The Myth of Normal 175

target is a substance or a behavior. In short, the choice model ignores the question of what would drive a person toward addiction in the first place. Though the disease paradigm still embraced by most addiction specialists and treatment programs is more compassionate, it, too, misses the human element. It separates mind from body—or, in this case, brain from mind, seeing the brain in purely biochemical terms. The fact is, personal and social life events, filtered through the mind, shape the brain throughout the lifetime. You cannot, scientifically, cleave biology from biography, especially when it comes to a process as psychologically layered as addiction. Not that there’s no value in considering addiction’s neurochemical side. The brilliant work of Dr. Volkow and others has demonstrated that substances of dependence do, over time, change the brain so that essential functions, such as impulse regulation—which would aid someone in resisting addiction’s pull—become significantly compromised, even as the circuits of reward and motivation become trained on the desired drugs. In this sense, the brain does become an impaired organ, with diminished capacity to make rational choices, obsessively intent instead on satisfying the addictive drives. We err, however, when we focus on drugs alone: it does not take a substance addiction to bring about changes in brain chemistry. Scans have shown similar deleterious changes in the brains of nonsubstance addicts as well, such as inveterate internet gamers.[4] The compulsive intake of foods that trigger the brain’s reward apparatus can also produce such effects.[5] For all that, the equation of addiction with a largely genetically programmed, treatable disease[][6] is, as mentioned, scientifically and humanely a step forward from the shaming “bad choices” model. Just as we wouldn’t think of blaming the owner of a diseased kidney, it makes no sense to reproach someone for having a “sick” brain, especially if that “sickness” was inherited.[] The problem is that, in typical medical fashion, the disease paradigm turns a process into pathology. Note, too, that “treatable” is a far cry from “healable”—which says less about the nature of addiction than about the medical system’s failure to understand it. The word “disease” also crops up frequently in the world of twelve-step recovery. People in programs like Alcoholics Anonymous or Narcotics