Dehnart, A. (2000). Is being hooked a choice? salon.com, January 10. http://www.salon.com/health/books/2000/01/10/addiction/index.html?CP=USE&DN=310

From Salon.com

salon.com Health & Body Jan. 10, 2000

Is being hooked a choice?

A new book argues that all addictions are a matter of free will, even heroin and coffee.

- - - - - - - - - - - - BY ANDY DEHNART

By simply titling his new book "Addiction is a Choice," Jeffrey Schaler guarantees controversy.

In a society that's addicted to identifying addictions, some -- "Internet addiction," for instance -- are obvious targets for valid criticism. But identifying drug addiction as a choice? It seems ridiculous, even blasphemous; isn't it scientific fact that drug addiction is an involuntary medical disease? According to the White House Office of National Drug Control Policy, it is: "Chronic, hardcore drug use is a disease, and anyone suffering from a disease needs treatment."

Not according to Schaler. A psychologist and professor of justice, law and society at American University, he argues that drug addiction is not a disease. Instead, he says it's a scapegoated behavior that has been incorrectly identified as a physical or mental illness, a victim of bad science and misguided policy. Schaler writes that -- like homosexuality, masturbation and other behaviors once thought to be physical or mental illnesses -- the idea that drug addiction is an uncontrollable affliction can and should be "swiftly discredited."

Schaler admits that these aren't new ideas, but he's arguably the first to put them into an easily accessible form. The book reads like a combination of an academic journal article and a commentary from a local newspaper. While he's certain to have his critics, Schaler presents a coherent rebuttal to an argument many people accept without a second thought.

If addiction is a choice, what is it not?

It is not a disease. And it is not involuntary. And it is not a thing that causes people to engage in certain behaviors. The conventional wisdom is that the availability of drugs causes people to use them. That's one of the big arguments that is used to support what I call "the war on people," "the war on drugs." And the conventional wisdom is also that if you use "addicting drugs," you will not be able to moderate your use of those drugs [or] stop using those drugs.

The conventional wisdom is that there is some power in the drug that makes people keep using the drug. Another part of that argument is that once you use the drug, something changes in your body. And that change -- which has never been identified, only hypothesized -- causes you to keep using the drug. What I have argued is that people use drugs as a way of avoiding and coping with certain existential experiences. They don't want to do what is necessary to change their experience. I'm not saying that's not difficult -- it can be very difficult. For example, Native Americans -- who are the victims of literal and metaphorical genocide -- have major problems they have to contend with; I'm not saying that those are small by any means. But instead of doing what they need to do to change their experience, they may tend to rely on drugs as a way of making themselves feel better so they don't have to cope with those problems.

Back to the power you mentioned earlier -- the power that people say drugs have over bodies. Don't drugs have significant physiological effects on people?

Yes, and this is a point that serves as a red herring for people who maintain that drugs are dangerous. There are two ways of looking at this. We can say, "Do drugs have a certain effect on the body?" Of course they do, and the people on my side who go against the grain [admit that]. However, drug use and addiction doesn't have to do with what drugs do to the body, but how drugs get into the body.

If you take a drug like cocaine, obviously something changes in your body. Every time you think any thought, your body changes. There's always a physiological change associated with whatever you do. Now the question is, "Does that physiological change make you do what you're doing, or do you choose to do that?" If you have epilepsy, and you have a seizure, of course there's a physical change in your body that makes you go into convulsions. I'm not saying that you have a choice as to whether you convulse or not -- that's clearly not a volitional act. But whether you're going to reach for another cigarette or not is a volitional act; it's not the same thing as an epileptic seizure.

But if you take heroin -- and even if that's a conscious choice at the beginning -- once you get "addicted" to it, there's a point at which you might die from the effects if you go off of it; you could have a seizure and die. Does that not prove that the drug actually has a sort of control over your body?

No, but you're right -- there are situations in which you may need to be medically detoxified. And by that same reasoning, we could say that "crack babies" aren't really born addicted in the way we talk about addiction, but they've been poisoned. The mother has been taking the drug, and it's obviously caused something physiological in the infant, and that infant may need some care to antidote the toxic effects of that drug. The same thing with heroin, the same thing with alcohol.

There's lots of evidence that shows that people who have been "addicted" to heroin for a long time give up heroin once their environments change. That's one point, which I show in the [book with the] Vietnam veterans study that was published in 1973. Aside from those who needed to be detoxed because of the physiological effects -- of course, many of those people who are detoxed go back to drug use -- if you ask anyone who's been a long-time drug user how they stopped, they'll reflect for a moment. And they'll say, "Well, I made a decision; it was time for me to do it."

The act and the behavior of using or consuming a drug -- regardless of what it is -- is a choice, and people engage in those kinds of behaviors for reasons. There isn't some power in the drug or in their physiology that causes them to do it. Because by that reasoning, if people committed crimes while they were on drugs, then we'd have to exculpate them; we'd have to say they weren't responsible for their behavior because they were under the influence of drugs, and that isn't the way the law works.

Why do you think our society is so obsessed with identifying everything from Internet use to gambling to, like you say, drugs, as addictive?

This isn't my original idea, but I think that people have always had an investment in scapegoating some group or thing as a way of easing their existential anxiety and as a way of boosting their self-esteem. So to persecute people for using illegal drugs is like persecuting any minority -- blacks, Jews or gays -- because they've been blamed for the problems that the majority experiences. People have always done it; they'll always do it.

What's different is that, in the past, people had a clearer sense that they were scapegoating blacks, or scapegoating Jews, or scapegoating homosexuals for their problems. But today, under this charade of science and medicine, we're "not" scapegoating drug users and addictions for our problems -- we're instilling public health.

Who's to blame for that? Is it doctors or politicians or addicts themselves?

I don't think it's the addicts. I think that it's human nature to try to find some blame as a way of easing anxiety. If people don't look to religion, then they look to persecute a minority or a substance.

Who benefits from persecuting people for being addicts or who benefits from persecuting illegal drug users? I think it's clear: The drug enforcement agents benefit because they earn a living doing that. Politicians benefit because they look like they're getting rid of or getting a control on evil in our society. But I think there's a subtle group that people don't really want to pay attention to -- those who build prisons to house lots of people for consensual crimes. Of course, the others that have a deep ideological and economic investment in the "disease model" of addiction are the treatment providers because they make money treating a mythical disease.

In the book you take issue with treatment providers, especially AA, which you compare to a cult and/or a religion. Even if it is a cult or a quasi-religion, they still do help some people get off drugs. Is there anything wrong with that?

I think that AA should be free to exist just the way any religious group should be free to exist. My concern is that it has become a tool of the state. The state arrests people for drunk driving and orders them into Alcoholics Anonymous. That to me is a violation of the First Amendment, and the separation of church and state.

I'm all for people who want to go to AA. I think it's great -- they should be able to go to any group just like they should be able to go any church, synagogue or Islamic temple. What I object to is people are being misled that AA has the truth about addiction, which is absolutely false. It would be like saying that Judaism has the truth about addiction or Christianity does or Catholicism does.

What concerns me about what AA teaches is that it goes against scientific research that has focused on the concept known as self-efficacy. That is, if you believe you can do something, you're more likely to try to do it.

What AA and similar disease-model groups say is that you can't control your behavior; you can't control your addiction. I think what we should be doing is teaching people that they can control their addiction. It's a choice. And then they're more likely to prove that to be true. And that idea has really been supported by psychological research; the AA idea has not.

So the best form of treatment then would be to help people realize they're actually making a conscious choice to engage in that behavior?

Yes. One, I think it's supported by scientific research; two, it is a common sense approach. But let me qualify one thing you said: You said, "Is this the best approach to treatment?" Well, yes and no. It's the best approach to helping people who want help with they're addiction or their behavior. However, I think we have to be careful and not call it treatment, because it becomes a euphemism for moral management. It's not the same thing as treating someone for cancer or diabetes or AIDS. There's no moral element there; you don't say to the person, "If you just have the right attitude, then you'll get better."

What about those who are too far gone, those who can't really realize that for themselves or are too overwhelmed by the effects of drugs to make that decision? What about those people?

I don't think they should ever be coerced into anything one might call "treatment." I don't think that's the right way; I think it's unconstitutional; I think people have the right to destroy themselves, as upsetting as that may be. That doesn't mean that private groups -- myself included -- might not try to talk these people into getting some help or talk them out of destroying themselves. But ultimately the choice rests with the individual, and I don't think we are ever justified in a civilized society that values freedom in coercing people into any kind of program, whether it's called treatment or conversation or psychotherapy, against the person's will.

What about the fact that their behavior because of those drugs can affect other people? As the saying goes, there are no fights at ice cream parlors, just at bars.

I think that people should be held responsible for any harm that they do to anyone else, and I don't think that we should excuse them because they're using drugs. One of the problems we get into here is what constitutes harm? It gets kind of fuzzy. If you engage in a behavior that upsets me, is that harm?

You have a right to engage in behaviors of your choice as long as you don't infringe upon my freedom. I think the libertarian dictum that one should be free to do whatever one wants as long as it's not at the expense of someone else is one we should abide by. My right to swing my fist ends precisely at my neighbor's nose; whether I'm using drugs or alcohol is essentially irrelevant. If some family member or friend is self-destructing using drugs, does that cause you harm? It causes you psychological and emotional harm, it's upsetting to you. But is that the same thing as some kind of criminal act? I don't think it is. I think that's part of the price we have to pay in a free society.

Based on your libertarian beliefs, would you be for legalization of drugs?

I don't think they should be legalized -- I think we should repeal, in total, drug prohibition. "Legalize" connotates government regulation, and I think that people have a right to drugs as property as guaranteed by the constitution. I don't think they should have a right to marijuana, for example, because it qualifies as medicine -- certainly, they should be able to use the drugs for any purposes that they want, whether it's medical or recreational.

Finally, are you addicted to anything?

It depends on what we mean by "addicted." The point that I try to drive home in the book is that addictions can be good or bad, positive or negative, and they could be to experiences, or activities, or substances. The answer is yes: I'm addicted to any number of activities and substances, like coffee. But does that mean that I can't control my behavior? No.

salon.com | Jan. 10, 2000

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About the writer Andy Dehnart is a writer living in Chicago and a producer for thepavement.com http://www.thepavement.com/ASIsapi/ASIsapi.exe?EDIT_2

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