Addiction Is a Choice, by Jeffrey A. Schaler, Chicago Open Court, 179 pages, $42.95/$19.95 paper
How to Stop Time Heroin From A to Z, by Ann Marlowe, New York Basic Books, 297 pages, $24.00
Jeffrey Schaler and Ann Marlowe probably would not get along very well. He is an addiction psychologist whose unabashed libertarianism clashes with the leftish sensibilities of other drug policy reformers. She is a rock critic who writes for The Village Voice and views capitalism with ambivalence. He seems to spend a lot of time online, vigorously defending his iconoclastic views against all comers. She hangs out all night in hip, grungy New York clubs. He likes "a glass or two of wine or scotch, and occasionally more than two." She doesn’t much care for alcohol; until about five years ago, her drug of choice was heroin. His writing style is relentlessly logical and straightforward, while hers is impressionistic and elliptical.
Despite the stark differences in their perspectives and approaches, Schaler’s polemic, Addiction Is a Choice, and Marlowe’s memoir, How to Stop Time: Heroin From A to Z, come to strikingly similar conclusions about the nature of addiction, a term that is hauled out with alarming frequency these days to explain away irresponsibility and justify paternalism. "I deny that there is any such thing as ‘addiction,’ in the sense of a deliberate and conscious course of action which the person literally cannot stop doing," writes Schaler, who deals with drug problems as a psychotherapist, college instructor, writer, and expert witness. "People are responsible for their deliberate and conscious behavior." Marlowe, a Harvard graduate who started snorting heroin in her early 30s and continued for seven years, using it almost every day for months at a time, is no less adamant about individual responsibility. "Not for a minute can I subscribe to the popular view…of addiction as uncontrollable need," she writes. "Still less can I take addiction as an excuse for bad behavior."
Much of what Schaler and Marlowe have to say about addiction will be familiar to readers of theorists such as Thomas Szasz and Stanton Peele. All see addiction as a pattern of behavior that can be understood only in the context of a person’s values, circumstances, and choices. In this view, addiction is about much more than pharmacology.
Indeed, for Schaler, "addictions are indispensable." Harking back to the original meaning of the term, he defines addiction as "a fondness for, or orientation toward, some thing or activity, because it has meaning, because it is considered valuable or even sacred." Addiction, then, is not inherently good or bad. "Addictions–and only addictions–can open us up to all that makes life rich and fulfilling," Schaler writes. "Yet addictions can also have appalling consequences. The moral is clear: Choose your addictions carefully!…Addictions we approve of are called ‘virtues.’ Addictions we disapprove of are called ‘vices.’"
Schaler’s approach sweeps away a fog of pseudoscientific obfuscation and reveals the moral issues at the heart of this subject. "Addiction is the expression of a person’s values," he writes. "Therefore, whenever we talk or write about addiction we are dealing with an ethical issue, not a medical one. Addiction is not a disease, nor is addiction a public health problem. Addiction is a choice."
Recognizing that the average reader will have a hard time accepting that assertion, Schaler cites an impressive body of research that contradicts popular notions about drug habits. He shows that experimenting with reputedly irresistible drugs such as heroin and cocaine generally does not lead to addiction and that addicts commonly moderate or stop their drug use on their own. He debunks studies that are said to demonstrate the overwhelming power of drugs and systematically attacks the disease model of habitual intoxication promoted by Alcoholics Anonymous. "The idea that addiction is a disease," he declares, "is the greatest medical hoax since the idea that masturbation would make you go blind."
In taking on the prevailing wisdom, Schaler shows a sharp eye for contradictions, non sequiturs, and unfalsifiable claims. "Addiction is a ‘disease’ to be ‘treated,’ yet ‘treatment’ consists of talking sessions aimed at changing the addict’s beliefs and motives," he observes. "Ironically, the fact that addiction treatment does not work helps to convince people in the addiction treatment field that addiction is a disease. What else could account for the tenacity with which addicts cling to their addictions? Could it be that people sometimes freely choose to do foolish and self-destructive things? Inconceivable! It must be a disease that makes them do it."
Marlowe is not nearly as wary of talking about addiction as if it were a medical condition. Growing up in New Jersey, she saw her father, a research chemist and patent attorney, succumb to Parkinson’s disease, an experience that colors much of her memoir. At one point she tentatively likens her habit, "with its intimations of loss of bodily control," to her father’s condition (though she admits, "I always could, and finally did, simply walk away from my illness"). Conflating the flu-like symptoms of withdrawal with addiction itself, she calls heroin use a "sickness," a "disease," an "illness." She does not pause to reflect on the implications of such language–surprising for someone who otherwise seems keenly aware of loaded terminology, whose book is organized as a faux dictionary, with each section tied to a resonant word. Still, she clearly does not believe that addiction is something that happens to you. "My addiction, such as it was, was chosen," she writes. "Getting a habit isn’t an accident, or the result of the ‘power of the drug’; it’s what you were after."
Marlowe rejects the idea of addiction as an impairment of will. "Taking heroin never struck me as showing a lack of willpower," she writes. "After all, what is a habit but self-discipline? Most people don’t have the capacity for it." Here she echoes Schaler, who suggests that "heavy drinking and drug use are characterized by strong will. The more single-mindedly self-destructive the drinker or other drug user is, the more indicative their behavior is of a strong will, even an iron will."
Marlowe warns that the "fetishization of dope" fostered by anti-drug propaganda only makes heroin more attractive. "The more heroin is hyped as ultimately powerful and irresistible," she says, "the more people are going to addict themselves to it." Schaler makes a related point when he observes that believing a drug cannot be used moderately, the way that Alcoholics Anonymous encourages heavy drinkers to think about alcohol, can be a self-fulfilling prophecy.
Like Schaler, Marlowe takes a dim view of A.A. and its progeny. "The twelve step programs encourage this nonsense [the belief that addiction is uncontrollable] with their obtuseness about psychoanalytic thought," she writes. "They’d rather have someone stand up and testify that eight years after his last heroin he still struggles every day against the temptation to do it again–a ridiculous notion–than send him to learn what he really is fascinated with."
Marlowe’s preference for psychotherapy over A.A.-style ritual reflects a conviction, displayed throughout her memoir, that drug abuse is a sign of other problems that need to be dealt with. Schaler would certainly agree. He describes a 16-year-old girl whose desperate parents brought her to him because she was using LSD and marijuana regularly. "As usual," he writes, "I kept the emphasis off drugs and asked her about the problems in her life." After a few months of therapy, the girl became "completely abstinent, except for a few very moderate intakes of alcoholic beverages."
Schaler does not tell us what this girl’s underlying problems were. For Marlowe, who says she has not been tempted to use heroin again since she gave it up in 1995, the drug was a way of "stopping time," of pushing away the consciousness of mortality that afflicts all of us but was especially acute in her case, partly because of her father’s long struggle with Parkinson’s. "If I had to offer up a one sentence definition of addiction," she writes, "I’d call it a form of mourning for the irrecoverable glories of the first time. This means that addiction is essentially nostalgic, which ought to tarnish the luster of nostalgia as much as that of addiction.…That drive to return to the past isn’t an innocent one. It’s about stopping your passage to the future, it’s a symptom of fear of death, and the love of predictable experience. And the love of predictable experience, not the drug itself, is the major damage done to heroin users. Not getting on with your life is much more likely than going to the emergency room, and much harder to discern from the inside."