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Is Addiction a Sin or a Disease?
I had another conversation that went like this. A man from church tells me of his daughter who got clean in AA. He admires the twelve steps but says that he has a disagreement. AA thinks that alcoholism (or the many other 12-step ailments) is a disease that needs to be managed through meetings and program for the rest of her life. The church thinks it is a sin that needs to be repented of towards a deeper cure in Christ.
I’ve also heard the conversation the other way. Someone in the rooms talks about his addictive disease. He rejects the moralistic teaching of the church and the idea of sin. He has come to believe that the god of his understanding doesn’t judge and pretty much accepts him the way he is.
When the founders of Alcoholics Anonymous spoke of addiction as a disease they were attempting to describe what was not understood in the 1930’s. The popular assumptions of the day were that if someone was a drunk, they were weak and were morally deficient. But this flew in the face of people who were strong and moral in every aspect of their life except in this one area. In their addiction, they were fighting on an unfair playing field.
Most people when drinking alcohol enjoy it until their body tells them to stop. But if someone who is constitutionally an alcoholic drinks, they don’t have the same reaction at all. They have a different physiological reaction much like people allergic to strawberries have a different reaction than the rest of us. The alcoholic develops an intense phenomenon of craving. There is something in their very being that longs and pines for more. Adding to this strange reaction of the body, their mind begins to obsess over it. As a result, they get another drink triggering once more this phenomenon of craving putting them on an endless cycle. This combination of craving of body and obsession of mind is what AA calls disease.
Behavioral addictions are similar though there are some differences. Unlike alcohol which can usually be avoided, sexual ideas can drop into one’s head at any moment. When the addict says “yes” to the idea on some level, it too triggers a strong internal euphoria much like the alcoholic craving. Add to this an obsessive mind (justified by Hugh Hefner’s concept of fantasy and our societies celebration of most things sexual), the only thing that awaits is opportunity and unaccountability.
Most people don’t encounter this craving of body and obsession of mind. Someone with an addiction does. In 12-step programs, the first three steps address this. Step one is the addict’s acknowledgment of this disease made up of craving and obsession and the unmanageability and havoc it has brought. Step two gives hope of sanity coming from a God who is not them. Step three is a commitment of action to stop trusting one’s own instinct and take direction from a higher power and authority.
But what of sin? The twelve step program of AA is not Christian but it does have Christian roots. Christian ideas and principles were not abandoned when the approved material was written. While disease is seen in step one through three, the reality of sin is seen in many of the other steps.
I once asked an Evangelical pastor when do we practice the admonition in James, “Therefore, confess your sins to one another and pray for one another, that you may be healed.” Other than a minority of Catholics who go to confession, the church has largely abandoned this.
Nevertheless, in AA and other twelve step groups, this is the high point of step work. Step four instructs the addict to make a through, written inventory of their life – misdeeds, resentments, fears, financial indiscretions, sexual unfaithfulness. In step five, the addict reads this inventory to another person, usually their sponsor. This coming clean process is much more thorough in dealing with one’s personal sins than most churches are where coming clean is often mumbling a brief mental confession to God a few minutes before the bread and wine arrives.
In step six and seven, the inventory is used to identify and pray for the removal of character defects. If there was no moral or sin component, why would one think that one’s actions sprung forth out of character defects? The action of sin springs forth from what I am as a fallen human being and bringing that fallenness to God in prayer is something both 12 step and the church have in common.
Finally, step eight and nine reviews the inventory and character defects to work on a plan to make amends to all that the addict has hurt. Again, the question can be asked if addiction includes no sin or moral component, why this insistence on making amends? After all, if I have a disease, the time and money I stole from the job couldn’t be helped. But twelve step teaches nothing of the sort.
I remember an epiphany when talking to a pastor about the moral wrongness of pornography as it was beginning to emerge on the scene as a new, major addiction. The pastor turned to me and says, “Dave, the people I work with know what they are doing is wrong.” The church can be stuck in this trap of thinking that if we only tell all addicts of substance and behavior that what they are doing is wrong (and even back it up with Bible verses), they will somehow have the strength and stamina to walk away. The lesson of groups such as AA is that it is not that simple. In many, there is a whirlwind of insanity, triggering, and obsession that puts the addict in a trap that she is not able to simply walk out of. Starting with the moral component doesn’t put out this strange fire. It stokes the fire further with the addition of shame.
On the other hand, there are many in 12-sstep that fall into the opposite trap of believing in a god they made up in their head and really approves and likes everything they do. Sin does not exist because this god always agrees with them. Nevertheless, conservative churches and synagogues remind us of a transcendent God who has spoken into the world laws and rules and social orders. A Creator-God implies there is a way things really are that are unalterable in spite of the impulses, longing, and personal narratives of the subjective heart. When we depart from these laws and rules and social orders, we hurt ourselves and others, human flourishing is diminished, and our relationship with God is damaged. This is the very reason we come clean with our sins, address character defects, and make amends to others.
So is addiction a disease or a sin? It is both but AA has shown that addressing the disease first brings the better hope for recovery. The church reminds us not to get lost in our own head and understanding when looking to the Divine.
Published in Religion & Philosophy
I had an addiction but it was neither. Although my addiction caused disease it was not a sin according to my priest who also smoked. See what I did there. I quit 37 years ago. I did my share of drinking but 15 months ago my doctor gave me some bad news. I have Michael Jackson’s disease. It’s called vitiligo a rare autoimmune disease. But that wasn’t the bad news. The bad news is that makes me ten times more likely to develop type two diabetes which also has been determined to be autoimmune.My numbers were a touch on the high side of normal. That was enough for me. Haven’t had a drink since New Years Eve 2016. Don’t miss it at all. I do have a tendency to over exercise but the cure for that is getting old.
This is a wonderful and thought-provoking post. I think the two are related. We have an addiction, a disease, that causes us to sin. For example, one lies to drink more or that they have drunk too much. The sin is the lie, the cause is the disease. I think these must be treated together. As a Christian and a Catholic, I believe we are obligated to be better to ourselves and to others. That means resisting sin, even sin pushed upon us by a disease like addiction. Most of all, if we do not trust in God, that too is a sin.
I completely agree.
There are people who have addictive personalities. I’m one of them. Early in my life I was headed down the road to alcoholism and to this day I have to limit how much I consume. I have it in the house, but if I started drinking two or three times a week, it would then become nightly. Then it would be a couple drinks. Then more. It would become the object of my affection, something I worship, a violation of the Commandments “You shall have no other gods before me”.
AA won’t work unless you embrace what they call a “higher power”, for the vast majority it’s God, for some it’s the fellowship itself (other members). Either way, you are held to account to somebody. I think it’s this accountability, along with the 12 steps, that allows AA to work as well as it does for so many.
AMEN
Romans 7:15-20 English Standard Version (ESV)
15 For I do not understand my own actions. For I do not do what I want, but I do the very thing I hate. 16 Now if I do what I do not want, I agree with the law, that it is good. 17 So now it is no longer I who do it, but sin that dwells within me. 18 For I know that nothing good dwells in me, that is, in my flesh. For I have the desire to do what is right, but not the ability to carry it out. 19 For I do not do the good I want, but the evil I do not want is what I keep on doing. 20 Now if I do what I do not want, it is no longer I who do it, but sin that dwells within me.
English Standard Version (ESV)
The title presents a false binary. Addiction is a disease, but it is a disease that can be controlled, and the addict therefore has a responsibility to at least make a sincere effort to control it. Obviously that’s easier said than done for some people, but as my Priest says, it doesn’t matter if you confess the same sin a thousand times, as long as your desire to stop is sincere. God knows the difference between can’t and won’t, and he will forgive as many can’ts as he needs to. It’s the won’ts we will have to answer for.
Very well stated. I would only add that every one of us has the disease of sin and every one of us has some addiction within us that we can’t give up, that harms us and those around us. AA is a wonderful instrument of God that has freed millions from bondage but the twisting of a handful of addictions into diseases for the purpose of eliminating accountability is evil.
Like any change in behavior, it has to be driven from within. There is a certain amount of will power that has to go in to curbing an addiction. My biggest problem with calling it a disease (though in many ways it is) is that many people think they are helpless against it- “oh, I’m an addict. It’s a disease. It’s not my fault. I can’t help it. It’s a disease.” Or they want a fast fix to help them. There are no fast fixes. Much of it is mind over desire. On one hand I sympathize with that- sweets are my downfall, and it’s really hard to tell myself that I don’t need to have dessert after dinner or to walk away from the treats someone brought to work. On the other hand, I have a hard time sympathizing with someone that tells me they can’t help it when they inject meth or heroin.
In the twelve step world, a distinction is made between powerlessness and helpless. Powerless tells us that we haven’t been successful in saying no to our addiction alone and that we need help from others and God. But that doesn’t make one helpless – he has tools, a program, others to help him.
How it may play out like this. A heroin addict who says, “I am strong so I’m going to go to inner city Atlanta and see my old buddies” will probably be back using. He will get with his friends and likely find it impossible to say no in the moment.
But if the heroin addict says, “I know that I am powerless over the lure of my old friends (powerless) therefore I am going to go somewhere else (not helpless) or talk to my sponsor and come up with a plan for success (again not helpless) or go to a meeting instead of hanging out with my old friends (again not helpless)” he will most likely succeed.
Anyone who uses the concept of powerlessness as a cop out to use really doesn’t understand what the founding fathers of AA was trying to communicate.
In the end, it is an attempt to move one from self-sufficient will power which has failed to humble trust in the guidance and suggestions of others.
I agree with all but this. The first step is admitting you have a problem. Without being confronted with a problem, how do you admit to it?
Recognition of brokenness comes before the addressing if it.
This isn’t a normal reaction? I’m being serious here. I may have my own addiction that needs help.
Addiction is a condition and these two similar tools are pretty much all we have to ameliorate it.
I’ll answer that an addiction can be both a sin and a disease.
I think that it is sometimes helpful to think of an addiction as a disease. We are physical, embodied beings. Addictions can have physiological and neurological causes and effects, which can be discussed and treated as a disease. This probably even holds for things that appear to be purely psychological addictions, such as gambling or porn. The initial stimulus may not be biochemical, but it induces biochemical effects in the body.
I think that it is always, or at least almost always, to think of an addiction as a sin. However, I think that this should not lead us to conclude that the only solution is spiritual battle or willpower. The physical world probably has a part to play, and this may mean changed behavior, psychological treatment, or even pharmaceuticals.
I don’t agree with the stark way that you present the difference between an alcohol addict and a non-addict. I may be wrong about this, but my impression is that there is more of a continuum in the physical response to alcohol use, which interacts with the specific personality and spirituality of an individual, with the result that some people seem easily able to control alcohol use, some people seem completely unable to control it, and some people are in the middle.
You speak of “constitutional alcoholism” which I think is what most people mean when they say it is a disease. They mean that there is something different about alcoholics even before they have ever tasted alcohol. This may be true, but I can’t see how that in itself is a disease. Susceptibility to a certain substance is present in almost everyone. Most people will become addicted to tobacco or heroin if exposed. This doesn’t mean that they have a disease. Do we think of addicted smokers or heroin addicts as having a disease in the same way we talk about alcoholics? Definitely not smokers, because even though smoking may harm your health, it doesn’t wreck your life in the meantime. So there’s a limit to the helpfulness of thinking of it as a disease. The Rational Recovery (AVRT) approach is helpful for many people and it outright rejects the idea of addiction as disease.
It’s not a disease. I don’t go to the corner Pancreatic Cancer Store to buy some fresh cancer and ingest it. There is certainly a genetic predisposition to become an alcoholic, or an addict of any kind. But there’s also a predisposition to play music, and that’s not called a disease.
Calling it a disease removes responsibility. In the short run, this is perfect, because it helps the surrender and realization of a need to change, or death results. In the long run, we have to make the choice, every day of our lives, how we choose to live it. Leaning on a “disease” removes the responsibility for personal choice.
That’ll never lead to a good place.
“Addiction” can be modeled as a really strong preference. It does more harm than good to call it a disease because it gives people an out when they are harming others. They always have a choice, no matter how hard that choice is to make.
People are more than happy to say they want to change, and other’s are more than happy to believe them. I think it’s more accurate to say they want to keep their preference and what they want to change is the hardship they leave in their wake.
I don’t have an opinion on whether addiction is a sin or a disease, but I admire tremendously people who have battled alcoholism by going through the twelve steps and who have emerged victoriously. I don’t think I could do it. It would be an extremely humbling experience. I suspect the people who get through it have a reason to do so–children and/or a spouse they love, for example, or a good job they want to keep. If there were nothing to go to, it would probably be very hard, if not impossible, to get through it. To anyone who has gone through it and succeeded, I applaud you.
The twelve step program of coming clean, dealing with character defects, amends, maintaining spiritual connection, and serving others speaks volumes of personal responsibility for oneself and others. Like a diabetic who accepts their condition and takes action to change their diet, exercise, visit doctors, and distance themselves their understanding helps them be more responsible in that area than someone who doesn’t see a need for a lifestyle change. Your assertion that the disease model removes responsibility lacks weight as it is contradicted by millions in twelve step rooms that demonstrate otherwise.
Fair enough. I was setting forth a simple illustration of why I may drink a glass of wine without getting on a destructive binge while for another the same wine leads ultimately to a drunken rampage. Why one may turn away from pornography in disgust while another spends all night obsessively comparing images while their family sleeps in the next room. As you point out, the problem with simple illustrations is that the reality is more complicated and nuanced..
If the problem is sin only, you expect it would be as easy to gain self-control over it as most other people around you.
How did he turn it down? Shrug it off? Why is that person laughing like he’s not struggling like me? Why is it so easy for them and so hard for me? The wrestling struggle to overcome sin, the constant failing, the desperate cries for God to please take this desire away.
Chris said they want the consequences to be easier, but I think they want the desire for the substance to dissipate first.
Acknowledging it as a disease gives you reason to think you need more help than the average Joe in overcoming it. And that’s what the 12 step does – it helps and supports them in a more drastic way than simply addressing it as a private sin does.
Though I have to say, I have been tempted to find an orthodox church with a confession booth. Confession seems to have a huge impact on spiritual and mental health.
As Kevin Williamson said, one of the hardest things to accept about adulthood is the idea that something can be your responsibility even if it’s not your fault. I think that’s why there’s such resistance to the addiction-as-disease model, because some feel that if we (meaning society) absolve the addict of fault, we relieve them of responsibility. This is a false binary.
If you want to understand why some people can’t get a grip on themselves in general, get the book Healing Developmental Trauma and listen to the dr. Drew Pinsky interviews of the researchers mentioned on page 26 on YouTube. Do not make a baby without scanning that information first; it will save everyone a ton of grief.
This was an EXCELLENT comment, well said. Anyone who poo-poo’s the idea of addiction being a disease probably hasn’t walked in those shoes. God can be asked a thousand times to remove the desire, the compulsion to drink/smoke/eat/injest/inject, but until help is sought from a fellowship of some type like AA, recovery can be elusive. When you see a person of true intelligence lose everything, job, family, home, freedom, and eventually their very life all in slavery to a drug or booze, it’s something far deeper than simple willpower at work.
The spiritual component cannot be overemphasized enough, and it must go hand-in-hand with accountability to other people, a fellowship of like-minded sufferers who have successfully turned away from the darkness of addiction.
Some things are baked in to your nervous system, otherwise all you would have to do is read Man’s Search For Meaning and just suck it up.
If alcoholism is an illness, it isn’t like pancreatic cancer, but it is quite a lot like bipolar disorder (and is often be co-mingled with this, disastrously). To some extent, at least, it is even treated the same way. A bipolar person often resists treatment for a considerable time before accepting that he or she really is sick. A lot of damage can be done in the meantime.
The difference, of course, is that the initiating event is optional: no one forces a person to drink alcohol.
But if a substance is present and accepted in the environment, it is difficult to see why the alcoholic—not knowing that he is an alcoholic-in-embryo— must be blamed for taking a drink if the rest of us did exactly the same thing. And I do know alcoholics who say that it literally hit them at the first drink, with choirs of fallen angels warbling “O’ Sweet Mystery Of Life At Last I’ve Found Thee…”
As with bipolar, the underlying personality and the quality of relationships that existed before the onset of the illness make a big difference in how quickly and successfully it is treated. A generally calm, pleasant, thoughtful person with good, trusting relationships is more likely to be “compliant with treatment” for bipolar; I’d have to assume that the same would be true for an alcoholic. Among other things, a mentally ill person has to be able and willing to substitute the judgement of others for her own—to believe Mom when she says “no, the CIA is not poisoning your oatmeal” or “drinking scotch out of a coffee cup at eight a.m. is not normal.” That’s a lot of trust, especially when a broken brain is doing its best to convince her otherwise.
Another similarity: each manic or depressive episode in uncontrolled bipolar disorder actually injures the brain further, making it even more difficult to self-repair. I can only assume the same is true for alcoholism—that the booze itself damages ones ability to resist it.
In both instances, ultimately, power and responsibility rests in the hands of the patient. It’s not something that can be fixed for them—at least, not yet. The bipolar person has to take the medication, endure the side-effects, do the therapy, monitor her moods, follow the boring and restrictive behavioral routines. The alcoholic has to do the same. For both, the goal is “Recovery” with the alternatives being prison or death. In a more humane society, a mental institution would be another choice, perhaps for both—didn’t there used to be homes for hopeless dipsomaniacs? But for now, it’s prison.
And by the way—a mentally ill person who refuses to get treatment or refuses to “do the program” is terrifying and infuriating for those who love her; this is also true—in spades—of alcoholics.
But it remains nonetheless true that you could put an alcoholic on a desert island, and he or she would not drink. The bipolar person would still be…sigh…bipolar.
Hence…the necessity and honesty in retaining the idea of sin (as AA does). An alcoholic does, in the end, have a choice.
Agreed. Same thing with OCD. There’s a movement that advocates 12 step programs for it too. I daresay it’s far easier to avoid consuming alcohol altogether than using soap or door locks. AA would be a failure if it advised consuming in moderation – so what would one expect if the problem is washing or checking? Addiction isn’t a disease. Withdrawal is an illness, but it’s a short-term illness, which makes it completely different from chronic mental illnesses.
Addiction is normal in the (fallen) human condition. We are addicted to wealth, pleasure, power, and honor. These are the root of sin.
Drug addictions and other forms of self-medication (to alleviate the suffering of life) are addictions to pleasure. The Left has a serious addiction to power (cf Hillary Clinton). Almost everyone seems to be addicted to material things (especially when it’s “free” at someone else’s expense. The Left knows government crack (welfare) is nearly irresistible and almost impossible to recover from.) And everyone wants to be loved and admired. Status is a huge driver of human behavior. It’s hard to be a deplorable.
Ricochet is also addictive, as some of you may have noticed. Ahem.
Very well put. And asking the Almighty for forgiveness and help (which can come through other people and programs like AA) is how we deal with our failings.
Cravings remain though, along with the brain’s reminding an addict how easily any present pain or frustration can be dealt with. Though not nearly up to ‘voices-in-the-head’ standard of madness, there is too much similarity for it to be completely different.
It doesn’t lack weight, chief. If you’re still in your 12 step rooms decades after becoming sober, something is wrong.
There is zero wrong with AA and its steps. It’s not the only path to sobriety. Continuing to call it a disease may function in the short run for alcoholics who are a step or two away from winding up dead under an overpass, but it’s a choice.
What you don’t notice, in your response, is how many people have tried AA, failed, come back, failed, failed, tried, come back, failed, etc. And died. Don’t tell me it’s not a choice. If it weren’t, how do you get healthy from a disease? Magical incantations?
It’s not a sin or a disease. A long list of articles and books have been written by specialists disputing the disease theory. Just google “is alcoholism a disease?” One book I’d recommend is Heavy Drinking: The Myth of Alcoholism as a Disease, by Herbert Fingarette.
The AMA classifies it as a disease. This was done in large measure to obtain insurance reimbursement for treatment. The American Psychiatric Association calls it a dependency. Other organizations go along with the AMA.
Much has been written about the addiction recovery racket. Check out https://www.thedailybeast.com/the-billion-dollar-rehab-racket-that-drains-family-savings.
The notion that AA isn’t religious is lame. How many times can you mention God. A higher power is just another way of saying God that is more PC to some members. There is the false distinction between spirituality and religion. I seem to recall numerous references to the spirit world in religious writings. Is the bible without spirit?
The recovery rate is poor. Even AA can’t squeeze the numbers to make it sound successful.
However, if you like group therapy, and are Christian at heart, and basically a New Testament oriented guy, despite having strayed far from your ancestral religion, I think AA can be way to recover from alcoholism.