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Do Addicts Have Free Will?

A popular model of addiction is that it's like a disease. But does that divest the addict of agency and the ability to change their lives?



Recently, the American Academy of Addiction Psychiatry sent me a paper by a Dr. Richard Rosenthal, which contained what the author allowed was an "overwrought" scenario. A young crack addict has been given a choice. A man is holding a pipe in front of her and a gun to her head. Have a smoke, he says, and I pull the trigger. The addict responds: “Do I at least get to take a really big hit?”

The story is meant to illustrate the dissolution of willpower in addicts, a central point of the paper. The doctor goes on to remark that, "as a result of loss of control in the addicted state, people can make exceedingly bad and completely unreasonable decisions." You could take this argument further, however, and say that the woman here isn't making a bad decision at all, for the simple fact that there is no decision to be made. Sick as she is, the addict is no more able to resist her impulse than a Tourette's sufferer is able to control his tics.

The disease model of addiction is so widely accepted, it has become dogma. Drug Czar Gil Kerlikowske, director of the US Office of National Drug Control Policy,  recently delivered a speech at the Betty Ford Center, in which he argued that drug dependency should no longer be viewed as a moral failing, but as a medical condition—which says something about the degree to which this idea has taken hold. "The disease of addiction, like other diseases, is chronic and organic," the Betty Ford website tells us. "It sites the brain as its target organ. It relapses. It remits. It is cunning, baffling and powerful."

There's some interesting semantic jiggery-pokery in the above statement, not to mention some dubious science. While any reasonable person might buy into the idea that addiction is chronic and organic, a glitch in the brain's reward system, here we have addiction presented as an "it," a cancer-like entity, perhaps, that somehow moves into, and subsequently corrupts, the brain. And that's not all—take another look at the language: It relapses, not you; it is cunning, not you. In fact, there is very little of you left in this analysis. It's as if you've been possessed by a demon spirit.

As a compulsive gambler, I find a certain appeal in the idea that there’s a foreign entity burrowing inside me. Like all addicts, I carry misery around like a stink. And, like all addicts, I am a fantastic liar. I lie constantly, atrociously, both to hide the results of my habit and to ensure that it can continue. And the person who most readily swallows this line of bullshit is me. I cannot count the number of times I’ve had my last spin, made my final trip to the ATM. And every time these lies are exposed for what they are, every time I've made decisions that hurt not only me, but my family, the post-spree self-recrimination has grown increasingly damning. I am, by popular internal decree, a bad, bad man.

One of the much-touted benefits of the addiction-as-disease model is that it helps mitigate these feelings, which are thought to stoke a fundamental psychological aspect of addictive behavior: The belief that you are damaged goods, that you don't deserve better. For sure, I started to feel a lot more positive about myself when I accepted that I had an illness rather than a rotted out moral framework. I also started coming to terms with the notion that, because this illness had rendered me powerless to my gambling, the only solution would be to stop completely. Hurrah!

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