Addiction is a psycho-biological disorder that, like a table, must stand upon four legs in order to support, sustain, and declare itself. The first leg represents the genetic, socio-biological predisposition to substance abuse, which facilitates and escalates the progression toward the substance-dependent state. The second leg represents the out-of-control, compulsive-craving, substance-seeking, and substance-abusing behavior that runs contrary to reason and sound medical advice.  The third leg represents the psychological enthrallment with its attendant justifications and denials that are needed to deceive and subdue the cognitive defenses.  The fourth leg represents the decline in the quality and duration of life that invariably results from this irrational substance-abusive and substance-dependent state.

Admitting addiction is the first step toward self-enlightenment Enlightenment, the first step toward accepting responsibility Responsibility, the first step toward recovery.

Denial of reality is a core human trait.  In Four Quartets, T.S.Eliot says: “Go, go, go, said the bird: humankind cannot bear very much reality.”  We spend our lives and intelligent energies diluting realities and justifying beliefs that are contrary to epistemological evidence.  We are reared to believe our dogmas and gut-feelings without cognitively questioning their sanity.  Our brains are inculcated from early childhood with indelible cultural ideas that furnish us with our herd personalities and ego defenses.  Hence, denial of addiction comes more natural to us than acceptance of its ugly realities.

Denial, burnishes our egos, saves them from time’s rust, and keeps them beautiful.  “I’m not an addict.  I can stop any time I wish.  There is nothing wrong with me.  I don’t believe what others think or say.  The whole world has to be wrong because I am right.  Modesty prevents me from saying it but, deep inside, I believe that I am a perfect being.”  That is how addicts commonly think.

Justifying excuses abound and the addict never doubts their veracity.  “Yes this is I; there hardly is a process that I could not justify,” says the Poet.  When it comes to smoking, we are all familiar with the euphemisms: “I don’t inhale.  I just puff for entertainment.  I only smoke with a drink, with coffee, after meals, at night, or on occasions.  I smoke to relax; it helps my nerves.  I smoke to control my weight; I’d rather smoke than be fat.  My grandfather smoked all his life and died at 96.  I can stop if I want to; once I stopped for seven years.  If it doesn’t kill me, something else will and if it does, something else won’t, so what’s the difference?”  Similar excuses justify drinking and drugs and we have heard them all...   

What can we do to promote health and halt the addiction epidemic that plagues our society?  There are no universal answers because most treatment approaches, so far, have suffered from steep failure and relapse rates.  It is far easier to raise a straight tree from seed than straighten a crooked one.  Although we should not abandon efforts to help addicts, we should direct our most sincere attention towards prevention, which means that we should inculcate the minds of our young children against addicting substances long before they are exposed to them and at a time when they are still impressionable.  “The child is father of the man,” says William Wordsworth.  Our hopes to eradicate addictions and save society from their onerous devastations depend entirely on our children.

Hanna Saadah was born in Amioun in 1946. He graduated from Tripoli Boys School in 1963 and earned his MD from the American University of Beirut in 1971. He did his post graduate training at the University of Oklahoma Health Sciences Center where he was awarded the American Board of Internal Medicine in 1974 and the American Board of Infectious Diseases in 1976.  He is an Emeritus Professor of Medicine and a Fellow of the American College of Physicians. Dr. Saadah is also a novelist and a poet. He will be contributing an article on health every month.

2008 - ISSUE68