Thursday, October 4, 2012

How A Crime Is Like An Addiction

Elizabeth Zelvin

A few weeks ago, I wrote about therapy, recovery, and finding out whodunit. I have more to say about the parallels, especially between fictional crime and the twelve-step recovery process.

According to the American Society of Addiction Medicine:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

When I started working in the addiction field thirty years ago, the role of brain circuitry had not yet been studied successfully. It was a big deal when the ASAM, ie the maverick part of the medical establishment, adopted the disease model that had first been proposed in conjunction with the founding of Alcoholics Anonymous in 1935. It was equally remarkable that physicians acknowledged the spiritual nature of the disease. That can be explained, without, without reference to any religion, as the hopelessness, negativity, and despair that underlie any destructive substance use or compulsive behavior. Finally, medicine and public policy agreed that the necessary condition for recovery was abstinence from the destructive substance or behavior. For reasons I won’t go into here, there’s been more debate about that in recent years, but it’s still a firm tenet of AA and the other 12-step programs, and I heartily agree it’s necessary.

So let’s look at the kind of crime committed in a murder mystery. Like an addiction, no matter why and how it starts, once committed, murder takes on a life of its own. There’s no way to put this runaway train in reverse. After the first murder, even when it’s committed for a seemingly justifiable reason by a previously law-abiding citizen, subsequent murders come more easily to the killer. Denial, the hallmark symptom of addiction, in the form of rationalizing, minimizing, and lying to oneself as well as others help justify further crimes. The killer, like the addict, gradually becomes more and more grandiose, narcissistic, and alienated from normal human relationships. The murderer’s “spiritual disease” may or may not include hopelessness and despair, depending on whether we’re talking about a psychopathic serial killer or an ordinary person who’s gone out of control. But certainly, as further crimes and more and more desperate attempts to escape detection unfold, the killer operates in more and more of a moral void.

So who’s the victim? In a murder mystery, of course, it’s the unfortunate person who gets killed. In addiction, the addicted person himself or herself is both villain and victim. In both cases, the secondary victims are all those affected by the murder or addiction: loved ones, family members, children, friends and colleagues who are hurt, deceived, and disappointed by the duplicitous criminal or addict.

The solution? For the addict, recovery, starting with the cracking of denial and admission that he or she is out of control and needs help. For the murderer, it’s getting caught and facing justice.

1 comment:

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