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What is addiction?

Module 03 Misconceptions in Treatment

So the state, health, function and education of the PFC is what determines your self-control. It determines your time frame: are you focused on the next few hours or what you want to happen in the next month or the next year? It determines if you avoid things that hurt your long-term health including the long-term health of your brain and self-control. It determines how much control you have over the use of alcohol, drugs, medications and other tempting short-term fixes that comes at a long-term price.

So why is treatment not focused on improving you in this respect? Why are rehab programs not specifically targeting changes that will improve your PFC and put you more in control? Why are there no education, training and treatment that is aimed as this kind of improvement? Why are alcoholics and addicts not improved by treatment in ways that make them less likely to relapse? Why is addiction treatment so inefficient that it has next to no influence on the relapse rate of the patients treated?Part of the answer is that addiction is informed by a set of severely misguided beliefs that are repeated everywhere, even if they are proven to be wrong and never made much sense in the first place. In the next few sections we are going to take a closer look at the way that addiction is understood and the different kinds of misinformation that makes it hard to everybody to deal with addiction and make improvements.

Let us briefly go over the main misconceptions in the common understanding of self-control and the PFC: First: The true nature of executive function is hidden by a reductionist understanding of short-term behavior. This is some simplified version of Darwinism, where going for the quick fix that will hurt you long-term is somehow “natural”. As if you were just being naturally greedy and doing what comes natural to you. And as if thinking about consequences is not pretty natural for a human.

Next misconception is that your level of self-control is genetic, is pre-determined and cannot be changed. And thus that you cannot effectively do anything to improve your present level of self-control if it is not serving your needs adequately. This is a great excuse for doing nothing, but it does not fit the evidence. Evidence shows that there are multiple different things that will limit your self-control and multiple different things that will improve your self-control.

The way that prefrontal function is usually explained is very abstract, focused on physiology and delivered in a medical jargon that does not make much sense to the average person. This understanding is so far removed from the challenges and choices of real people that it does not help people navigate the complicated lives that they face. If you are somewhat addicted to alcohol you will also notice how the information is often presented in a very pejorative, arrogant and demeaning way. The kind of language that is suited only to scare away the people who need the information the most. And most importantly: With respect to alcohol or drug abuse, low self-control is almost always explained as a bad consequence of drug use, and almost never as a cause of the use of drugs or alcohol.

This is perhaps not by accident. The task of gaining self-control is often framed in a vague moralistic way that suggest that any failure of self-control is really a moral failure and that any victim of bad self-control is really to blame for his or her own misfortune. Not only is this not true, not only is this not constructive in anyway, it is a major obstacle to improvement and probably one put there deliberately by people who in some way or another profit from people being weak and addicted.

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