PTSD, Substance Abuse, and the Disease Model

This morning, I was listening to a Tedx presentation from Janet Seahorn on PTSD’s effects on the brain.

During the talk she says,

 “And I’m going to take issue to the word disorder. We’re changing the language. Because, post traumatic stress by a neurological standpoint is not a disorder. It is a reordering of your neural networks and pathways, and your sensory pathways, so that you can survive in a really dangerous situation.”

 The statement implicitly acknowledges the plasticity of neural networks. After all, what can be reordered, can be reordered yet again.

 We don’t call PTSD a disease simply because neural pathways become reordered as a result of traumatic experiences. Why then would we call addiction a disease simply because PET scans illustrate similar changes in neural pathways as a result of substance abuse? In what therapeutic world is telling someone, “you’re not a bad person, but you do have an incurable disease,” supposed to help? As a 20yr drug addict, I would rather be a bad person.

 Much like trauma clients, substance abusing clients need to be understood and empowered. To do that, we have to change the dialogue, and part of that change is removing ourselves from the disease mentality. We must recognize the difference between the ability to choose and freedom of choice. We also must recognize that addiction is much more than psychological and behavioral dependence and decisions. It is very much about emotion and attachment.