One of the country’s leading experts in addiction and recovery, Elias Dakwar, Associate Professor of Clinical Psychiatry at Columbia University’s Center for Healing Opioid and Other Substance Use Disorders, or CHOSEN, has just published a book in which he takes aim at many of the half-truths of addiction treatment.

The book is called The Captive Imagination: Addiction, Reality and our Search for Meaning, and it was published by Penguin in June this year. Dr. Dakwar wrote a summary of his book under the headline, “A Psychiatrist Breaks Down the Top 5 Myths About Addiction” for Next Big Idea Club. Here’s a summary of their summary:

Myth 1: Drugs are the problem.

Here is an addiction researcher at the top of his field who disputes the theory that drugs contain some magical property that causes people to lose self-control, or that drugs cause irreparable brain damage. “[O]nly a fraction of people who use drugs develop addiction, which indicates that drugs are not the main issue,” writes Dr. Dakwar.

Myth 2: The brain is the problem.

“We are not merely our brains,” Dr. Dakwar says, noting that addiction is a complex web that involves the brain, the gut, the environment, and other factors. Genetics plays a big role in predisposing people to addictive behavior, but so does psychology, including our fears, our anxieties, our economic position, and our social position. Trying to isolate addiction to the action of chemicals in the brain will never be workable and more promising solutions can be found in treating the psychology of addiction.

Myth 3: Addiction is a disease.

This is where Dr. Dakwar starts to lose me. His argument, if I understand it correctly, is that addiction is part of the search for meaning, and addicts are reluctant to give it up because in some way the addiction gives their lives structure and meaning. Reviewing for The Guardian, psychiatrist Rebecca Lawrence accuses Dr. Dakwar of “trying to explain something that can’t quite be grasped.”

It’s an absolutely fascinating argument, however, because it meshes with much of the reality of recovery. Addicts find it difficult to simply stop using without replacing the activity with something else. This is part of the need to maintain structure, and to realize that not using feels like a loss to the addict that must be psychologically replaced. Behavioral therapy for eating addiction, for example, seeks to channel the urge to eat into healthier habits.

Myth 4: People with addiction lack freedom.

We hear about people in the grip of addiction, who are chained to their habits, or whose brains have been hijacked, all metaphors for the lack of control of an addict in the presence of his or her drug. But these are stories we tell ourselves, says Dr. Dakwar, and we can tell ourselves different stories. We can tell ourselves it was a phase, a passage, a moment in time but reality must change as well. It is very difficult to cure addiction if you live in the same place, see the same people, do the same things. Dr. Dakwar talks about this shift in the story:

A pivot occurs, sometimes all at once and without treatment, toward a wholly different way of being, where the entanglements of the past no longer have us in their grip.

Myth 5: Addiction requires a medical solution.

Dr. Dakwar is careful to state that medication is helpful in many attempts to deal with addiction withdrawal. His point is that medication is not required. More to the point, medication is not sufficient. By itself, it leads to relapse. Only with cognitive behavioral therapy of some sort are most addicts able to successfully reimagine themselves.

Dr. Dakwar suggests that the addict’s journey may have a great deal to teach us about dealing with problems, resisting urges, adjusting priorities, and building something new once you’ve hit bottom. Learning to deal with dangerous substances, toxic situations, peer pressure, poverty, loneliness, depression, and anxiety — are things all humans have to tangle with. The addict can teach us a great deal.

Written by Steve O’Keefe. First published July 17, 2024.

Sources:

“A Psychiatrist Breaks Down the Top 5 Myths About Addiction,” Next Big Idea Club, July 15, 2024.

“The Captive Imagination by Elias Dakwar review — a window into addiction,” The Guardian, June 5, 2024.

Image of The Captive Imagination book cover is used under Fair Use.