If Addiction is Considered a Medical Illness, Why Should it Require a Moral Inventory?

By Steve K.

Some critics of the 12 Step approach within the field of addiction ask this question and view the practice of taking a moral inventory as part of a recovery program as invalid and unscientific in relation to addiction treatment. In my opinion, this viewpoint seems to be based upon a narrow understanding of the addiction recovery process which in practice involves biological, psychological, social, and behavioural changes.

The scientific journalist, author, and addiction writer Maia Szalavitz is one such prominent critic of the 12 Step approach to addiction treatment. The following quote from her New York Times article ‘Can You Get Over an Addiction’, is a common example of her negative viewpoint in relation to taking a moral inventory and making amends for harms done to others as an aspect of addiction treatment.

“We treat no other medical condition with such moralizing — people with other learning disorders aren’t pushed to apologize for their past behaviour, nor are those affected by schizophrenia or depression.”     (1)

While I accept that addiction to alcohol and other drugs can occur regardless of a person’s character, virtue, or moral fiber this doesn’t mean that practicing a self-reflective moral inventory and making amends isn’t a helpful part of the addiction recovery process. Moral self-reflection, meditation, and the exercise of virtue is a beneficial practice leading to peace and well-being and goes back to the ancient Greek and Roman philosophers.

“An unexamined life is not worth living” Socrates

“Knowing yourself is the beginning of all wisdom.”  Aristotle

Human beings have a naturally evolved capacity to reflect ethically and morally as we can anticipate the consequences of our actions and make value judgements. The decisions and actions we take have moral consequences and recovery from addiction involves changes in thinking, behaviour, and quite often our relationship boundaries. So moral self-reflection in recovery can be viewed as part of a naturally occurring human process and not some type judgemental penance.

The well-known mutual help organisation Alcoholics Anonymous (AA) and its suggested 12 Steps for recovery view alcoholism as an illness of the mind, body, and soul and view healing and recovery as a holistic process. In the ‘Doctors Opinion’, which is an introductory chapter at the beginning of the book Alcoholics Anonymous (aka the Big Book, p.24, 3rd ed), alcoholism is described as an illness which results from being ‘maladapted to life’ combined with and an unknown ‘physical factor’ (an illness of ‘mind and body’) responsible for the compulsive behaviour seen in those addicted to alcohol.

This understanding is an early version of the ‘medical model’ of addiction before the advent of modern research and the use of technology.. which has clearly mapped out the neurobiology of addiction and its effect upon rational choice and decision making in people suffering from the condition. Despite the lack of scientific study back in the 1930’s when the ‘Doctor’s Opinion’ was written, AA’s suggested theory of alcoholism has been largely validated by modern medical research, which considers addiction an illness with biological, psychological, and social interacting components.

Early members of AA found that following medical intervention to relieve physical dependence, a spiritual and altruistic approach (and therefore moral) was effective in helping them to recover from chronic alcoholism. They found that through spiritual practice and helping others to recover (behavioural changes) they healed mentally and emotionally and were able to maintain physical freedom from alcohol.

A self-reflective moral inventory as part of treatment encourages personal responsibility, self-awareness, and behavioural change which most would consider as necessary for recovery from addiction to occur. Awareness of one’s thinking and how this impacts emotionally and behaviourally is the basis of Rational Emotive Behaviour Therapy (REBT), which is used in other scientifically based programmes for addiction, e.g., SMART recovery. The ABC self-reflection tool used in SMART (Self-Management and Recovery Training) is very similar to the Step 4 inventory model used in 12 Step recovery.

Regardless of its causes or nature, addiction is an illness/behavioural condition (I avoid the label disease, as did co-founder of AA, Bill Wilson) that tends to corrupt the suffer morally over time leading to selfishness, dishonesty etc, and often results in substantial harm to others. It is a condition that negatively distorts emotions and cognitive processes and can significantly alter personality.

Therefore, addiction is a condition that a moral, psychological, and behavioural inventory and interventions process is without doubt appropriate to engage in for individuals trying to recover. Sharing a moral inventory with others and making amends also relieves the burden of shame and guilt that often accompanies addiction and can help to heal damaged or broken relationships. I acknowledge that not everyone who suffers addiction needs to do this type of work (AA only suggests it), and that many who suffer addiction are clearly victims as well and require support and compassion as part of their recovery. Mutual compassion, love and service are a core characteristic of 12 Step fellowship groups, and this type of support is an important component of the change, healing, and recovery process.

The “bio-psycho-social [and AA would suggest spiritual] model provides a holistic conceptualization of addiction that acknowledges the complexity of the disorder and provides guidance toward a solution, which must necessarily be multifaceted and holistic as well.” (2)

The practice of taking a moral inventory and making appropriate amends fits well within a holistic approach to recovery from addiction. Many in recovery can attest to the benefits of carrying out this age-old ethical and spiritual practice. I am myself one of these beneficiaries.

References

  1. ‘Can You Get Over an Addiction?’ By Maia Szalavitz, NYT, 26/06/2016.
  2. ‘What Exactly Is the Biopsychosocial Model of Addiction?’ By Amanda L Giordano, Psychology Today, 10/07/2021.

Further Reading:

Addiction. By Steve K.

4 thoughts on “If Addiction is Considered a Medical Illness, Why Should it Require a Moral Inventory?

  1. Excellent article, you tackle criticisms of AA not as if defending AA but defending a proven methodology which happens to be suggested by AA and seems to have worked. It has worked in my life for 42 years and I observe it working in the lives of so many in my area. I enjoy your writings and encourage you to more.

    Liked by 1 person

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