at least, not until we realise that we can’t live without them.
Using substances and manipulating situations to fix your mood isn’t new. It’s the pace, intensity, range and scale of this mood-fixing that is unprecedented, irrespective of whether it involves drugs, alcohol, food or sex.
Put simply, both our need and our ability to manipulate our feelings are growing. We’re always searching for new ways to change the way we feel because, to state the obvious, we’re not at ease with ourselves. That’s a very broad-brush statement, so let me try to be more specific. Our ancestors were unable to insulate themselves from fear and despair in the way that we try to: certain forms of unhappiness, such as grief at the death of children, were more familiar to them than they are to us. Nor did they possess many fixes to address those feelings – and, in any case, experiences of such intensity aren’t easily fixed, even in the short term. We, on the other hand, struggle with small but inexorable and cumulative pressures in our daily lives. These produce a free-floating anxiety that is susceptible to short-term fixes.
The hi-tech world that ratchets up the pressure on us also yields scientific discoveries that speed up the flow of pleasure-giving and performance-enhancing chemicals in our brains. Indeed, producers and consumers collude vigorously in this process, which helps us cope with commitments that we feel are beyond our control. (Note, incidentally, how the verb ‘to cope’ has invaded so many areas of human activity: sometimes it seems that we need a ‘coping strategy’ just to go to the bathroom.) The jokey phrase ‘retail therapy’ has entered the language for a good reason. We, as consumers, know that the instant gratification of a purchase goes beyond simple pleasure at acquiring something new – it can change the way we feel about everything, albeit only for a short time. Manufacturers are well aware of it, too. They know they are the purveyors of fixes, and that the moment their fixes fail is the moment they start losing market share.
The problem is that these increasingly complex interactions between producers and consumers are also increasingly unpredictable, especially in their effects on the human body. It’s not possible to predict with any accuracy the sorts of relationships that people will form with the substances and experiences thrust at them. Neuroscientists are learning new things about our reward systems all the time, but they’ll admit privately that the attempt to turn these discoveries into drugs that target specific mental disorders have been shockingly hit-and-miss. Meanwhile, the rest of us know only one thing about those reward systems: how to stimulate them.
In other words, we are sitting in front of the controls of a machine whose workings are basically a mystery to us. And someone has just handed us the ignition keys.
IS ADDICTION REALLY A ‘DISEASE’?
‘When people ask why I don’t drink, I explain that I’m allergic to alcohol. But really, it’s a disease. We all have it – everyone in this room.’
The speaker was Pippa, a former actress in her sixties with dyed auburn hair and scarlet lipstick applied so thickly that her mouth looked like a clown’s. This may sound rude, but of all the AA regulars gathered round the trestle table in the church hall she was the easiest to imagine as a drunk. She had what my father used to call ‘a whisky voice’, though she hadn’t touched a drop for 15 years. ‘I behaved in a very unladylike fashion,’ she recalled. ‘And I don’t know if you agree with me, but I think there’s something particularly undignified about the sight of a drunk woman.’
This produced a sniffle of feminist disapproval from a couple of young women in the room, who looked like business executives: the meeting was hosted by one of the Wren churches in the City of London. But no one argued with Pippa’s claim that she suffered from a disease. I attended those lunchtime meetings three times a week in the shaky few months after I stopped drinking, and never once did I hear alcoholism described as anything other than a physical illness. ‘Allergy’ was one description; much more common was the phrase borrowed from the ‘Big Book’, the bible of Alcoholics Anonymous – ‘a cunning, baffling and powerful disease’.
I had no doubt that I was an alcoholic. Alcoholism is the name for addiction to alcohol, and therefore I was also an addict – a useful word to describe someone who indulges in a pursuit so excessively that it harms them. The AA fellowship kept me away from alcohol thanks to the remarkable power of peer-group moral support, and especially the support of strangers, which has its own special potency. But I never thought my alcoholism, or any form of addiction, was a disease. Wisely, though, I kept that opinion to myself at those lunchtime meetings.
Lots of the attendees, Pippa included, seemed almost proud they had this ‘disease’. They talked about it in the defensive but boastful manner in which, years later, people would discuss their recently discovered ‘food intolerances’. They also referred all the time to ‘the alcoholic personality’, as if everyone who ended up in the rooms shared deeply rooted personality traits. Again, I couldn’t see it: on the contrary, I was surprised by how little the members of the fellowship had in common. But if I’d questioned any aspect of the AA worldview, I’d have been corrected immediately: ‘Don’t you dare tell me I haven’t got a disease!’ Or I’d have been fobbed off with words of wisdom: ‘Alcoholism is the one disease that tells you that you haven’t got it’ – an infuriating AA epigram designed to close down debate rather than open it up.
Alcoholics Anonymous dates its foundation from 1935, when it changed from a specifically Christian mission to drunks into an independent fellowship of self-help groups with a strong but deliberately all-inclusive religious ethos. Since then, AA has achieved two extraordinary things. First, it has saved the lives of innumerable drunks. I’m probably one of them, so I feel a bit churlish suggesting that its other major achievement – the dissemination of the disease model – has distorted the modern world’s understanding of addiction.
The fellowship’s first medical adviser, the psychiatrist Dr William Duncan Stillworth, declared: ‘Alcoholism is not just a vice or a habit. This is a compulsion, this is pathological craving, this is disease!’1
This disease is both incurable and progressive, according to AA. The only way to keep its symptoms under control is by a programme of total abstinence based on the famous 12 steps to recovery. In Step 1, sufferers acknowledge their powerlessness over alcohol. Other steps tell them to seek help from God, examine their character defects and make amends for the harm they caused when they were drinking. But – and this is the crucial point – AA reassures them that they cannot be blamed for the wreckage of their lives, because the disease robbed them of their free will.
This raises an obvious question. What about heavy drinkers who give up alcohol of their own accord, without any help from AA or the steps? The fellowship’s answer is a masterpiece of circular logic. Since these drunks exercised free will in stopping drinking, and since the disease of addiction robs you of your free will, they cannot have had the disease and were therefore never alcoholics in the first place.
That AA formula has had an extraordinary appeal for generations of ex-drinkers. The organisation has 1.2 million members in the United States who attend 55,000 meeting groups; there are over two million members worldwide. The fellowship is sometimes described as a religious movement, but it would be more accurate to describe it as a self-help group with religious overtones. The Big Book talks explicitly about God, though it adds that ‘God’ is shorthand for ‘a power greater than yourself’. That power can be a supernatural being or (for atheists and agnostics) simply the fellowship itself.
The disease model, enshrined in the 12 steps, has spread everywhere, perhaps thanks to the fact that AA has never attempted to copyright it. It’s
