Addiction: Disease or Conditioned Pattern?

Addiction: Disease or Conditioned Pattern?

This post is a follow up to last week’s “Stress, the social crisis of our time.” As most of you know, I work in rehab. The facility I contract with, Sierra Tucson, has five separate programs—chemical dependency (addictions), mood and eating disorders, trauma and chronic pain. As mentioned before, I regard all of these as stress related illnesses. If you recall, the reason I lump them all together is because I believe, at the root of each lies a common mechanism, what I call attentional fixation.

Attentional fixation is where a person’s attention gets stuck on something: like an obsession. Behind all situational stress is an obsessive, fixated attention. The reasoning behind my assertion is simple to understand. One’s attention is naturally drawn to objects one craves or hates. No one fixates on neutral objects. Attentional fixation therefore lies at the heart of emotion—intense liking or disliking. Emotions then release stress chemicals into our bodies—serotonin and dopamine on the liking side, cortisol and adrenaline on the disliking side. If the stress chemicals persist in a person’s body for too long, and in too high a concentration, biochemical “dysregulation ” occurs. In other words, we’re not born with our habits, we learn, or evolve our way into them. Downwardly spiraling mental and physical feedback is what eventually causes stress illnesses to arise.

Attentional Before
Accelerating Feedback

The mind and body are therefore interdependently connected through one’s emotional fixations. The whole of Buddhist psychology is based on this concept, i.e., people suffer because of uncontrolled cravings and aversions. Additionally, Buddhist philosophy teaches that psychology directly influences cosmology. In other words, ‘it is your mind that creates your world.’ The way I read it, Buddhism offers a more substantive and rational exposition for interdependence than does the “New Age” version of this same concept, what is now popularly referred to as the Law of Attraction. The pith Buddhist teaching on this subject is the 12-Links of Dependent Origination, or Dependent Arising. Let me list the 12-links and then offer an explanation.

  1. Ignorance
  2. Karmic Formations
  3. Consciousness
  4. Name and Form
  5. 6 Sense Bases
  6. Contact
  7. Feeling
  8. Craving
  9. Grasping
  10. Becoming
  11. Birth
  12. Aging and Death

Every being wants to be happy and to avoid suffering. This is referred to as the Universal Aspiration because it is universally true. What mindfulness expert Jon Kabat-Zinn refers to as the “full catastrophe” boils down to the sum of one’s effort to achieve this goal. But just like a blind man, we cannot unerringly walk a straight path towards happiness. ‘We stumble from the right road to the wrong road without a correct understanding of what we are doing[1].’ This is ignorance (1). It’s not our fault, we’re looking for happiness in the wrong places; we just can’t see clearly. But ignorance does not stop us from trying. In our efforts, we perform intentional actions. Such striving leaves imprints or memories on our nervous systems, which then feed back into the system to incline us to perform the same actions (2). Therefore, conditioned by ignorance, we create formations. The entirety of these conditioned tendencies then persist and condition our present moment consciousness (3). Consciousness, or a mind, so conditioned, gives rise to our mind-body and all of its tendencies (4). This habituated mind-body determines where our attention goes and what it fixates on (5 and 6). Attentional fixation creates emotion (7). Emotion left unchecked, intensifies (8) until one reacts reflexively (9) out of the emotion. Repeating these conditioned actions causes “becoming” (10) i.e., one becomes a smoker by smoking. A future moment conditioned by these past actions occurs (11). The endless process continues to evolve us (12).

Even modern scientists can be pressed to agree on this point; the universe we live in is absolutely, interdependently connected. Everything shows up in some way as a ‘chicken and egg’ dependency. The same can be said for addictions of all kinds—a person becomes addicted to nicotine by smoking, to alcohol by drinking and to cocaine by using. An addiction, no matter the kind, can’t arise before a set of actions. So I ask you, is addiction a disease of a conditioned flow of actions?

As explained deftly by the 12-links, one’s biology does change as a result of what one does. Neuroscience agrees on this point. This is an unassailable fact. And altered biology does affect one’s thinking—what and how we think depends on our brain activity. Said another way, we must think what our brain cells think. Thus a conditioned brain creates a patterned way of thinking, which in turn further changes the brain. This is called neuroplasticity, and is the self-reinforcing feedback loop I referenced earlier. Yet, all this being true, does it preclude one from making a different choice? Does the fact of neuroplastic interdependency leave no room for free will?

I ask these important questions because it is widely accepted, both by the public and the medical establishment, that addiction is a disease. Alcoholism and obesity are listed as diseases in the current Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. But is this so, and can thinking of addiction this way actually make it worse? There is evidence that defining addiction this way does indeed make it worse[2]. In informal conversations with hundreds of addicts, I’ve never encountered a person who did not answer, “yes” to this question: “Did you still know right from wrong the moment before your relapse?” The truth is, we know better. Maybe behavioral health professionals think that the disease concept helps people understand the seriousness of their problem. To me, the misunderstood idea of powerlessness instead engenders a victim mentality, which only increases the likelihood of relapse and chronicity.

I believe it’s important to teach the truth of both neuroplasticity and interdependent arising. From those perspectives, we are indeed powerless over our current imprints. Meaning, they’re there, and they do condition our present moment thoughts and feelings. But these teaching prove that powerless is not complete. We remain empowered make different choices, grow and evolve. Where most recovery programming falls short is not teaching this subtle distinction. When life gets tough as it inevitably does, and a person believes in the inevitability of “powerlessness over the disease,” that misinformed belief can then incline him to give up more quickly. And then the idea of “powerlessness” has become a self-fulfilling prophecy.

The ancient teaching of the 12-links of Dependent Origination and the modern science of neuroplasticity agree: our intentional actions create imprints that change us and from those changes emerge our habits of thought and behavior. But it works both ways; we can think and act our way into destructive patterns or healthy happy ones. The end result depends on where we allow our attention to go, and onto what we allow it to fixate.

Let me offer to teach you a daily mindfulness practice, one that will train you to watch your attention and regain your health and happiness. Please visit my website for more information on my guided meditation programs for healing stress related illnesses, retreats, and other recovery services. I want you to be happy.


Yours truly,



[1] Gethin, R., 1998, The Foundations of Buddhism, Oxford University Press, New York: Vibhanga-atthakatha, 150.

[2] The proportion of substance abusers in the population has slowly increased since the inception of 12-step programming.

2 thoughts on “Addiction: Disease or Conditioned Pattern?”

  1. mark…just read your skillyfully aware blurb on fb. I am disappointed that we didn’t meet earlier in my stay. things happen for a reason so it is what it is. you are on a level communication wise and intelligence wise that I have a hard time understanding completely. I mean that totally as a compliment to you!

    Are you saying in the blurb I read that any drinking or nicotine for anyone is negative behavior? For example, I can smoke occasionally and have for years and then I go without it for years. My husband is extremely happy and he chews tobacco (gross) and can’t walk away from food on his or his family’s plate(s). Neither his doctor or dentist say either is a problem. Are you saying any behavior that is “negative” is conditioned as opposed to an addiction. I am confused as I know may people who can have alcohol occasionally or smoke or overeat but it doesn’t impair their lives or relationships. Then I know people who can’t keep lots of things in moderation. I am thinking again about my question. are you saying any behavior that is “negative” is conditioned as opposed to an addiction. I am confused as I know may people who can have alcohol occasionally or smoke or overeat but it doesn’t impair their lives or relationships. Then I know people who can’t keep lots of things in moderation. I am confused!

    Do you ever travel outside of Tucson for conferences? I would be there in a heartbeat for example if you came to Chicago and I had enough time to plan. Wish you the best with your upcoming conference and happy holidays! Think of you often! Travel, please! best!

    • Hi Laurie, I’m not saying just negative behavior is conditioned behavior, all behavior is conditioned behavior. What ever we do creates imprints. Imprints are like memories, but include a whole flow of triggering sights, sounds, thoughts and sensations. For example, if an alcoholic sees a bar at an airport (sight and sound), thoughts related to past memories of drinking and the sensations that go with the urge immediately arise. All of it, is a conditioned pattern.Strong emotions related to craving and aversion strengthen conditioned patterns. The only way to break out of conditioned patterns is to work mindfully (observing, accepting, not acting) with the experience as it arises. That skillful awareness lays down new patterning. Make sense? Let me know if you have more questions. Best, Mark


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