[acb-hsp] Do Addicts Have Free Will?

[Baracco, Andrew W]

As one who works with addicts on a daily basis, I like this article
because it sums up how I have always felt, but it does not reflect the
culture prevalent today in addiction treatment. I think I will share it
with some of my colleagues, and see the reaction.

Andy


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From: acb-hsp-bounces at acb.org [mailto:acb-hsp-bounces at acb.org] On Behalf
Of peter altschul
Sent: Sunday, December 02, 2012 12:04 PM
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Subject: [acb-hsp] Do Addicts Have Free Will?

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.
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