Addiction and Virtue: Beyond the Models of Disease and Choice
by Kent Dunnington
Back to Vice & Sin
A Review by Ray A.
Before the advent of AA, what we now call alcoholics were just plain old drunks, bums, or, less disparagingly, inebriates. What we now call alcoholism was a bad habit or vice, namely, the vice of intemperance (hence the Temperance Movement). Seen philosophically and psychologically, it was the product of a weak will. Theologically it was the product of sin. Neither view did much for the alcoholic.
AA changed all of that. It popularized the terms "alcoholic" and "alcoholism" and gained widespread acceptance for the idea that alcoholism was a disease and the alcoholic a sick person. The idea that the alcoholic suffered from a disease helped AA to account for the involuntary nature of his problem: the alcoholic had lost control over his drinking. He was “powerless” over alcohol.
Its concept of a disease was unique. Reflecting the experience of AAs with medicine, psychology, and religion, it came to be understood as a “threefold” disease: physical, mental, and spiritual. Because experience seemed to show that the spiritual was the root of the disease, its treatment called for working a series of steps leading to a “spiritual awakening” which would free the alcoholic from the obsession to drink and enable him or her to grow and live on an entirely different basis.
As is well known, the 12-Step program that emerged from this has been very successful. It has helped millions of us alcoholics to stop drinking and rebuild our shattered lives. Adapted for use by other groups, the same Steps have helped millions of other people suffering from what later came to be called “addictions,” an umbrella term which now covers an increasingly wider spectrum of “disease.”
While the idea of addiction as disease caught on with the culture, the idea of a threefold disease never fared well outside of AA and the 12-Step recovery movement. Instead, the concept was deconstructed and reduced to the single fold of physiology. Addiction became a medical disease narrowly construed, i.e., construed “scientifically” as biologically determined. It came down to a matter of genes and brain chemistry. Moving to the other extreme, some "professionals" and other "experts" (in what by now had turned into a recovery industry) eventually started to challenge that view, arguing that addiction was not involuntary like a disease, but a voluntary choice. The alcoholic simply chose to drink.
As its subtitle suggests, Addiction and Virtue (A&V) is an attempt to go beyond these two now dominant and opposing views: the disease and the choice concepts of addiction. Addiction, contends the author, is neither a disease nor a choice. It is a habit. According to him, the category of habit (as found in Aristotle and Aquinas) offers an alternative to the disease and the choice models, both of which he claims are plagued with flaws and contradictions.
Dunnington convincingly argues that the disease concept understood in exclusively medical—in reductive and deterministic—terms is untenable. If addiction is only a medical disease, addicts should not be able to recover non-medically, that is, independently of medicine. But they do, by the millions. Hence the concept is patently false. We might also add what is a side but not an unimportant point, and this is the fact that few addicts recover solely through medical treatment. Most medically-based treatments work in tandem with one version or another of the 12-Step program or therapies inspired by it.
The fact that addicts can recover in a non-medical context is what led many in the “addiction studies” field to challenge the involuntary disease paradigm and argue that addiction is a matter of choice. On this view, what vitiates the addict’s will and makes him succumb to the object of addiction is not a disease but a character or moral weakness. But if the addict can simply will his own recovery if he so chooses, Dunnington points out, then he’s not an addict. The choice concept solves the addiction problem by denying the category of addiction. Drinking and drugging is just one more failure of will, no different from any other. Though couched in the contemporary language of choice, this view takes us back to the days before AA and erases whatever progress we have managed to make since.
As Dunnington sees it, the category of habit offers an alternative to the disease-choice dichotomy because of its ability to account for both the involuntary and the voluntary aspects of addiction. This is because, on the one hand, a habit is formed in the process of repeated voluntary action over time. On the other hand, once it is formed, the actions that follow from the habit are largely unconscious and involuntary. We just do, more or less automatically, what we have become used to doing. Thus habit facilitates action. In a moral context, the action can lead to the formation of a good habit (a virtue), or a bad one (a vice). For Dunnington “Addictions are like virtues and vices in this respect, [in that] virtues and vices are habits that empower persons to pursue consistently, successfully and with ease various kinds of goods . . . habits through the practice of which human beings aim at the good life, the life of happiness” (96). Vices differ from virtues in that the latter actually do lead to the good life while the former don’t.
In Dunnington's view, then, addiction is a bad habit or vice. But it isn’t the vice of intemperance, as was generally thought in the past. The alcoholic is not just pursuing the sensory pleasures associated with drinking. He or she is not pursuing a life of hedonism. Instead the alcoholic is pursuing certain moral goods, “like the ability to communicate, being at ease with oneself, being unafraid and being part of a community" (94). This echoes what we say in the rooms: drinking makes us feel like we belong; it makes us feel comfortable in our own skin; it makes us feel confident. For a while anyway, it makes us feel that we are OK and life is good.
But if addiction is not the vice of intemperance, then what kind of a vice is it? To answer this question Dunnington reaches beyond the philosophical notion of habit to the theological notion of sin. Addiction, he says, is not the same as sin, but it cannot be understood apart from sin. For, insists Dunnington, the good life that the addict seeks can only be found in a right relationship with God. Addiction is a misguided quest for that relationship, a form of counterfeit worship. It is the sin of idolatry.
Now, if Dunnington is right and addiction is a vice rooted in sin, if it is an expression of idol worship, wherein lies the solution? How does this understanding help the alcoholic to stop drinking or the drug addict to stop using? Dunnington doesn’t tell us. His is not a self-help book, he says. It is not meant to provide a list of steps or recovery principles. It is intended instead to help Christians “who rightly sense the spiritual significance of addiction . . . to articulate this significance in theologically substantive terms” (9).
And here we come up against an all-to-familiar problem. A&V is another book about addiction which is of no practical use to the addict. Dunnington is writing for a different audience, namely the church. “If addiction is false worship," Dunnington asks, "how should the church, which hopes to practice true worship of the true God, respond to addiction?” (169). Dunnington recognizes that such a question cannot be answered without taking into account the success of AA and the 12-Step movement. Indeed, throughout A&V he makes extensive use of the Big Book, the 12&12, and testimony from recovering addicts to support his own view of addiction. Hence one would expect him to find much of positive value in the 12-Step experience for the church to draw on.
That is unfortunately not the case. Though acknowledging the church’s abysmal failure to help addicts, Dunnington sees AA and the 12 Steps—despite their undeniable success—as presenting more risks than opportunities for the church. Regrettably, much of the analysis that results from this outlook reveals a lack of understanding of how AA works and how 12-Step programs in general do help the addict to recover.
This lack of understanding is in many ways baffling. Most baffling for a book that argues against the materialist, reductionist account of addiction as a purely physiological disease is its failure to even so much as mention AA’s alternative concept of alcoholism as a threefold disease. The book argues for a spiritual understanding of addiction and yet it ignores AA’s understanding that a spiritual malady is at the root of the physical and the mental illness in the alcoholic. It proposes a spiritual solution yet gives not the slightest consideration to AA’s solution of a spiritual awakening or experience. It advocates a distinctly Christian solution yet completely overlooks the distinctly Christian understandings underpinning the Big Book and the 12&12, including one of the most fundamental tenets of AA recovery: that "we are sober only by the grace of God" (12&12, 92). What, one may ask, is more distinctly Christian than the concept of grace?
A&V’s inability to seriously engage AA is evident from the start. One of the book’s main arguments against the disease concept is that it “obscures the extent to which persons may be expected to take responsibility for their addictions” (10). Yet no one takes more responsibility for her addiction than the person in a 12-Step program who assiduously works Steps 4 through 12. As another fellowship rightly notes “Amending our behavior and the way we treat ourselves and others is the whole purpose of working the steps. We’re no longer just “sorry”; we’re responsible.”1 Indeed, responsibility is enshrined in one of AA’s most important declarations: "I am responsible. When anyone, anywhere, reaches out for help, I want the hand of AA always to be there. And for that: I am responsible."
Saying that the disease concept obscures a person’s responsibility for his addiction is a little like saying that the concept of original sin or of salvation by grace obscures the sinner’s responsibility for his sin. The concept of disease, seen in spiritual terms as AA does, as fundamentally a “soul-sickness” (12&12, 49), is not at all incompatible with the concept of sin. Indeed, sin is often seen in orthodox Christian terms as being in the nature of an illness, a spiritual malady that exhibits physical, mental, and emotional symptoms, just as AA says of alcoholism.
Unable to appreciate the AA concept of a threefold disease, A&V is unable to grasp the AA concept of powerlessness. Thus we read that according to AA the “admission of powerlessness over alcohol is supposed to be the ‘first step’ toward regaining, in some sense, a power over alcohol.” By making this admission, “they [alcoholics] find access to a power sufficient to reinvigorate the once-impotent will” and make “the inroad to regaining power over the same behavior” (32).
Nowhere does the Big Book or the 12&12 claim that we regain power over alcohol in any sense whatsoever. Our admission of powerlessness is the start of a humble surrender of an illusory power over alcohol which, in the process of subsequent Steps, allows the grace of God to enter the alcoholic and remove the obsession to drink from us (12&12, 64). We are not given any power, strength, or control over it, nor is our will in any way "reinvigorated."
This conception of powerlessness is the basis of the AA claim that “once an alcoholic, always an alcoholic,” a claim Dunnington downgrades to a “slogan.” Far from being a slogan, that statement is central to the AA understanding of what an alcoholic is. There are of course many understandings of what an alcoholic is, but in AA, an alcoholic is by definition a person who has no control over alcohol and therefore cannot drink normally or safely like other people. Once the disease progresses to the point where I become alcoholic, I do not stop being alcoholic, that is, I do not regain control. What that means in concrete and practical terms is simple: I cannot drink again, ever. If I do, I revert to drinking alcoholically; I will not be able to take it or leave it as other people do.
It is in this sense that AA refers to “alcoholism as “no mere habit,” a statement Dunnington also appears to misinterpret. For him the passage is trying to make a distinction between “’merely’ problem-drinkers and those who are ‘full-blooded’ alcoholics” (68). From this he draws the conclusion that the text is conflating a habit with just a mere disposition or tendency. But the passage is not talking about problem drinkers at all. It is talking about drinkers in the early stages of alcoholism and those in the later stages. By sharing their stories, these low-bottom “last-gaspers” could show the others that they had already lost control over alcohol, sparing them “the last ten or fifteen years of literal hell the rest of us had gone through” (12&12, 23). The “mere” refers to the fact that alcoholism is the kind of habit that, as it progresses, leads to physical, mental, and spiritual breakdown. The AA idea of a “progressive disease” encompasses the concept of habit, a concept addressed elsewhere in our two texts. But those of us who regularly see people die of alcoholism and drug addiction would definitely concur that addiction is “no mere habit” but “indeed the beginning of a fatal progression,” which is clearly the point the text is trying to drive home.
AA doesn’t deny that habit enters into alcoholism any more than it denies that sin enters into it. It just doesn’t reduce it to either. Its concept of a threefold disease allows for both. Dunnington doesn’t seem to recognize this. Thus he claims that “Most addicted persons learn from their recovery programs and from a flood of addiction recovery literature to be averse to the language of sin” (126). That's not exactly how we see it. We avoid the language of sin in the rooms because of the stigma associated with it. We learn to avoid it because of our personal experience with religion. The attitudes of condemnation and shame it tends to foster is one of the reasons why alcoholics didn’t feel welcome and couldn't find any help in the church. Though these attitudes have softened—thanks in large part to AA—they have not disappeared.
Our negative experience with religion is one of the reasons why the Big Book emphasizes that ours is a spiritual and not a religious program. The number of people making such a distinction has grown exponentially since the start of AA and the 12-Step movement, and not just among those in recovery. But for Dunnington, as for other religious people, those who identify themselves as “spiritual but not religious” are just uttering a “platitude” (171). Such a dismissive attitude hardly makes religion appealing.
Ironically, Dunnington’s own comments unwittingly give evidence of the distinction he denies. This is illustrated by the assertions he makes about what addicts in 12-Step programs “must” do. “First, the addicted person seeking recovery must acknowledge a power greater than himself on which he is dependent” (he cites Step 3 as evidence). And “Second, [he] must adopt as his most fundamental identity that of “alcoholic or addict.” Thus “every time that a person wishes to speak in a meeting of Alcoholics Anonymous or some similar twelve-step recovery program, he or she must begin with the introduction, “I’m Joe, I’m an alcoholic,” or “I’m Sue, I’m an addict” (179-180, my emphasis in all three citations).
Of course, these “requirements,” as he calls them, are not requirements at all. “The only requirement for membership,” reads the AA Preamble, “is a desire to stop drinking.” The fact is that “must” is not the language of recovery. It is the language of religion with its commands, exhortations, and injunctions. We have a name for that. We call it “musty” language. Had AA tried to use it on alcoholics, it would have never gotten off the ground. Indeed that language, and the pressure and coercion that went with it, is one of the reasons why alcoholics split from the Oxford Group, which remained too much under the influence of religion even as it tried to distance itself from it. Following the split, AA consciously tried to fashion a different, less religious and more spiritual idiom, a "language of the heart," as we call it.
Step 3 doesn’t tell us what to do. It tells us what other alcoholics did that helped them stop drinking. The “decision to turn our will and our lives over to the care of God” comes gradually as part of a process of spiritual awakening where we come to trust God and surrender entirely to him. It is not a decision that can be imposed. It comes after we admit our powerlessness over alcohol in Step 1 and come to believe that God can restore us to sanity in Step 2. That admission of powerlessness is what leads us to identify ourselves as alcoholics. It too is an act of surrender and humble acceptance of a condition from which only God can deliver us. As I identify myself as an alcoholic, I am also identifying myself with other alcoholics. My admission is not an obligation. It is a recognition of spiritual fellowship. Dunnington shows a similar religious and erroneous understanding of the Steps when he suggests that after Step 1, “the other eleven steps can be understood as exhortations" (165). No they can’t. They are accounts of spiritual experience that works, spiritual principles practiced by alcoholics to stay sober and grow in recovery.
AA’s reference to “God as we understood Him” in Steps 3 and 11 is criticized along the same lines. Anybody who knows the history of AA knows that this phrase was part of a necessary compromise between those who wanted to make AA an explicitly Christian program and those who wanted to rescind with religion altogether and make it a secular psychology program. Were it not for that compromise, there would have been no AA. Nevertheless, the insertion of that phrase in those two Steps in no way changes the understanding of God which is found throughout the Big Book and the 12&12, an understanding that we have already noted is anchored in the distinctly Christian concept of grace. Nor is it accurate to state, as Dunnington does, that “Reference to ‘God’ was permitted to remain, provided that it was always accompanied by the caveat, ‘as we understand him’” (128). God is mentioned without qualification in Steps 5 and 6 and some 289 times in the pages of our two primary texts.
These and other misunderstandings and mischaracterizations unfortunately detract from what is an otherwise carefully reasoned book. Dunnington’s is simply not a sympathetic view of AA. He gives it as little credit as he can. Hence his final take on the program. “I am convinced,” he writes, “that the twelve-step movement has been successful largely because of the way in which its format and method demand transformative friendships” (184-185). Format and method: a curious conclusion for a book written from a philosophical and a theological standpoint. In any case, that—not anything of substance—is what the church should emulate.
The sponsor-sponsee relationship is given as a prime example of how format and method can be used by the church to foster friendship and attract addicts to it. The problem is that Dunnington conceives of such a relationship as an Aristotelian “master/apprentice” relationship (188). Thus he cites the 12&12 as purportedly calling newcomers to recovery “novices” and invents a “sponsor/novice” and a “master” and “apprentice” relationship (188) that not only does not exist in AA at all, but is contrary to its very spirit.
Dunnington’s take reflects the kind of leaders-and-the-led type of relationships that predominate in church. AA is a fellowship of equals, not a hierarchical organization. We have no experts or teachers, no students or disciples. Nor do we place ourselves “under the authority” of “elders” or in “relationships of accountability” (189). No matter how many years sober she may be or how much experience she has acquired, a sponsor is just one drink away from a drunk, just like a newcomer. She simply tries to pass on, humbly and gratefully, what has been so freely given to her.
What the 12&12 is talking about when it uses the word “novice” (60) is doing Step 5 with another person, that is, admitting the exact nature of our wrongs not only to God and to ourselves, but “to another human being”—who need not be one’s sponsor. The danger of “[g]oing it alone in spiritual matters” (60) was another negative lesson learned from the more religious Oxford Group, some of whose members believed God gave them direct “guidance” and so they had no need to check with others what that guidance was. This of course led to all sorts of presumptuous attitudes and behaviors.
Dunnington’s conclusion that “recovery is primarily an exercise of friendship” does not reflect a “twelve-step insight” (187) as he believes. Recovery involves both a program and a fellowship. The program is found in the Big Book and the 12&12 and, together with the 12 Traditions, forms the basis of the fellowship. The fellowship is spiritual because it is based on a common spiritual problem—being alcoholic—and on a common solution—a spiritual awakening, which results from the practice of the Steps. Without the Steps and the Traditions as laid out in our two basic texts, meetings can and do drift into secular group therapy—or, as in the case of some church groups which try to copy the “format” and the “method” of AA, into religion.
One final question remains. What does any of this—alcoholism, addiction, recovery—have to do with virtue? According to Dunnington, in its approach to addiction “The church must be bold to implement relational structures that are explicitly designed for training in virtue” (189)—training in the Aristotelian sense already noted. There are many problems with this. We will mention two. One of them is that much of “the church” has no use whatsoever for the concept of virtue2. The other is that Dunnington himself has but a limited use for it. For him, the only real virtues are those that are “infused” by the Holy Spirit. These require no effort on our part and reflect “the life of grace.” The other virtues are not really virtues at all but “glittering vices” as Augustine derisively called them. They require us to work for them and reflect “the life of sin.”
Thus grace and moral effort are set against each other. This runs directly counter to the AA understanding of recovery. It runs counter to the whole idea of working the Steps and practicing the principles of the program, principles which, though not always identified as such, include the virtues—whether “infused” or “acquired.” The concept of “a faith that works” (taken from the Book of James), that is, that combines grace and action, is central to the AA program of recovery. Hence the twin conclusion to the Promises of the Big Book, namely that a) “We will suddenly realize that God is doing for us what we could not do for ourselves,” and that b) “They will always materialize if we work for them" (84). Paul gives voice to this dual process when he tells us to "Work out your own salvation with fear and trembling, for it is God who works in you his purpose to accomplish."
We practice the virtues found in the Big Book and the 12&12 (among which are the three theological and the four cardinal virtues along with such other virtues as acceptance, compassion, forgiveness, generosity, gratitude, honesty, humility, kindness, patience, peace, perseverance, and tolerance) so that as we acquire them they can change us, so that as they turn into habits they become second nature to us and enable us to perform the actions characteristic of them consistently and with ease, whether under favorable or unfavorable circumstances. We know from on our two texts that we practice those virtues by the grace of God and in the service of God, not to “save” or build ourselves up. Practicing them is no sin. They are part of God’s will for us.
As our review suggests, much of A&V is based on a faulty understanding of AA and the 12-Steps. The book is nevertheless very much worth reading. Its flaws notwithstanding, it makes an important contribution to the understanding of addiction. This reviewer has read it three times and will continue to reflect on it. Its discussion of habit is instructive and of relevance to recovery.3 Unfortunately, Dunnington’s view of vice and virtue makes habituation applicable only to the process of addiction and not to the process of recovery.4 This is due mainly to certain theological commitments (God as he understands him) which effectively deny human agency and, as we have noted, pit grace against moral effort. This accounts for his almost total emphasis on the problem, another way in which his approach differs from that of AA, which focuses on the solution. After all, there is not much that can be said about the solution from a practical standpoint if God does it all and we do nothing but be passively infused.
This brings to mind the distinction C.S. Lewis made between looking “at” and looking “along.”5 In A&V, Dunnington seems to be looking “at” addiction from the outside, using the tools of his trade (philosophy and theology) to work out an “abstract and theoretical” (11) account of it. This is useful and necessary. But it is not the same as looking “along,” from the inside, as the addict experiences not only his addiction but his recovery. Of course such an internal, experiential look is not always possible to the specialist. But its value needs to be duly appreciated if one is to recognize the limitations of the specialist’s perspective and look at addiction as much as possible through the eyes of the addict and not exclusively through one’s own.
One is reminded also of a related insight of C.S. Lewis: “The application of Christian principles, say, to trade unionism or education, must come from Christian trade unionists and Christian schoolmasters: just as Christian literature comes from Christian novelists and dramatists—not from the bench of bishops getting together and trying to write plays and novels on their spare time.”6 So with the application of Christian principles to recovery from alcoholism and other addictions. It can best come from Christians in recovery—not from church leaders and thinkers. This does not obviate the need to follow AA's example and welcome the contributions of religion, together with those of medicine, psychology, and other disciplines. For it is probably the case that we can best approximate reality and hence deal with it most effectively when we look at it from both perspectives: "at" as well as "along." In recovery, both perspectives are directed to the goal of right living. To which the words of the Big Book: “The spiritual life is not a theory. We have to live it.” (83)
1. Narcotics Anonymous, Just for Today: Daily Meditations for Recovering Addicts, p. 196
2. See on this site "Practice What You Preach": A Review of Being Good: Christian Virtues
for Everyday Life
3. See "Practice & Habit" and "Of Mice and Men": A Review of The Power of Habit:
Why We Do What We do in Life, both on this site
4. For how the virtues relate to the 12 Steps and their role in recovery, see the book
Practice These Principles, Chapter A. These Principles, and chapter B. In All Our Affairs:
Emotional Sobriety. See also entries under The Virtues in "Practice These," on this
5. The Business of Heaven: Daily Readings from C.S. Lewis, August 1 – August 5
6. Mere Christianity, Bk III, Ch. 3
For other reviews, please click on Ray's Book Reviews.