[acb-hsp] Do Addicts Have Free Will?

[peter altschul]

Do Addicts Have Free Will?
  Chris Wright November 30, 2012
  Recently, the American Academy of Addiction Psychiatry sent me 
a paper by a Dr.  Richard Rosenthal, which contained what the 
author allowed was an "overwrought" scenario.  A young crack 
addict has been given a choice.  A man is holding a pipe in front 
of her and a gun to her head.  Have a smoke, he says, and I pull 
the trigger.  The addict responds: "Do I at least get to take a 
really big hit?"
  The story is meant to illustrate the dissolution of willpower 
in addicts, a central point of the paper.  The doctor goes on to 
remark that, "as a result of loss of control in the addicted 
state, people can make exceedingly bad and completely 
unreasonable decisions." You could take this argument further, 
however, and say that the woman here isn't making a bad decision 
at all, for the simple fact that there is no decision to be made.  
Sick as she is, the addict is no more able to resist her impulse 
than a Tourette's sufferer is able to control his tics.
  The disease model of addiction is so widely accepted, it has 
become dogma.  Drug Czar Gil Kerlikowske, director of the US 
Office of National Drug Control Policy, recently delivered a 
speech at the Betty Ford Center, in which he argued that drug 
dependency should no longer be viewed as a moral failing, but as 
a medical condition-which says something about the degree to 
which this idea has taken hold.  "The disease of addiction, like 
other diseases, is chronic and organic," the Betty Ford website 
tells us.  "It sites the brain as its target organ.  It relapses.  
It remits.  It is cunning, baffling and powerful."
  There's some interesting semantic jiggery-pokery in the above 
statement, not to mention some dubious science.  While any 
reasonable person might buy into the idea that addiction is 
chronic and organic, a glitch in the brain's reward system, here 
we have addiction presented as an "it," a cancer-like entity, 
perhaps, that somehow moves into, and subsequently corrupts, the 
brain.  And that's not allbtake another look at the language: It 
relapses, not you; it is cunning, not you.  In fact, there is 
very little of you left in this analysis.  It's as if you've been 
possessed by a demon spirit.
  As a compulsive gambler, I find a certain appeal in the idea 
that there's a foreign entity burrowing inside me.  Like all 
addicts, I carry misery around like a stink.  And, like all 
addicts, I am a fantastic liar.  I lie constantly, atrociously, 
both to hide the results of my habit and to ensure that it can 
continue.  And the person who most readily swallows this line of 
bulls--t is me.  I cannot count the number of times I've had my 
last spin, made my final trip to the ATM.  And every time these 
lies are exposed for what they are, every time I've made 
decisions that hurt not only me, but my family, the post-spree 
self-recrimination has grown increasingly damning.  I am, by 
popular internal decree, a bad, bad man.
  One of the much-touted benefits of the addiction-z-disease 
model is that it helps mitigate these feelings, which are thought 
to stoke a fundamental psychological aspect of addictive 
behavior: The belief that you are damaged goods, that you don't 
deserve better.  For sure, I started to feel a lot more positive 
about myself when I accepted that I had an illness rather than a 
rotted out moral framework.  I also started coming to terms with 
the notion that, because this illness had rendered me powerless 
to my gambling, the only solution would be to stop completely.  
Hurrah!
  Only I didn't stop.  In fact, as I entered into that important 
phase of accepting that there's something catastrophically wrong 
with me, my problem worsened.  And I think I know why.  You see, 
by ascribing to the idea that there is an it inside me, a demonic 
being that overrides free will and makes me do these terrible 
things, I divested myself of responsibility.  In doing so, I 
created the Mother of All Rationalizations.  I can now go home 
after a disastrous night and tell myself that I'm the victim 
here, which somehow makes it easier to go out and do it all over 
again.
  Dr.  Alex DeLuca, a New York-based addiction specialist, has 
heard this story before.  "Ah," he says, "it turned on you, huh?" 
He goes on to point out that my biggest problem stems from the 
fact that, having identified my condition, I failed to do 
anything about it.  "You've fallen into a binge pattern: 'Oh 
well, I'm down to zero days, so may as well go mad, have a cry, 
then start again tm.' That's harmful.  You need a good 
therapist."
  Maybe so.  But it seems to me I will also need to do a little 
internal adjusting on my own behalf.  And part of this will be 
accepting that, contrary to the received wisdom among addiction 
specialists, a little self-loathing can be a good thing.  At 
least that crushing sense of moral failure serves as some form of 
deterrent, and suggests a degree of agency on my part.  "I 
couldn't agree more," says Damian Thompson, a U.K.  journalist 
and recovering alcoholic, who this year published a book titled 
(no relation to this magazine) The Fix.  "A little self loathing 
is the only thing that stops me from indulging in various 
addictive behaviors."
  Thompson's book is highly critical of the addiction-z-disease 
model, particularly with regard to the way it tends to gloss over 
free will and personal responsibility.  "You cannot apologize for 
human behavior as easily as the 12-step people or the 
neuroscientists seem to think," he says.  "Nobody is compelled to 
do these things.  Even if someone has a gun to your head, you're 
still making a choice.  It may be a highly predictable one, but 
in philosophical terms it's not what you can call a true 
compulsion."
  While Thompson allows that there may be benefits to viewing 
addiction as an illness-"It helps people make sense of the random 
and rather frightening things happening to them"-he also believes 
that, in explaining away people's bad decisions, it can hinder 
their ability to make good ones.  "I had a friend who kept 
relapsing, going in and out of clinics, having the disease model 
shoved down his throat," he says.  "In the end he stopped for 
practical reasons: He got married and had kids.  No one's been 
able to explain to me how someone with an organic disease was 
able to help himself through the exercise of free will."
  Alex DeLuca, like Thompson, takes issue with the flexible 
scientific principles underlying the disease model of addiction, 
but he doesn't dismiss the idea altogether.  "I think it's a nice 
story that can be used to get people in the door," he says.  
"It's like the nursery rhymes that teach children how to read.  
But once you've learned, you have to go and find the real story.  
So let the fairytale bring you to the awareness that you are in 
trouble, then start getting professional help."
  Professional help's a start, but the fact remains that all the 
treatment in the world isn't going to remove the addict from 
temptation.  Avoiding the bars and the betting parlors requires 
willpower, the element of choice.  As effective as the disease 
model has been at reducing the stigma associated with addiction, 
it has also diminished a couple of important elements in the 
recovery process: The sense that we are ultimately in charge of 
our own destinies, and that we must accept responsibility for our 
actions.  Sure, this approach may cause us to bang our heads 
against the wall from time to time, but that may be just what the 
doctor ordered.
  London-based writer Chris Wright is a frequent contributor to 
The Fix.  His most recent piece detailed The Truth About 
Workaholism.