Sadly, There Is No Magic Bullet

It sounds great. And the new medications will have their place as treatment protocols evolve. In our passion for the prescription quick fix and pharmacological solution, however, we should recognize that drugs alone are not the answer to addiction.

The law of unintended consequences warns us that there's a downside to just about every advance. So discovering that addiction involves profound changes in the brain has led to a widespread assumption that addicts are powerless over their condition-that drugs have hijacked their brains. This, in essence, rules out free will and the possibility that some addictive behavior may be voluntary. It is a seductive proposition, for it suggests that the addict is incapable of self-control, and hence cannot be responsible for his or her behavior.

It is clearly true that addicts become increasingly incapable of controlling their behavior, for the compulsive nature of their drug use is the defining characteristic of their addiction. Moreover, addiction is far from an equal opportunity affliction. Certain individuals-by heredity, mental illness or age-are far more vulnerable than others. There appears to be a genetic component to addiction, and a substantial proportion of addicts suffer from co-occurring mental illness. As parents and policymakers, the vulnerability of teens rightly concerns us most, for the adolescent brain is a work in progress. While the brain's pleasure-and sensation-seeking center is up and running strong at puberty, that portion of the brain exercising control over impulsive and irrational behavior isn't yet fully hooked into the mental communication system until the mid-20s. Lives can be destroyed before they even begin.

My work-I founded Phoenix House, the drug and alcohol treatment program, 40 years ago-and the work of my colleagues would be much easier if the brain were the sole culprit in addiction. As jarring as it can be to say this in a milieu constantly shaped by reports of new scientific insights, it must be said: biology is not necessarily destiny. To accept the proposition of an addict's powerlessness is to eliminate volition from the equation, for we know from hard evidence that addicts can and do kick the habit. And, no matter how difficult it eventually becomes to exercise choice, there is always a period at the outset when choice is not only possible but relatively easy.

More significantly, to treat addiction solely as a disease of the brain is to ignore the psychological factors that generally prompt and sustain it, the behavioral factors that derive from it and a broad range of social and practical issues that need to be resolved before most addicts are able to arrest drug use and achieve what is called recovery. Guilt, remorse and anger must be addressed. There are relationships to repair. It is through talk therapy that most drug abusers come to understand themselves well enough to take control of their lives, working with an individual therapist or some form of group therapy. Groups generally provide a more powerful intervention for addicts, and proper medication often proves a useful adjunct. This combination of drugs and psychotherapy can work as well for addiction as it does for depression.

What may make the search for a magic pharmaceutical bullet so attractive, however, is the harsh reality that addiction is a lifelong condition and can recur at any time. It can-but it need not. This makes addiction no different than any other chronic disorder-diabetes, asthma or heart disease-that can be treated, monitored and controlled. Neither chemistry nor psychotherapy is going to provide a quick fix or sure cure. Relapse is always possible, but it is never inevitable. To argue otherwise is to deny that treatment can be empowering. This eliminates hope-and it is hope, grounded in self-awareness, that is the best safeguard for recovery we now have.