In Part 1 of this blog, I discussed the root and meaning of substance use disorder (SUD), as well as general criteria for its diagnosis. Part of the motivation to designate problems with drug use as a mental health disorder was to provide an avenue for insurance coverage for treatment. If seen as a medical disorder, insurers would be more inclined, and perhaps even mandated, to include treatment of SUD within their insurance plans. Indeed, the Affordable Care Act mandates that insurers cover the costs of SUD treatment, as well as other behavioral health interventions. Many believe this outcome is a positive consequence of the current classifications for problematic drug use. But there are also negative consequences to the medicalization of behavioral problems, including substance use.
Having a diagnostic label attached to you readily influences how you think about yourself. One of the problems with the label of SUD is that it makes people see themselves as sick rather than as sinners. Indeed, organizations like the National Institute of Drug Abuse argue that SUD is like diabetes or asthma—it is seen as an illness that has afflicted a person through no fault of their own. It is argued that the underlying cause of addiction is a combination of inherited factors and environment exposures (including adverse childhood experiences), things beyond a person’s volition. This easily leads to a view that they have no control over their drug use and that medical treatment is the only viable means to address their problem. While drug use can and does lead to medical problems, the root cause is spiritual and not medical. If the root cause is left unaddressed, the problem is, at best, simply covered over.
How then should we engage with those who report being diagnosed with an SUD (or having a loved one so diagnosed)? More important than debating the appropriateness of labels is understanding the implications for the individual bearing the label. The most significant issues for the counselee and others to recognize are responsibility and agency. SUD or addiction is not like Parkinson’s Disease or schizophrenia. A person enslaved to the use of drugs or alcohol bears a measure of responsibility for their present state—regardless of how use was initiated. This does not deny the complexity of factors contributing to the development of addiction. Nor is it inconsistent with the notion that some people may have an inherited predisposition making them more likely to develop addiction if they experiment with drugs, just as some people are more prone to anxiety than others. Inherited weaknesses do not remove responsibility.
Moreover, a person bearing the label of SUD retains agency, meaning they are not powerless to effect change. They have not been overtaken by something that is out of their control. A person with Parkinson’s Disease cannot make their tremors or shuffling walk disappear through self-determination. In contrast, a person with SUD can resist the urge to use drugs and being in places where such drugs are accessible. This does not deny that accomplishing abstinence is hard, but it is within reach. Removing agency can lead to hopelessness. I have had addicts say things to me such as, “I’m an addict. It’s who am and who I will always be.” This sense of being forever trapped in the compulsive use of drugs is not only erroneous, it is self-defeating.
Thus, however one wishes to label compulsive and destructive drug use, what truly matters is that such a label not negate the reality that choice is involved and individuals retain the ability to change. Biblical counselors can help counselees see how ways of thinking and doing lead to and sustain drug use. Moreover, they can show people that a mind renewed by the Spirit and Scripture can lead to godly ways of thinking and doing—which provides the resolve to abstain from intoxicating substances.
