If you were asked to physically point to the location of a person’s addiction illness, where would you point?
My answer might surprise you.
- Where would you point if you were asked?
- Have you ever thought of that question?
I’ll share my answer to that question a little later in this essay.
But first, try to think of some ways someone could go about answering that question.
- One way to find or build an answer to that question would be to look at the addiction definition from the American Society of Addiction Medicine (ASAM). The current language from ASAM1 includes the idea ASAM has used elsewhere that “the public understanding and acceptance of addiction as a chronic brain disease and the possibility of remission and recovery have increased.” Based on that, one might naturally conclude that addiction is located inside the skull.
- Another way to build an answer would be to look at research from the National Institute on Drug Abuse (NIDA). NIDA prioritized brain research in the 1990’s and called the 90’s the “Decade of the Brain”2. The results of that research and the resulting information campaign might leave one to think that addiction is located inside the skull.
A different way of knowing would be look, see, and say what you see.3
- Here’s an example of “look, see, say what you see”. In the history of scientific inquiries some things have been named how they simply looked.
- In the history of the study of human anatomy and physiology we learn that a portion of the brain, when it was found and seen, looked blue.
- In Latin, “locus” means “place” or “location”. And “coeruleus” is a word that contains the root for the word blue (like “cerulean blue”).
- You might have heard of the brain structure we call the “locus coeruleus”; they named that portion of the brain the Latin for “blue place”.
Where would you look to see addiction illness? And if you looked, what would you say you saw?
After you looked and told us what you saw, what you said would have been based on where you looked.
This is a puzzle or a paradox. How so?
- You will already lead yourself to a certain answer simply by deciding where to look. Looking in a certain place or in a certain way naturally results in certain conclusions. ASAM and NIDA decided where they were going to look. And they found brain function.
I have previously covered the question “What IS Addiction?” here at Recovery Review. Two posts of mine discuss what addiction illness IS.
- One of those two posts centers on work Norm Hoffmann did in determining the relative weight that each of the DSM-5 SUD criteria separately contribute to the potential identification of addiction illness.
- The other post examines definitional expressions from ASAM and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)4 about “addiction”.
But in this current post, I do not ask what addiction is. Rather, I ask where addiction sits.
After 3 decades of looking at clinical work, if I was asked to point at where addiction illness is physically located, I would point to the nexus of the individual person’s social network (family, friend, neighbor, etc.).
That is to say, the seat of addiction illness is not merely inside the physical person of the one using substances, but is located in the centrality of their relevant relational web.
When I presented that idea in a recent conversation, I was challenged to locate the seat of addiction illness in the person5. Admittedly, I must say that the seat of addiction illness being inside the individual person is a real possibility. And thus, I need not unnecessarily complicate the matter with an irrelevancy. However, in my thinking, the example of such a phenomenon would be something like a castaway on a deserted island, out of human contact for decades, initiating substance use and developing addiction illness under those conditions. Possible? Yes. Commonly the case? No.
To be thorough and cover that contingency, I will add my perspective of what a person is. And overall that perspective includes two basic ideas:
- Developmental layers across the lifespan
What follows is my treatment of each.
One of my favorite ways of thinking about a person as a total person is to use the phrase “bio, psycho, social, spiritual” as a reminder and starting place. And then, I often use either or both of two images to provide some details.
Here is the first image. After years of meditation, I decided that I could represent the essence of the phenomenological function of a person in the form of this diagram6:
For clarity and thoroughness I’ll say that I mean the words shown in that diagram in their simplest sense. For example:
- “science” could include any rational information gathering (e.g. a child turning over rocks in a tidal pool, or someone tracking the movement of stars), and
- “art” could include any craft on any level (e.g. a child using paint, or an adult practicing advanced metal work).
On the one hand, philosophy, science and art are products of considering; so in that way they could be thought of as petals produced by a flower. And on the other hand, philosophy, science and art are ways we take-in from the world around us; so in that way they could be thought of as the green leaves of the plant.
Generating questions, hypotheses, and answers to questions in life all seem central to the human experience. Meanwhile, much of what we know (that is either immediately accessible or even relatively out of access) seems to be stored below our level of conscious considering. And it seems that we take-in from the environment around us (e.g. soil, or other or deeper material, etc.) at this level too.7
In these ways, even though the plant does stand in a certain way relative to top/down or bottom/up as a whole, the parts of the plant are without superiority of being (is) or function (does) in terms of top or bottom. Both top and bottom result from the function of the other, and sustain the function of the other. And both result from and sustain the whole.
Is addiction located merely in the essence of the phenomenological function of a person? I don’t think so.
Here is the second image. After years of meditation, I decided that I could represent the layers of essential development of a person over their lifespan in the form of this diagram8:
Temperament is the closest to genetics. For example, shyness is irrespective of introversion and extraversion, and can be reliably identified in neonates just minutes out of the womb.
Imprint refers to life events from birth to around age 18.
Adaptations are the more primitive reflex patterns we regularly rely on to avoid or manage pain or stressors – either external or internal. They start showing up early in life and personality formation rests on the preceding adaptations.
Alas, the image is simplified and cannot properly show how some of these layers or their effects are more continuous across developmental stages. For example, our temperament never really leaves us.
Is addiction located merely in the layers of essential development of a person? I don’t think so.
Regardless of the bio-psycho-social-spiritual model, and of developmental layers and stages, when I look back out the rear windshield of my addiction career, I see that addiction illness is located in the nexus of interpersonal relations, differently, for each person.
Examples include the:
- seat of the family system
- relational web of street associates
- network of colleagues and work partners
It seems to me that addiction illness has its nexus or epicenter in the space of relationships, nested inside our developmental heritage, and the essence of what it is like to be ourselves.
I might change my mind or develop other ideas down the road, but right now this is how it looks to me.
And to the extent the idea of addiction illness being nested at the level of relationships is accurate, that makes me think about the word “connection” as it pertains to addiction. And it makes me wonder (in terms of actual location), “WHERE is recovery?”
1 ASAM definition of addiction; accessed 07/07/2021.
2 NIDA decade of the brain
3 Look, see, say what you see (cf. “Scout mindset” ala Julia Galef)
4 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. (DSM-5)
5 Personal communication with April Martin
6 “Unthought known” is borrowed from Christopher Bollas
7 “Facilitating environment” from Donald Winnicott was one muse for this image
8 “Basic fault” is borrowed from Michael Balint.
Merleau-Ponty, M. (1945/1978/2014). Phenomenology of Perception. London: Routledge.
Hamilton, N. G. (1977/1999). Self and Others: Object Relations Theory in Practice. Jason Aronson, Inc.