Over the course of three decades, the people I have treated have generally not been weak-willed.
A significant number of these individuals have been surgeons, lawyers, entrepreneurs, and senior executives—people whose careers were based exactly on the ability for prolonged self-denial, which they are told that they do not possess. They had studied for many years, run businesses, had children, and had held themselves to standards that most people would regard as intolerable.
They couldn’t manage to stop drinking.
The explanation must clearly be wrong since it predicts the opposite of what is actually observed. If addiction were indeed due to a deficiency of willpower, then those people who showed the most willpower should have been the least affected; they haven’t.

What the willpower frame gets right

I agree with the strongest form of the counter-argument since entirely dismissing it leads to a different kind of error.
People do make choices; one of them buys the bottle and another opens it. These are actions carried out by a person, not things that happen to them, and any explanation of addiction which completely removes agency is both inaccurate and clinically unhelpful since it suggests that nothing people do makes any difference, a notion which is neither true nor useful.
Recovery also most certainly calls for effort—great and continuous effort. Anyone who suggests that it does not is someone who has never actually gone through it.
The problem isn’t that there is no choice; it is that the term ‘willpower’ refers to the incorrect thing, and when the incorrect thing is described, the wrong kind of treatment follows.

What willpower actually is

Approximately speaking, willpower is the ability to overcome an impulse in order to achieve a longer-term goal.
Look at the elements of that definition. It assumes the presence of an impulse and portrays it as a struggle between a force pulling and a force resisting.
What this shows is that willpower reflects the degree of resistance and gives no at all information regarding the strength of the thing that is being resisted.
That is where the entire argument fails. It regards the person’s resistance as the variable and the pull as constant—as if everyone experiences the same impulse and differs only in the extent of their resistance.
They do not.
Suppose that two people are given a drink. In the first case, the alcohol is pleasant; it has a reasonable taste and causes a slight warming effect. The refusal involves almost no effort since there is very little to refuse.
With regard to the second case, alcohol is the only reliable method they have discovered for getting rid of a particular, intolerable internal condition — namely, a persistent anxiety, an intrusive memory, or a silence which they cannot bear. To refuse to take it means being left in that state since there is no other alternative.
It is stated that both have a choice, since this is the formal position. However, the choices they are making are not the same, and it is as if you were comparing the grip strength of two people when one is holding a suitcase and the other a car.

The question that actually matters

That is the reason why, from a clinical point of view, I do not consider the question “how much do you drink” to be very interesting after the first few minutes.
The interesting question is: what is it doing for you?
No one drinks every day for years simply because they enjoy the taste; alcohol is carrying out a certain function. From my experience this function is almost always one of a very limited number of things.
  • Switching off anxiety that is otherwise continuous
  • Interrupting memories that become available when the house goes quiet
  • Making social situations survivable for someone who finds them unbearable
  • Filling a silence, or an emptiness, that has no other content
  • Producing a temporary reprieve from a persistent sense of being fundamentally wrong or bad
  • Providing the only reliable hour of relief in a day
As soon as you have worked out which of them it is, a number of conclusions can be drawn right away.
You know how difficult it is to stop — it’s not because the person is weak, but since stopping involves giving up the one tool they have that works for a real problem and receiving nothing as a result.
You can see why methods which depend on willpower result in that cycle—of control, exhaustion, collapse, and shame, before resuming again. Continued resistance is both a metabolic and a psychological burden. No one is able to maintain it indefinitely when the fundamental pressure stays the same.
You know what the treatment really consists of—it is a matter of dealing with the pressure, not just of strengthening the resistance.

Why the frame does active harm

That is not just a wrong description; it causes damage by means of a particular mechanism.
If addiction is due to a weakness of willpower, then the fact that one keeps on drinking shows that there is a character flaw — not a difficulty, but a defect. It means that you are the kind of person who cannot do the things that ordinary people are able to do even with some effort.
It’s a shameful kind of narrative, and shame is one of the strongest indicators of ongoing use that I come across in my clinical practice.
The mechanism is sadly elegant. Shame is a very unpleasant internal feeling. There is one reliable way for a person to make unpleasant internal states cease, and that way is to drink alcohol.
The frame causes a certain feeling, that feeling in turn leads to a particular behaviour, and the behaviour then confirms the frame. It thus forms a closed loop and individuals can stay within it for decades.
I have observed it in operation more times than I can remember: the harder people are told to exercise their willpower, the more they drink — not as a act of defiance, but because failing to exercise willpower produces exactly the state which drinking is meant to alleviate.

Why “it’s a disease” is not the whole answer either

The usual replacement theory is the disease model, which regards addiction as a chronic medical condition of the brain.
It has genuine advantages; it is largely correct concerning the neurobiology, it diminishes moral blame, which is truly useful, and it accurately points out that a physical change has taken place and that this change is not undone by intention.
On its own, however, it has a weakness which I frequently observe in practice; it may lead to a state of passivity — the feeling that one has a condition being imposed upon them, about which they are basically just a spectator — and since it focuses on the substance, it promotes a treatment approach that is based on getting rid of the substance rather than on the individual.
Both the frames only deal with half the question: Willpower explains why you won’t stop and places the blame on the person, whereas Disease investigates what has happened to your brain and focuses on the chemistry.
Neither asks what benefit this brings you or what changes would be necessary for you to no longer need it.

What replaces the frame in practice

If we regard drinking as serving a function, then treatment must perform two things rather than just one.
First, safely remove the substance. Where there is physical dependence, this is a medical process, and it is not optional or negotiable. Alcohol withdrawal can cause seizures and can be fatal, and no quantity of psychological insight makes it safe.
The second point—indeed, this is the one that decides whether the proposal is valid—consists in considering the function. You must determine what role the alcohol was playing and then design something that carries out that function, or else reduce the pressure which had made such a function necessary.
When it comes to anxiety, the anxiety has to be treated. If the issue is interfering with trauma memories, then the trauma requires proper clinical intervention. If the problem is occupying a silence, then the silence needs to be filled with something, and from my experience that something is almost always people.
The reason why the principle which I have been coming back to for thirty years is that the opposite of addiction is not sobriety, but connection.
Sobriety involves taking something away, which creates a vacancy. Recovery is what fills that vacancy, and if nothing fills it, the vacancy will eventually be filled again with the thing that was there originally.

What this means if you are the person drinking

It is probably not the case that you are weak; you have most likely been putting in tremendous effort for a long time by using the one method you had been given, and that method couldn’t have worked because it focused on the resistance rather than on the pull.
The more useful question is not about wanting it more, but rather what effect the drinking actually has and what would have to be the case in order for you not to need it.
It is a question which has an answerable form and therefore should be the starting point of any treatment; it is precisely what our first assessment is meant to find out—not how much alcohol you consume but rather what lies beneath that.
If you want to have that conversation, you can reach us on 069 624 3110 or at info@recoveryfromhome.co.za.
And if the honest answer to “what is it doing for you” frightens you, that is not a reason to avoid the question. It is the reason the question matters.
This article is general information and not medical advice. Alcohol withdrawal can be life-threatening in physically dependent individuals — consult a doctor before stopping abruptly. If you are in crisis, contact emergency services or SADAG for support.