[acb-hsp] Do Addicts Have Free Will?

[peter altschul]

Hi:

I am far from an expert on working with people with addictions, 
but in graduate school, I grew to understand addiction as a 
chronic disease - a disease yes but something you could control 
(kind of like diabetes).

Best, Peter



> ----- Original Message -----
>From: "Baracco, Andrew W" <Andrew.Baracco at va.gov
>To: "Discussion list for ACB human service professionals" 
<acb-hsp at acb.org
>Date sent: Mon, 3 Dec 2012 12:45:14 -0800
>Subject: Re: [acb-hsp] Do Addicts Have Free Will?

>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


>-----Original Message-----
>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
>To: Acbhsp
>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.
>_______________________________________________
>acb-hsp mailing list
>acb-hsp at acb.org
>http://www.acb.org/mailman/listinfo/acb-hsp
>_______________________________________________
>acb-hsp mailing list
>acb-hsp at acb.org
>http://www.acb.org/mailman/listinfo/acb-hsp