I Suffer from a Disease, Not a Metaphor

I was greatly offended by Dr. Carl Erik Fisher’s essay on addiction published in the New York Times over the weekend. (“It’s Misleading to Call Addiction a Disease” January 15, 2022). I’m an alcoholic and it took me more than ten years of trying to finally get sober. One thing I’ve learned on my journey, which has taken me through a variety of rehabs and IOPs and mental health professionals: The medical establishment really has no clue how to treat addiction. A fact Dr. Fisher cheerfully and candidly admits. When I reflect on my path to sobriety, one thing that is remarkable is the near-complete absence of the medical profession. Every primary care physician I’ve encountered has almost no idea about the disease of addiction, much less the efficacy or nature of the treatments available.  Given the number of people afflicted with substance use disorders (how it’s listed in the DSM 5, not “addiction” as Dr. Fisher refers to it) and the associated mortality rates, it’s more than shocking that the medical establishment has so little to offer, as Dr. Fisher frankly concedes. What triggers my anger, though, is yet another doctor talking about addiction as a disease with implied air quotes: “I know that for some..the disease analogy helps them make sense of those struggles…” (emphasis supplied)

The Foreword to the First Edition of the Big Book, written in 1939, says this: 

"We, of Alcoholics Anonymous, are more than one hundred men and women who have recovered from a seemingly hopeless state of mind and body. To show other alcoholics precisely how we have recovered is the main purpose of this book."

The emphasis is in the original.  When Bill Wilson wrote this nearly 80 years ago, he knew alcoholism was a disease and naturally recognized the importance of getting the medical profession’s support and assistance in treating this malady of the "mind and body." He ended the Foreword: “Inquiry by scientific, medical, and religious societies will be welcomed.” It is also not an accident that the next section of the Big Book is the “Doctor’s Opinion.”

Alcoholism and addiction are complicated diseases that span a variety of genetic and environmental causes; just like every case of diabetes and cancer is also the consequence of a unique confluence of events and factors. The uniqueness of each patient’s experience is a reflection of that complexity and does not logically compel the conclusion that those patients, those people, do not suffer from a definable disease or condition. And Dr. Fisher’s phrase, the “disease analogy,” is simply profoundly offensive to me, someone with the actual disease, not just a metaphor.

The traditional view of alcoholism was that with just a little more self-control, more will power, well, there wouldn’t be a problem.  Anyone who can’t stop, who relapses over and over (the actual hallmarks of this disease), that must be related to some defect in them and not a condition that the medical profession should try to treat. That view has killed a lot of addicts and alcoholics. Bill W. realized how profoundly wrong that view was nearly 80 years ago. Candidly, for most of those 80 years, much of the medical profession wondered whether it even ought to try and treat us alcoholics and addicts. Dr. Fisher is hardly alone in suggesting that since he doesn’t know how to treat it, it must not be a disease.

I think Dr. Fisher is exactly wrong in suggesting that the disease model somehow risks marginalizing us who suffer from it. I believe, as did Bill W., that I suffer from a chronic and fatal disease that requires constant effort and vigilance. It is the recognition that it is a disease, not just personal weakness, and that there is a treatment, that frees us to take the steps that can actually save our lives.  At least, that’s how it’s worked for me. We all learn in recovery that we can and should only speak for ourselves. 

I’m glad that Dr. Fisher is also in recovery, but having read his essay, I wonder what exactly is it that’s he’s recovering from?

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