doing this so long we think the world is really divided that way. It justifies our cruel behavior towards those we call addicts. The conventional view of addiction presents it as a categorical, fixed entity affecting only certain individuals. This leads to stigma and cruel treatment of those we label as "addicts". However, addiction is a deeply ordinary mechanism for engaging with the inherent pleasures and challenges of life. Thus we turn some people into whipping boys while the rest of us continue our own addictive behaviors unchallenged. Looking at my own habits, I can confess many mindless, inflexible thoughts and feelings. I imagine my friends and family know them better than I. For instance, when I’m listening to a person in obvious distress, as I am daily in my job, I have an overwhelming urge to interrupt them and say something that I believe will solve their problem. In most cases, my coming up with solutions to another person’s problem does not solve his problem, it’s better when he solves his own. I often give unsolicited advice anyway, not because it solves his problem, but because it solves mine. My problem is that his hopelessness and despair is making me feel hopeless and in despair. I’m worried if I don’t hurry up and cure him, I’ll be a bad therapist. I try to avoid this feeling by telling him how easy it would be to solve his problem. However, if it were that easy, he would have solved it already. He would not be coming to me to sort through his options. The person I’m talking to can be an addict, in the usual sense of the word, who cannot find a way to say no to his drug. Meanwhile, I’m giving unsolicited advice, which is my drug. In acknowledging my own addiction, I don't mean to trivialize others' suffering but to show what we have in common with them. I'm a grateful, recovering advice-giver. My addiction is cunning, baffling, and persistent. I don’t even have to go to a bad neighborhood to get my drug. I can easily relapse by just reaching into my bottomless stash of advice. Your particular type of mindless inflexibility might be different from mine, but I bet you have one. Therefore, you can say you’re addicted. We are both on the spectrum of addiction, along with the most wretched junkie. Spectrums are very popular these days in the mental health world. We increasingly think of all mental conditions as existing on a spectrum. We all have our autistic moments, some more than others, so there is an autism spectrum. In the same way, none of us are strangers to depression, anxiety, narcissism, being affected by trauma, or even, if you're willing to admit it, psychosis. The same could be said for addiction. We're all addicted to something, whether it be substances we put into our bodies, or ways of thinking or behaving. But when we treat any mental disorder, including addiction, as a categorical, fixed entity, we mistreat it and the people we think have it. Looking at the people typically labeled as addicts, there's tremendous variation in degree and nature of their addiction. We usually categorize them by the substance or behavior they're addicted to: alcoholics here, heroin users there, compulsive gamblers and sex addicts over there. These distinctions are not as substantial as the distinctions between the chronic user, the binge user, and the dabbler; or those who report a loss of self-control versus those who are happy to use. The true distinctions are a matter of degree, not kind. The Meaning of AddictionThe meaning of the word addiction has changed over time. It originally entered the English language through John Frith (1503-1533), a Protestant theologian who used it about the Pope. He got it from the Latin "addicere," which describes a binding relationship, like between a master and a slave. For centuries, addiction wasn't seen as an overwhelming force but as a deliberate choice. You could "addict yourself" to beneficial practices like prayer, as well as harmful things. Addiction was the label given to the gray area between free will and compulsion, where you could have free will but gave it up. It was a willed compulsion, an active process of surrendering agency, a choice to forgo choice. Throughout the late 19th and early 20th centuries, medical research, the temperance movement, and institutional developments reshaped how addiction was conceptualized and discussed. Physicians began to see how chemicals interacted with the human body. They started to recognize addiction not as a personal choice, but as a complex condition with specific biological mechanisms. They started to call it a disease. At the same time, the temperance movement reframed substance use from a matter of individual choice to a serious social issue. They pushed society to see certain substances as inherently problematic. In the United States, the Harrison Narcotics Tax Act of 1914 institutionalized the medical understanding of addiction. The word shed its broader use and transformed from a nebulous concept to something associated with chemical use. Contemporary research has begun to challenge this narrow definition, identifying behavioral addictions other than chemical dependencies. Now we recognize that the psychological aspects of addiction are stronger than the physical aspects. This realization has paved the way for recognizing behavioral addictions related to gambling, sex, shopping, or smartphones. This returned “addiction” is its original meaning, which captures addiction's ubiquity and expresses the truth that once we make certain choices, they become extraordinarily difficult to unmake. Is Addiction a Disease?People have debated whether addiction is a disease for decades without resolution. The answer depends on what we mean by "disease." The term is slippery. People who claim addiction is a disease say it's not a moral failing, a choice, or a character flaw; it's about brain chemistry. The brain rewards pleasurable activities with dopamine, and substances can trigger large surges that teach the brain to seek the addictive object at the expense of healthier goals. Those who become addicted may have genetic predispositions, trauma exposure, or early substance use that increases vulnerability. They argue that harsh consequences, shame, and punishment are ineffective ways to heal addiction. While this perspective has value, we must be careful about reductionism. Often, when people call addiction a disease they mean that medical treatment is the single best approach because the problem is rooted in biology. When taken too far, this view suggests addiction is only about brain chemistry and only medically trained professionals can help. When we take the disease concept too reductively, we miss how psychological, spiritual, social factors matter. We overlook the contributions non-medical approaches can make toward healing. A reductive disease model implies that therapists, clergy, recreation specialists, yoga teachers, family members, and supportive peers have little to offer. It suggests medicine "owns" addiction. We also need to examine what we mean by disease. Disease often implies that people with the condition are fundamentally different from those without it. It suggests that it's a property of an individual, not their family or society at large. Disease is something that happens to you, with little choice involved. Proponents sometimes claim that the medical model alleviates stigma and encourages sufferers to seek help. None of that is necessarily true. The more we learn about all diseases, the less simple they look. We used to think of diseases as discrete categories with clear lines between sick and well. Now we know they are functional, complex, interacting systems. With addiction, there is much gray area between sick and well. Calling something a disease doesn't automatically alleviate stigma. Homosexuality was once called a disease, yet carried tremendous stigma. Nor does the disease label necessarily encourage people to seek help. It only encourages them to see doctors when they do. The binary disease model can make it harder for people to recognize when their behavior is harmful. They start thinking, if they’re not on skid row, they’re not an alcoholic. Perhaps the greatest risk in calling addiction a disease is that sufferers may conclude recovery isn't their responsibility or is impossible. Some research suggests that addicted individuals who strongly believe in the disease model are more likely to relapse because they don't see the point of struggling against it. A Therapeutic Approach for the Spectrum of AddictionWhen we recognize addiction as a spectrum of mindless inflexibility, new possibilities for treatment emerge. It’s no longer about the drug or behavior of choice. This shift allows us to see a common psychological processe across the spectrum of addiction, from the therapist compulsively giving advice to the person injecting heroin. Rather than asking "what are you addicted to?" we ask "how does your mindlessness manifest?" The capacity to observe our own mental processes without immediate action is perhaps the most fundamental skill in addressing mindless inflexibility. Whether giving unwanted advice or reaching for a needle, the first step is the same: noticing the urge arising before we act on it. This mindfulness creates space between stimulus and response where choice becomes possible. Once awareness is established, we can explore what function the addictive pattern serves. All addictions protect us from something: usually difficult emotions, thoughts, or experiences we haven't developed the capacity to face directly. The heroin user might be avoiding trauma memories; the compulsive advice-giver might be avoiding feelings of helplessness. By gradually turning toward whatever we avoid, we learn we don’t need to escape. The relational dimension of healing is vital. Addiction thrives in isolation and secrecy, where shame can maintain a grip. Creating safe connections where you can be real without rejection counteracts the alienation that often feeds addiction. These relationships provide both support during difficult moments and models for how to relate to oneself with kindness rather than condemnation. Existential engagement with meaning and choice forms another crucial element. The disease model, while helpful in reducing shame and explaining neurobiological aspects, inadvertently diminishes the role of meaning-making in recovery. When we help people reconnect with what matters most to them: values and aspirations beyond immediate gratification, we strengthen their motivation to endure the discomfort of change. The question shifts from "can I stop?" to "what am I living for?" The work of facing our addictions ultimately involves reconciling contradictory truths. We’re powerfully influenced by neurochemistry, but are also capable of making choices. We struggle alone, but are also part of a universal human experience. We’re wounded by past experiences, but can heal. By holding these tensions rather than resolving them prematurely in favor of disease or choice, we open deeper possibilities for transformation. Perhaps most importantly, this approach calls us to recognize our common humanity with those whose addictions differ from our own. When I sit with a person devastated by heroin addiction, I must acknowledge that we share the same fundamental vulnerability to mindless patterns; the same human tendency to avoid discomfort through repetitive behaviors that ultimately increase suffering. This recognition dissolves the artificial boundary between helper and helped, between addict and non-addict, creating the conditions for authentic connection and mutual growth. In practical terms, this means developing interventions that address mindless inflexibility directly: practices for increasing awareness of triggers and automatic responses; exercises for building tolerance of difficult emotions without immediate escape; techniques for reconnecting with values beyond momentary relief; methods for repairing relationship ruptures caused by addictive behaviors; and approaches for integrating disowned aspects of self that the addiction protects or expresses. The healing journey involves gradually expanding psychological flexibility: the capacity to stay present, open, and engaged even when facing discomfort. This doesn't happen all at once but emerges in countless small choices, of saying yes to life's full range of experience rather than ping ponging to pleasure and away from pain. And because mindless inflexibility exists on a spectrum affecting all of us, this work is never truly finished but becomes an ongoing practice of awakening from automatic patterns into more conscious living. I am grateful to Carl Erik Fisher for many of the ideas presented here. For a more in-depth discussion, read his book, The Urge: Our History of Addiction You're currently a free subscriber to The Reflective Eclectic. For the full experience, upgrade your subscription.
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Monday, 14 July 2025
The Spectrum of Addiction
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