Original Paper

Culture, Medicine, and Psychiatry

, Volume 36, Issue 4, pp 712-734

First online:

The Experience of Addiction as Told by the Addicted: Incorporating Biological Understandings into Self-Story

  • Rachel R. HammerAffiliated withMayo Medical SchoolSeattle Pacific University Email author 
  • , Molly J. DingelAffiliated withUniversity of Minnesota
  • , Jenny E. OstergrenAffiliated withMayo Clinic Biomedical Ethics Research UnitSchool of Public Health, University of Michigan
  • , Katherine E. NowakowskiAffiliated withMayo Clinic Biomedical Ethics Research Unit
  • , Barbara A. KoenigAffiliated withDepartment of Social and Behavioral Sciences, Institute for Health and Aging, University of California

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How do the addicted view addiction against the framework of formal theories that attempt to explain the condition? In this empirical paper, we report on the lived experience of addiction based on 63 semi-structured, open-ended interviews with individuals in treatment for alcohol and nicotine abuse at five sites in Minnesota. Using qualitative analysis, we identified four themes that provide insights into understanding how people who are addicted view their addiction, with particular emphasis on the biological model. More than half of our sample articulated a biological understanding of addiction as a disease. Themes did not cluster by addictive substance used; however, biological understandings of addiction did cluster by treatment center. Biological understandings have the potential to become dominant narratives of addiction in the current era. Though the desire for a “unified theory” of addiction seems curiously seductive to scholars, it lacks utility. Conceptual “disarray” may actually reflect a more accurate representation of the illness as told by those who live with it. For practitioners in the field of addiction, we suggest the practice of narrative medicine with its ethic of negative capability as a useful approach for interpreting and relating to diverse experiences of disease and illness.


Addiction Substance use disorders Narrative therapy Biological etiology