We’ve been told for several decades that the disease model of addiction would help people to stop blaming themselves for their substance use problems,provide hope, and motivate them to seek help. It’s supposed to be an empowering message. A new study from researchers at North Carolina State University demonstrates the opposite.
The researchers had one group of people with substance use problems read an article that described addiction as a brain disease, noting the changes in the brain that are correlated with addiction. This is the kind of information typically presented in public information campaigns about addiction and taught in treatment programs. The other group read an article meant to promote a growth mindset view of addiction, stressing “that addiction behaviors are subject to change.” It “described various factors that can contribute to substance abuse, and stressed that there are multiple ways for people to address their addiction.”
The researchers found that study participants who received the growth mindset message reported stronger growth mindsets and more confidence in their ability to handle their addiction, relative to the study participants who received the disease message. Importantly, there was no difference between the two groups regarding the extent to which they blamed themselves for their addiction.
Those who received the disease message also became less likely to want help than those who received the growth mindset message. These results were predictable and make sense. If you think that change is possible, you naturally become more likely to want to attempt change than someone who believes that change is impossible. The brain disease article used in this study quoted a researcher as saying that addiction “seems to be a fixed quality, remaining fairly stable over a person’s lifetime.” It only makes sense that those exposed to this idea would be less motivated to seek help and less confident in their ability to change.
The researchers behind this new study suggest we move away from the message that addiction is a disease. They’re right to say so, but not just because of this study. There has been much research to point us to this conclusion of the years. For example, one study in the late 70s found that alcoholics exposed to AA’s disease and loss-of-control concepts became far more likely to binge drink than those exposed to a choice/cognitive behavioral model of help. Even the control group who received no help in that study was less likely to engage in binge use during the year-long follow up period than those who received the disease messaging.A study by William Miller of the University of New Mexico during the mid 1990s tested dozens of factors to find out what could predict relapse following treatment. Those who scored highest on a test of belief in the disease model of alcoholism were the most likely to relapse, even after controlling for other factors. These are just a few of the results that have continued to mount, showing that the disease model of addiction is hurting rather than helping.
We should also move away from the brain disease model of addiction because it is factually wrong.It relies on a faulty interpretation of the neurological evidence. In a recent article for the New England Journal of Medicine, neuroscientist Marc Lewis explained how each of the brain activity changes seen with addiction actually represent the common neurological processes of learning and habit formation, rather than a disease process. For example, he notes that in the brain disease model of addiction it is claimed that “Addiction is characterized by a shift from impulsive to compulsive processing, loss of free will, and a shift of activation to dorsal striatum.” But Lewis explains that these shifts happen in many aspects of our lives, that “All behavioral habits devolve to stimulus–response mechanisms; automatization is a normal outcome of learning.” Addicts seem to mindlessly continue using drugs, but we all mindlessly carry out our habitual activities every day, most of which are not seen as addictions nor out of our personal control. This is part of being human, and as Lewis puts it, “why we can talk, eat, and drive at the same time.”
Lewis continues to knock down each pillar of the brain disease of addiction in the same fashion, showing that the brains of people with substance use problems are not diseased, but functioning healthily. He’s not the first to take down the disease model of addiction, but he is the first to show the folly of these brain disease claims in such detail. What we call “the disease of addiction” is a learned, preferred behavior. We can change our preference, and move beyond it by the same processes involved in all habit change. This means the growth mindset view of addiction is not only more inspiring and empowering – it is also more accurate than the brain disease model of addiction.
The growth mindset, as defined and studied extensively by Carol Dweck, is a belief system in which personal traits are malleable with effort. Dweck’s work focused mostly on mindsets regarding intelligence. Her research pitted the growth mindset against the fixed mindset, a view in which traits are unchangeable, and bestowed upon us at birth. What she found when studying mindsets among students regarding intelligence was that those who believe intelligence is a fixed trait tend to give up on academic tasks in which they struggle, whereas those with the growth mindset tend to persist and put in the effort to overcome the challenges. Over time, growth mindset students do better in school, choose more challenging classes and goals, and even increase their IQ. Fixed mindset students, even the “gifted” ones, tend to perform worse academically, increasingly choose easier rather than advanced classes, avoid challenging goals, and do not experience IQ score increases. Dweck also showed that educational interventions that help fixed mindset students to learn a growth mindset lead to them achieving the same performance gains as the students with a pre-existing growth mindset.
Dweck’s research isn’t limited to intelligence though. She’s also investigated the effect of mindsets regarding social abilities and personality traits. Results for these traits fit the same template as mindsets regarding intelligence. Most relevant to addictions, she tested the effect of mindsets on “willpower” tasks. Those who see themselves as having a fixed amount of willpower (like a fuel tank of willpower that depletes as you use it) do worse on willpower tests. Those who don’t see themselves this way perform better on willpower tests.
The current study from NC State is the natural next step of the mindset line of research. If mindsets towards personal traits and abilities have so much sway in other areas, it’s only natural to apply this framework to the effort people are willing to put into changing troubling substance use habits.The researchers noted that their findings “highlight the potential to use growth mindset interventions” in helping people with substance use problems. Luckily, this is already occurring, in The Freedom Model for Addictions.
Dweck showed that when she taught students who had a fixed mindset about the flexibility of their traits, they took on a growth mindset and began achieving the same performance gains as the students with a pre-existing growth mindset. She did this by presenting a course that explained how the brain constantly changes with effort and learning, allowing us to grow and change our abilities. Essentially, what she was doing was countering the barrage of information in our culture telling us that our brains are genetically hardwired to determine our traits.
This biologically deterministic message about human traits is heightened in the arena of addiction treatment, where troubled people are coerced to “admit they have a disease,” told constantly that drugs have “hijacked” their brains, and forced to listen to lectures and watch jargon-filled videos explaining to them that their brain dooms them to constantly crave and use substances. For 30 years, The Freedom Model has helped people with substance use problems by countering the disease model, and showing troubled people their inherent flexibility and power to change. We help them to escape that sense of doom that makes them want to give up their efforts to change. In the latest version of The Freedom Model, the growth mindset is explicitly discussed in chapter 10, after the reader has been shown that they are indeed flexible. It puts a great button on the lessons of the previous chapters. Once we get our readers and students over to the growth mindset side, we can then discuss the topics relevant to implementing growth and change.
Burnette, J. L., Forsyth, R. B., Desmarais, S. L., & Hoyt, C. L. (2019). Mindsets of Addiction: Implications for Treatment Intentions. Journal of Social and Clinical Psychology, 38(5), 367–394. https://doi.org/10.1521/jscp.2019.38.5.367
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