I also feel very strongly that addiction is a universal problem. All of us are taken up in addictive behavior. Hopefully, we are in a process of change now where we are beginning to see the universality of addiction. But still there is a tendency to focus on some kinds of addictions as the ones that are serious and to ignore others either because they are socially acceptable or because they don’t fit our conceptual model of what addiction is.

Tobacco Is Not Addictive?

I watched a movie the other night that was made in 1934 in black and white. All of the characters in the movie smoked. No wonder that generations of Americans were fascinated by smoking!

There was a tendency in the 1920s and 1930s to encourage people to smoke in the belief that smoking facilitated concentration. During World War II soldiers were issued cigarettes in their rations. You only have to look back to the 1950s to Life magazine to find doctors selling cigarettes. You will find full page ads of doctors in white coats with mirrors on their heads, holding out packages of Old Golds saying, “I recommend these to all my patients because they’re soothing to the throat.” Imagine. That was forty years ago. It was only within the past ten years that the American Medical Association was forced to divest itself of tobacco stock by voices of protest from its constituents.

When I was a student in Harvard Medical School between 1964 and 1968, I was taught that tobacco was not addictive. I was taught that it was a health problem in that it led to emphysema and lung cancer, but there was not a word about it being addictive. It was a psychological habit and therefore unimportant. So it was not discussed. We didn’t hear much about what they considered real addictions, either. Basically we heard a little bit about heroin addiction, which was the model or prototype of addiction. Tobacco did not fit that model so it wasn’t taken seriously. Nobody paid any attention to it, and that consensus was so strong and it so affected American science that no one even did research to find out why that substance had such a powerful control over people’s behavior.

For years I have urged people to look at smoking for what it is. Heroin addicts only have to get a fix once, twice, or three times a day. Tobacco addicts have to fix up every twenty minutes. Every twenty minutes the brain demands a discrete pulse of a high dose of nicotine coming through the arterial system. Why didn’t anyone do research on that? Why didn’t anyone look to see how nicotine caused such a profound influence on brain physiology? They didn’t do it because it didn’t fit the conceptual model and because it was a socially acceptable addiction.

Other “Non-Addictions”

Well, there are many other socially acceptable addictions today that we don’t take very seriously. It’s awfully difficult in mainstream America to talk about sexual addiction as a concept. In the cultural context in which we live, sexual addiction is invisible.

Or take addiction to work or addiction to making money. These are both things that our culture tells us are good. So it is not seen in the same way that addiction to an unpopular drug is seen.

I think that many of our theories of addiction and our ways of looking at addiction are limited because they don’t take into account the full spectrum of addictive behavior. As an example, let me read you a definition of addiction: “In the broadest sense, addiction can be defined as an attitude that sees various aspects of the material world as exclusive sources of satisfaction. Addiction, understood in this way, represents a prominent feature of the entire Western civilization, which has lost the connection with its inner resources.”

What about addiction to thought? That’s something hardly ever discussed in the Western world. It is discussed in Buddhism. In Buddhist psychology, addiction to thought is seen as a serious impediment to enlightenment. That’s one of the reasons you meditate — to try and get some freedom from thought. So you could look at universities as monuments to thought addiction where you are rewarded for the beauty or complexity or novelty of the thoughts that you produce. Given that social context, with those social rewards, why would you ever even think that thought could be addictive. And if your conception is that addiction involves something material and external, then that doesn’t fit, so you don’t pay attention to it.

I maintain that the essence of addiction is craving for an experience or object to make yourself feel all right. It’s the craving for something other than the self, even if that’s within the realm of the mind. I also feel that addiction is something that’s fundamentally human; it affects everybody.

My Addiction is Better than Your Addiction

It’s very easy to feel special about our addictions. One of the things that in the past has put me off about some of the twelve step programs is that they tend to regard certain addictions as more important than others, that alcohol addiction is somehow fundamentally worse, more difficult, than coffee addiction, the most interesting drug at the moment, because it’s a hidden addiction in our culture.

So I don’t agree that alcoholism is somehow more important than coffee addiction. On the level that I’m talking about, on the level that we have to look at addiction, it is the same thing. It’s the same process. It’s the same craving for something apart from yourself to make you feel okay.

What I’m most interested in is that process. What is the origin of craving? And what is the solution to the craving?

Addiction Does Not Equal Pleasure

I had a patient come to me about four or five years ago who was shooting five to six grams of cocaine a day intravenously. I had never encountered cocaine use on that scale. She had been doing that for six months and had gotten into it after several years of snorting vast amounts of cocaine. When she moved in with a man who was dealing cocaine, he introduced her to using it intravenously and her usage quickly escalated. Remarkably, given the nature of that drug and the nature of her usage, she was in good health. She actually held a job. She was a single mother, and at the moment she was doing a fantastic juggling act of keeping her life together despite her drug usage. I didn’t know how much longer she would be able to do that.

I learned a number of things just in listening to her talk about her addiction. First of all, in describing the experience that she had from using cocaine in this way, she said that the first few minutes after the first injection of the day, she felt an overwhelming pleasure and rush. But that was it for pleasure. The rest of the time — five or six hours — was filled with paranoia, violent shaking, insomnia, and palpitations.

I find this interesting because many people think that people get involved with addictions because they’re sources of pleasure, but when you look at people caught up in extreme forms of addiction, especially with substances and food, the percentage of pleasure relative to the percentage of distress is minimal. There’s not that much pleasure there, so the pleasure is certainly not the thing that keeps the addiction going. So after going on very articulately about how awful her life had become being a slave to this compulsion, she looked off and said something that was just a beautiful expression of the plight of the addict.

She said, “I want not to want it.”

What Is Craving?

If you want not to want things, how do you achieve that? What is this problem of craving? Where does it come from? What is the origin?

Why do we crave? Why does everyone crave? Why aren’t we content to just be as we are? If, in fact, our core essence of being is pure self-luminous consciousness, why do we have to go outside of that? That’s not an easy question to answer.

To me, if you try to trace the root of craving, you literally get tied up with the origins of the universe and the evolution of human consciousness. It’s that fundamental. It’s that much a part of our humanness. Not only is addiction universal, not only are all of us in it, but it’s the essence of our being as humans. It’s not something to be disowned. You can’t do that, because addiction is part of our core being. It’s part of who we are.

Given that, what can we do about addictive behavior? I can think of only two things to do about it. The first is to try to move it, to try and shift it so that the forms of its expression are less harmful rather than more harmful. lt is better to be addicted to a twelve-step program than to be addicted to alcohol. It is better to be addicted to exercise than it is to be addicted to smoking. You can make those value judgments about addictive behavior. And that approach to addiction should not be discounted because, in fact, maybe that’s the only thing that most of us can do.

The only other strategy is to try and get at the root of craving. The Oriental religions would have us believe that this is possible through intense introspection and meditation and practice. I’m not so sure of that. I think maybe you can go a long way — you can get way down there — but if the origin of craving is indeed tied up with the origin of the universe, then I’m not so sure that it can be uprooted. I think all you can do is do the best you can. I mean, go after it; try and contain it and understand it. The biggest mistake we can make is trying to disown it.

Acceptance Leads to Solutions

What we need to do is to accept that aspect of our humanness and work with it so that it’s not destructive to ourselves or to other people. We also need to celebrate it for what it is. Because it connects us with all other people, it’s a source of great compassion and great empathy. It’s a motivation to work with others to try to halt the kinds of destructive behavior that are happening today. I can think of nothing more important than that.

— Dr. Andrew Weil is a botanist, physician, and author.

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