Is Addiction a Choice?
{Originally appeared at http://more.abcnews.go.com/sections/2020/ABCNEWSspecials/JohnStossel.html] April 22, 2003
If you're addicted to something, whose fault is it?
As ABCNEWS' John Stossel reports, "don't blame the addict" is the message we often hear from treatment facilities.
But psychologist Jeffrey Schaler says we're stronger than we think, and that overeating, smoking and other so-called addictions are things we can choose to control.
"Addiction is a behavior and all behaviors are choices," says Schaler, author of the book Addiction Is a Choice.
Schaler joined a live discussion with our viewers on Tuesday, April 22. The transcript follows.
Also: Read Stossel's report on addiction and weigh in on our message board.
Moderator
Irene Soble asks:
Dr. Jeffrey Schaler
For example, smoking is a behavior that may cause lung cancer. Drinking excessive amounts of alcohol is a behavior that may cause cirrhosis of the liver. The causes are behaviors in these two cases. The diseases are different from the causes. A disease, according to the standard textbooks on pathology, refers to a physiological lesion.
Another way that we can look at this is to see that diseases are something that are present in the cadaver at autopsy. Behaviors are something that living people do. Diseases are something that people have.
Smoking and drinking, like addiction, are not found in standard textbooks on pathology because they are not diseases — they're behaviors. While we are always able to control the behaviors that lead to diseases, diseases are something we cannot control by choice; they are involuntary.
Tom George writes:
Dr. Jeffrey Schaler
Here we have an example of a person addicted to a love relationship. There is nothing that the person is physiologically addicted to. Yet the withdrawal symptoms, or the ending of the addiction, is very painful and distressing.
Many people would consider the pain associated with the breaking off of a love relationship far greater than the pain associated with heroin withdrawal. Many heroin users report that the ending of their use of heroin was no worse than a bad case of the flu.
In order to achieve anything good for ourselves, we have to struggle in life. Giving up drugs is no exception. Changing behaviors and breaking habits is often difficult. If you look back on your life, every decision you made to better yourself included some experience of discomfort.
We accept this as a matter of fact in life; the giving up of drugs is no exception. Dr. Stanton Peele and Archie Brodsky have written about this extensively in their book about addiction to love.
What we know for a fact is that many people give up heroin despite painful withdrawal symptoms. Every drug has an effect on the body and the effects may vary by the person's constitution and by the chemical properties of the drug. Many people experience very few painful withdrawal symptoms. There is no evidence to support the idea that the withdrawal symptoms, in and of themselves, cause the person to continue to use the drugs in an addictive manner.
Leigh writes:
Dr. Jeffrey Schaler
When we say a person chooses to engage in addictive behavior, we are not passing judgment on that person insofar as they are a good or bad person; what we mean to say is that they engage in certain behaviors for reasons that are important to them. These reasons may be psychological, social, emotional, cultural and existential.
Saying that a person is not in control of his or her behavior impresses me as decidedly disrespectful of their humanness. People do things and behave in certain ways for reasons; they are not things that are caused by chemicals or brains.
There is plenty of evidence to show that genes have everything to do with our physiological makeup, but that's very different from saying genes cause us to behave in certain ways. After all, we are all genetically programmed to die, but that does not mean that life is a disease.
I firmly believe that in order to be free, a person must accept responsibility for his or her behaviors. A myth perpetuated by people who believe addiction is a disease, is that you can be free if you just say a disease or gene made me do it.
My view on why people use illegal drugs and legal drugs and psychoactive prescription drugs is that they want to change the metaphorical lens of perception; in other words, they want to change the way they view themselves and the world.
In order to understand why someone continues to use these drugs, we must take a look at what it is existentially that the person wants to avoid dealing with.
A mistake in many of our addiction policies today is to focus solely on the availability of the drug, the chemical properties of the drug, and the physiology of the person. As long as we focus on those factors instead of the existential factors, we will never resolve the key issues.
The research consistently shows the best explanations for drug use have to do with the values of a person, their mind set and the environment they live in. People often use drugs in a self-destructive manner as a way of avoiding coping with some experience in life.
What they may need to do is muster up the courage to face some difficult facts about themselves and their existential predicament. When they do that, they are unlikely to rely on drugs as a way of coping with life.
Kate asks:
Dr. Jeffrey Schaler
Positive addictions are activities we engage in that enhance our sense of well-being; negative addictions are activities we engage in that detract from our sense of well-being.
What we call a positive or negative addiction is something that varies from person to person. The population of people we call addicts is a heterogeneous one, not a homogeneous one. In other words, people use drugs in different ways, for different reasons, with different results. No two people are identical.
The fact that people may transfer their addiction from one activity or substance to another is nothing particularly unusual. Hopefully, people will transfer their negative addictions to positive ones. People engage in multiple negative and positive addictions all the time.
All addiction really means is that you are moving towards something, you are saying "yes" to something, you are consenting or are devoted to some erson or activity.
The idea or meaning of addiction as devotion dates back hundreds and hundreds of years. The idea that addiction means you can't control your behavior came out of the alcohol temperance movement in the early part of the 20th century.
The idea of addiction as involuntary is not only illogical but has been consistently disproved in scientific experiments. There is no such thing as an involuntary behavior.
These experiments are well documented in my book Addiction is a Choice and in numerous writings by my friend and colleague Stanton Peele.
Moderator
Dr. Jeffrey Schaler
In other words, it's not that the person can't change his or her behavior; we need to recognize that what they do is continue to engage in a self-destructive behavior at any cost for reasons that are important to them.
The people we call "drug addicts" are not weak, but strong. What we need to recognize is that they themselves are the higher power.
Moderator
Jeffrey A. Schaler, Ph.D.
Q&A: Psychologist Jeffrey Schaler
Dr. Jeffrey Schaler
Welcome to our live chat with Dr. Jeffrey Schaler, a psychologist and author of the book, Addiction Is a Choice.
How do you define a disease? How does addiction to a drug such as alcohol or heroin compare to diseases such as adult onset diabetes or heart disease? Many of our chronic diseases are caused by multiple factors including lifestyle choices, diet, exercise, etc. Why is one a disease and the other not when choices play a major role in the development of both?
Let's slow down just a bit. Let's be careful not to confuse the cause of the disease with the disease itself.
It seems to me there is a difference between different addictions. Heroin addicts go through very real and painful withdrawal symptoms when they give up heroin. But if I give up my nightly bowl of ice cream, I may whine and feel sorry for myself, but other than that I do not suffer ill affects. Would it be better to reserve the term "addiction" for cases where there are serious withdrawal symptoms?
This is a good question. Let's consider love as an addiction. When you end a love relationship, you often may experience terrible withdrawal symptoms; these may include insomnia, great emotional distress and gastrointestinal problems. The person may become so despondent that they commit suicide.
I think blame is the least important thing here! The important thing is to get over the habit. I've gotten over some addictions with help and some on my own — it's horrible either way, and no matter what, you're bound to blame yourself. Chastising the addict, however, claiming that they are to blame and that it was their intention to ruin their life, is not the confidence-building tool that the person will need to get back on their feet and turn it around. There are genetic predispositions, psychiatric, psychologic, medical, and socio-economic reasons for impulse control issues. I really don't think anyone wants this for themselves, truly. 'Give me a break' John Stossel; this is a sensitive issue that you are treating very insensitively.
I would like to differentiate between viewing addiction as a moral and ethical issue, and making a moralistic judgment about a person who uses drugs.
What about people who have multiple "addictions" or lose one and start another?
As Professor Bruce Alexander at Simon Fraser University has written, there are positive and negative addictions, neither of which have anything to do with not being able to control one's behavior.
Dr. Schaler, do you have any final thoughts?
I think it's important to remember that what we call addiction is not the symptom of a weak will but the expression of what I call an iron will.
Thanks to Dr. Jeffery Schaler, and all those who joined this chat session.
http://www.schaler.net
