I just heard that quote from the Surgeon General in an advertisement for a rehabilitation program touting itself to be a place of mercy and compassion and not one of judgment. They likened addiction to the disease of diabetes which caught my attention because I have diabetes.
The disease model of addiction has definitely become the prevalent paradigm by which our culture understands the subject. It is also the basis of a $36 billion rehab industry in this country which must show a medical model in order to receive health insurance payments for treatment. Certainly the influence of genetics and the biological and physiological components of addiction need to be recognized for effective treatment.
In a similar way, Diabetes (type 2) has a hereditary link (but no gene for diabetes) which makes a person more susceptible to the disease. However, genetics does not guarantee its inevitability. There are other life-style factors that come into play with diabetes; age, obesity, high blood pressure, lack of exercise, etc.
Unlike diabetics, most recovering addicts that I have spoken with have recognized far deeper issues than a disease model can explain. They remembered days of being out of control; when they reached the point when “the drink (or drug) made the choice” and not them. Yet, when they sobered up for any length of time they recognized the need to take responsibility for their powerless condition and to realize they were not helpless; though they felt out of control, they still had choices to make. One person said that her alcoholism was a “disease of the free-will”. While genetics and biology may predispose to addiction, they cannot an addict make. There is a vast difference between predisposing and determining.
God created us with physical needs and desires which when kept within the boundaries of our love and obedience to Him can lead to pleasure and joy. However, sinful human nature is curved in upon itself and wants to consume these cravings upon itself without the limits of restraint. These cravings become our idols and we worship them so they will give us what we want. Edward Welch in his helpful book Addictions: A Banquet in the Grave writes: “The purpose of all idolatry is to manipulate the idol for our own benefit. This means we don’t want to be ruled by idols. Instead, we want to use them. For example, when Elijah confronted the Baal worshippers on Mt. Carmel (1 Kings 18), the prophets of Baal slashed themselves and did everything they could to manipulate Baal to do their will. Idolaters want nothing above themselves, including their idols. Their fabricated gods are intended to be mere puppet kings, means to an end.”
Bottom line: We do not want to be ruled by God. Every addiction breaks the command “You shall have no other gods before me.” We also do not want to be ruled by our cravings. No one wants to be a sex addict, a gambler, an alcoholic. We just want to be happy and to satisfy our hearts with our “drug of choice” without any consequences. Our selfish hearts want to construct a world in which we can live as we please and have everyone else live for our benefit and under our control. (I think Hitler tried that.)
However, our idols do not cooperate (Welch). Instead of allowing us to manipulate them for our benefit, they begin to control us. Jesus said, “No one can serve two masters, for he will either hate the one and love the other, or he will be devoted to the one and despise the other.” (Matt.6:24) In the context Jesus was talking about money, but it should be noted that there is a deeper significance here. Jesus implied that we are never the master, but always the slave. Paul said the same thing; “Do you not know that if you present yourselves to anyone as obedient slaves, you are slaves of the one you obey; either of sin, which leads to death, or of obedience, which leads to righteousness.” (Rom. 6:16) So much for being in control!
How could sticks and stones enslave Old Testament Israel? How can simple substances or lifeless objects or harmless images enslave us? Certainly they hook some of us who have emotional vulnerabilities or trust issues because of our dysfunctional backgrounds, while others of us are captured biologically or physiologically. All of this is explained by the disease model. However, there is a deeper spiritual struggle that rages in every form of idolatry. First, there is desire to run from the worship of the true God, and run to those gods who will help us cope, give us pleasure, and ask nothing in return (so we think). Second, behind every idol of addiction there is a world of the demonic and we expose ourselves to the power behind “not-the-god.”
Thus we do not struggle in our addictions “against flesh and blood, but against rulers, against authorities, against cosmic powers over this present darkness, against the spiritual forces of evil in the heavenly places.” (Eph. 6:12) This is why we need a power greater than ourselves not only to restore us to sanity (a new mind), but to help us turn our lives and wills over to God (a new heart). This comes through the gospel.
Any treatment program that is going to have the maximum effect must be based upon more than a disease model. Our addictions may have morphed into a disease, but our healing will always begin with the spiritual. As Christians, we believe it must begin with the love, mercy, and forgiveness of God in Jesus Christ our Lord. From there we must learn to be people who are responsible for the choices we make. Then, we must learn to make those choices daily to deal with the biological, physiological, and social components that have intertwined to make our lives “insane.” This will take a lifetime; we will not be driven by the fear of slipping back, but by trusting in God’s grace to grow up and move on.