Drugs of Choice
By Jacob Sullum
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 leftist 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, whiles 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 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 heard 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 will-power," 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-then 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."
During her years of heroin use, Marlowe made a nice living from a "consulting business" (presumably financial consulting, since she worked at an investment bank after college). Although her habit apparently did not affect the business, her writing career stalled. Her chief regret about heroin is the time it wasted and the experiences it blocked. "After I quit," she says, "it gradually came to me that the messy stuff I'd been screening out with dope-the nitty-gritty of having a relationship, constructing friendships, getting along with acquaintances, meeting new people-the stuff that hadn't seemed worth the trouble, the stuff that had to be controlled so I could focus on the important matters, was in fact the only material life presents."
Schaler, too, sees missed opportunities as heroin's main danger: "I oppose the use of heroin for the same reason I oppose the use of Prozac: I think relying on these is an existential cop-out-a way of avoiding coping with life." The deliberately provocative comparison with Prozac helps clarify the moral and practical issues raised by chemically assisted living. People who like Prozac would probably say that it helps them get on with their lives by relieving anxiety and chasing away the blues. But Schaler argues that using drugs this way is counterproductive because it eliminates the discomfort that spurs people to make the changes that would ultimately lead to better, more satisfying lives. Surely there is truth to both positions; the trick is recognizing which more accurately describes a particular person's situation.
The answer to that question does not hinge on the drug's legal status. Americans like to pretend that pharmaceuticals are morally unproblematic, because they are approved by the government and prescribed by doctors. Conversely, they like to pretend that illegal drugs, unsanctioned by authority, are inherently immoral. This pretense breaks down when similar substances-say, amphetamine and Ritalin-are used for different purposes, or when different substances-say, heroin and Prozac-are used for similar purposes. Then we are forced to think about what makes one kind of drug use life-enhancing and another kind self-destructive.
To talk about the reasons why people use drugs-and, especially, to distinguish between good and bad reasons-is risky, as Marlowe discovered in 1994, when she first wrote about her heroin habit. "Doing heroin isn't as scandalous as writing about it," she notes. After her account appeared in The Village Voice, "I got lots of nasty letters that all agreed on one thing: because I emerged from years of heroin use without noticeable health, career or financial effects, I wasn't qualified to writer about dope. I didn't really have the experience, because the sign of really having the experience is ruining your life. This is a circular argument of course-'we ill only trust accounts of dope use that end in ruin, because dope use always ends in ruin.'"
Marlowe rejects the charge that writing about heroin glamorizes it, making the writer responsible for anyone who might be inspired by the account to try the drug or return to it. "If I wrote an article about how wonderful a time I had surfing," she says, "I doubt readers would blame me for any injuries they received trying to duplicate my experience. But accounts of heroin use (and sex), like the real thing, are supposed to be irresistible, powerful drugs in their own right."
Although her criticism of the conventional take on heroin suggests that Marlowe is skeptical of the war on drugs, she is not nearly as explicit in condemning it as Schaler, who declares, "It is no more the business of the government what chemical substances you put into your body than it is the government's business where or in what manner you practice your religion." And while her memoir is filled with intriguing ideas, she occasionally goes astray, especially when she deals with economics. She claims, for example, that "copping reveals the aggressivity behind buying that capitalism usually manages to cloak." Because "heroin is a commodity and inspires no affection except for its use value . . . and because the commerce of heroin is deeply illegal, the aggression beneath all purchasing seeps out."
But surely it's the drug's illegality, rather than its status as a commodity, that explains the market's undercurrent of violence. When I buy salt or sugar, I never worry that the grocer will refuse to hand over the goods after I pay, or that he will try to substitute some other white substance, and he never worries that I might be an undercover cop. Later, Marlowe more accurately describes buying as "a way of negotiating the competition for scarce goods without physical violence." Buying can do that because the transaction is voluntary, meaning that both parties see themselves as benefiting from it.
Marlowe's confusion seems to reflect her uneasiness with earning and spending. "Stereotypical wisdom has it that when people get addicted to dope, they become greedy and money-centered," she writes. "But it's really the other way around: only those with an inclination to greed and a fascination with money become serious about dope. Heroin use is a disease of those who are naturally most suited to capitalist society-bossy wired hustling obsessive-compulsives-but, perhaps, are ashamed of that. We decide we would rather be cool, but we gravitate to those aspects of this aesthetic that can be purchased because this is an action we understand . . .: While dope is in some ways the ultimate hipster buy, when all is said and done it's still a purchase the user is a consumer. Centering your life around copping is not so different from centering your life around shopping, or making deals. Same activity, different aesthetic."
You can interpret this as a swipe at consumerism or as an attempt to normalize heroin use. Either way, the important point is that people can get into trouble by trying to substitute easy sources of pleasure for more worthwhile activities, whether they're buying heroin or fancy clothes. Both of these books help us see that just about any harmless diversion can become a dangerous distraction-a realization that makes the risk of addiction seem more immediate but also puts it into perspective. The next step is to recognize the difference between good and bad habits, an ongoing task that engages anyone who tries to find meaning in a world of choices and temptations.
Senior Editor Jacob Sullum (jsullum@reason.com) is writing a book about the morality of drug use.
Copyright, 2000, REASON Magazine
