Addiction and Choice

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The National Council on Alcoholism and Drug Dependence objects to John Stossel's recent ABC News special about addiction, calling it "woefully one-sided, misleading, and factually incorrect." The NCADD (whose press release does not seem to be available online) is especially perturbed that Stossel dared to question the assertion that alcoholism is a disease. After all, "it has been years since the American Medical Association first proclaimed alcoholism to be a 'complex disease' in their landmark statement of 1967." Get with it, Stossel!

Although the issue really was settled back in 1967, biological reductionists continue to look for evidence that "addiction is a brain disease," as Alan Leshner, former director of the National Institute on Drug Abuse, put it. According to the NCADD, "NIDA found that there may be a core biochemical change that takes place in any addiction and has to do with the neurotransmitter dopamine and the nucleus accumbens."

Or there may not be. And if there is, how would it in any way disprove the fact that so many addicts manage to moderate or give up their habits, showing that they are ultimately in control of their behavior?

It becomes clear that even the folks at the NCADD do not believe addiction is a physical compulsion, akin to an epileptic fit, that addicts are powerless to resist. "Clearly," they say, "there is a volitional component to alcoholism and drug addiction." They just don't think anyone should talk about it.

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  1. Well i couldnt exactly comment on this as far as what the special was about because as the atlanta tv viewers reading this knows, the assholes at our local abc station didnt air the special.

    But as far as addiction goes i pretty much agree with what sullum said.

  2. Maybe if they admitted that a person’s behavior is largely of that person’s choosing, they would be forced to accept that a good number of people CHOOSE to get drunk, high, or strung out.

    I’m an insomniac, and I CHOOSE to get drunk or high so that I don’t lay in bed for hours, staring at the clock and ceiling. I was an insomniac before I started drinking and smoking, and I would still be an insomniac if I quit drinking and smoking. Why quit either, though, when one or the other makes it vastly easier to fall asleep, and sleep through the entire night without waking up again… and again… and again… ?

    I guess a prohibitionist worldview is only reinforced with the belief that people cannot control their own actions, and therefore their actions must be controlled by someone else. But, who watches the watchmen?

  3. I don’t know anything about medicine, but anyone who’s been close to an alcoholic, recognizes it as a disease. I’m not suggesting that people should not be held responsible (in the eyes of the law) for their actions, but nobody “chooses” to be a drunk or junkie.

    I am totally opposed to prohibition as well as granting special status to addicts.
    However, self-governance means taking responsibility for all those things we want the Government to stop doing. Including compassion for our fellow man. A person in the grips of addiction is as pitiful a creature you are ever likely to encounter. So take pity on them, and save your contempt for those that use the pitiful as stepping-stones to power.

  4. …nobody “chooses” to be a drunk or junkie.

    But they *do* choose to drink or do drugs, which leads to their addictions.

    Your statement is like saying that a man driving 100 miles per hour doesn’t choose to have an automobile accident.

  5. I should clarify that I don’t get drunk every night. I usually get high instead of drinking. Some people see this as better, some see it as worse.

    Anyway, Poge, your analogy is flawed. People do choose to drink, or use drugs, but most people who drink and use drugs don’t get addicted. The people who make that choice, every single night, until that one choice has overruled everything else, get addicted.

    It’s all about being responsible, and the only person who can make someone responsible is themself.

  6. Stossel’s show was excellent. I drank like a fiend after multiple tragedies, including the death of my oldest child followed shortly by my ex leaving me for a guy. I went nuts, and self-medicated with booze.

    Choice? Yes, I did have it, but needed to find reasons to make the choice not to do that to myself anymore.12 Step programs didn’t help me with that, for a message of powerlessness and redemption by God was poison, at least for me.

    It is not a disease, at least not as that word is understood when applied to cancer or diabetes. I had a predisposition as a result of a genetic load from both sides of my family, which makes us find alcohol particularly soothing. (It cannot be an accident that certain gene pools are so overly afflicted with alcohol dependency.)

    People quit using to excess every day. I did, and so have many others, and they had been doing so before it was considered a “disease.” Support groups can be helpful, they were for me, but at the end of the day it is up to the individual.

    The treatment industry has a vested, very vested, interst in the disease model. Screw them, you don’t need to spend tens of thousands of dollars to not destroy yourself with mood altering chemicals. Of course they hated Stossel’s special.

  7. I won’t speak for the NCADD but the treatment community (the respectable ones anyway) and AA don’t have any particular position on prohibition. AA, which contributed greatly to the adoption of the disease model by the medical community, does indeed focus on taking responsibility for one’s actions. What AA will tell you that purely physiological medicine will not is that addiction is a spiritual disease as much as it is a physical one. There are varying degrees of addict/alcoholic in each person, so it seems silly to say “I was a drunk and I quit without help, so what’s their problem?” The contributing factors are numerous and complex. The disease model allows for the medical community to develop treatments that take as many of these factors into account as possible and experiment with medication and behavioral science. For people who are institutionalized or very far gone, it is hard to argue with AA’s results where all traditional medical treatment has failed.

  8. Gutter drunks and junkies are rare and always have been.

    There’s a lot of folks who use to varying degrees of success or failure, though. The fact remains, there are more people who have quit smoking and quit drinking, by whatever means, than who are currently using, giving me hope in the dignity and strength of man (and woman).

    Alcoholism was termed a disease to get insurance companies to pay for treatment. Period.

    As Homer says, “alcohol is the cause, and the solution, for all our problems.”

  9. The only way you can justify forcible intervention, either on a personal basis or a societal one, is to say that the problem is too overwhelming for the “victim” to be able to overcome it.

    Clearly, all addictions, from alcohol, to drugs, to video games, to compulsive posting on online message boards, must be seen as invariably more powerful than those poor souls who are afflicted with them. To admit that people can actually beat these addictions — or worse yet, that people can perhaps be addicted while still also being productive and worthwhile members of society — is to attack the entire intervention infrastructure, and we can’t have that, can we? Why, that would lead to anarchy in the streets. Horrors!

    I think older, wiser societies have a better take on addictions. They initiate their young people, “inoculating” them with tastes of taboo substances and behaviors in environments that, while not without risk, provide support and protection to help the youngster master the vice before it turns into the overwhelming vise of addiction. We would rather put people in the equivalent of sterile bubbles and have them live as prisoners to their fears. Sometimes, the “inoculation” method ends badly. But it almost always ends badly for the people who live in prohibitionist bubbles. I’d rather take my chances in the former scenario than the latter.

  10. There is no contradiction between saying that alcoholism and drug addiction conform to the disease model and continuing to believe that there is an element of choice in one’s addictive behaviors. To say otherwise is extreme reductionism.

  11. The “volitional” aspect of “drug abuse” is equivalent to the volitional aspect of anesthesia for surgery. No one needs it. It is just that surgery outcomes are much better in all respects with it.

    As you know my research shows that chronic drug use is a response to pain. Here is an article I wrote that gives my argument along with supporting evidence.

    http://windsofchange.net/archives/003370.html

    Here is what a drug councilor had to say about that article (you can find it at the above url as well)

    Posted by: M. Simon on April 26, 2003 01:42 AM

    As a drug and alcohol counselor, I agree wholeheartedly with pain being the main cause of alcoholism and chemical dependency. PTSD is but an extreme example of the pain that alcoholics and drug addicts suffer. For many of my clients, abuse both phyisical and emotional was the means used to teach them destructive beliefs. The more “energy” used in the abuse, the more pain carried into adulthood. Consequently, that results in more “energy” needed to overcome those beliefs.
    Oh, and the one emotional pain that I see? Shame…..whether it be men or women, it is shame that routinely surfaces as the undelying pain being covered up with drugs/alcohol. Women who suffered incest speak more about the pain they felt when, after the deed was done, they got the look of scorn and disgust from their father.
    Posted by: Guy Hall on April 26, 2003 03:08 AM

    ===========================================

    Bottom line here is that you can’t trust anything the government says about drugs. Nothing.

    M. Simon

    (c) M. Simon – All rights reserved.

    Permission granted for one time use in a single periodical.
    Concurrent publication on the periodical’s www site is also granted.

  12. “NIDA found that there may be a core biochemical change that takes place in any addiction and has to do with the neurotransmitter dopamine and the nucleus accumbens.”

    Actually the NIDA found no such thing. What they found was that certain structures in the brain thought to mediate “addictions” were smaller in addicts than in non-addicts.

    The critical clue here was that no before and after or longitudinal studies were done. So that it may in fact be the case that these structures were smaller in the “addicts” than in the rest of the population before the addiction began.

    Thus “addiction” may be the result of the smaller structure not the cause. My research tends to confim that hypothesis. Addiction consists of two components. A genetic susceptability and one or more traumatic incidents.

    ==========================================

    In addition Stossel did not do his usual excellent research. He cut and pasted from government scientists. He ought to know better.

    BTW the NAADAC agrees with my research. They had Dr. Lonny Shavelson give a number of talks to their organization several years ago.

    http://www.sierratimes.com/02/11/10/edms111002.htm

    Discusses Dr. Shavelson’s work.

    Bottom line here is that you can’t trust anything the government says about addiction. Nothing.

  13. Why can addicts quit?

    Because pain memories decay over time.

    http://www.mpg.de/news02/news0217.htm

    Quitting has very little to do with will power and everything to do with changes in neurochemistry over time.

  14. M. Simon wrote:
    “(c) M. Simon – All rights reserved.

    Permission granted for one time use in a single periodical.
    Concurrent publication on the periodical’s www site is also granted.”

    Are you freaking serious? I hope not.

    To add this sort of thing to the bottom of a message board post is absurd… To add it to the bottom of a message containing only self-evident and inane scribbling is beyond absurd. It is vapidity that borders on idiocy (though I’ll take this all back if the notice is just a joke).

  15. “AA, which contributed greatly to the adoption of the disease model by the medical community, does indeed focus on taking responsibility for one’s actions. ”

    Right, which is why the entire program entails admitting your own powerlessness over drinking and turning over your life to some undefined “higher power.”

    Whoops! Silly me — that’s actually the textbook definition of NOT taking responsibility for one’s actions.

  16. To any athiests, agnostics, or rugged individuals with substance abuse problems out there-

    Rational Recovery is a drug/alcohol addiction program that doesn’t require you to believe in a higher power of any sort. They’re in most metro areas (sorry rural folks)- check google or the phone book.

    As to the stated topic- Stossel’s a clown. As repulsive as victimology is, the medical model has been ultimately less harmful than the sin-based model that preceded it. Perhaps radical personal-responsibility may be more helpful- or maybe it’s just a pose to feel self-satisfied.

    (aside- not sure how rats “choose” to starve to death taking cocaine in experiments- perhaps they have lots of pain memories..)

  17. If I coerced you into commiting a crime with the threat of causing you the degree of pain felt by someone withdrawing form nicotine, heroin, or late-stage alcoholism, you would be found innocent by a jury, and I would be conviced of assault or worse.

    I’ve seen strong men reduced to tears because they haven’t had a cigarette. Free will my ass.

  18. Phil,

    As your post shows, you are completely ignorant of the underpinnings or mechanics of a successful 12-step program. But don’t let that stop you from making what you deem to be clever comments based on an out-of-context reading of the first 3 steps. After all, somebody reading here might actually have gotten some help there. But after your rather cavalier reduction in the name of cuteness, one would have to be a real dupe to believe that 12 programs have anything to offer. Clearly you are an expert in behavioral science.

    To everyone else, in case you hadn’t figured it out, Phil has no idea what he is talking about.

  19. Hello
    All I know is that I am there for 10 to 20 clients everyday. I teach the 12 step program. I see failures and I see success. I believe in the power of prayer. I want every one to be helped. I am not a theorist or a anylist, but what I do know is that I am there for them. The program is helping thousands of people everyday. It has its flaws like everything but the main focus is on self-esteem and recovery, not a religion per say. All those that are complaining about the program are against us, and that is not unity. We need Unity for a addicted person to stay sober. Not desension. Wish all would be free of this terrible problem, but underlying issues prevent most people from recover. I am not a mind reader so only the addict or alcoholic knows the real truth to their recovery.

    Peace and recovery to all

    Vern

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