If the River was Whisky
“Never underestimate the strength of a habit.”[1]
For several decades American courts have frequently made mandatory attendance of Alcoholics Anonymous and other 12-Step programs a regular part of sentencing for drug and alcohol offenders, despite the fact that these programs are statistically no more effective at ending addiction than is anything else, including doing nothing at all
(Orford 26). The underlying philosophy of AA is that drug and alcohol dependency is a medical problem, a disease that forces its victims to abuse substances in a way they cannot control. According to this theory, 12-step programs offer the only legitimate treatment for the “illness” of addiction, and while they do help approximately 20-30% of the people referred to them, so do the decidedly non-medical approaches of herbal treatments, abstinence pledges and Buddhist prayer rituals (Orford 26). The American judicial and health systems have been treating substance abuse as a medical problem for years, with no particular success, because it is in fact not a disease. Addiction is often compared to such chronic illnesses as diabetes, but this is wildly inappropriate because while a disease is an involuntary condition caused by a physiological dysfunction, chemical dependency is the unfortunate result of a series of voluntary choices, however poor.
The theory that alcohol and drug abuse are diseases was conceived by a researcher named Jellinek in 1960, in part in response to a series of conversations with Alcoholics Anonymous members (Skog 1310). Jellinek describes alcoholism as involving “loss of control” and the “inability to abstain”, both terms borrowed from the AA rhetoric (Skog 1310). According to Jellinek, those individuals who are afflicted with the disease of addiction are unable to control their own actions. Jellinek paints a Dr. Jekyl and Mr. Hyde type scenario in which individuals find themselves forced into terrible binges against their will, and a single alcoholic drink causes them to become absolutely “unable to adhere to their [original] intention to ‘have one or two drinks only’ but continue to ingest more and more—often with quite some difficulty and disgust—contrary to their [own] volition.” (Skog 1310)
The concept of chemical dependency as medical problem may at first glance appear to explain why some people are able to enjoy drinking a moderate amount of alcohol, and then stop before suffering any ill effects, and other people are not, but under more intense scrutiny it quickly becomes absurd. There is no known physiological or psychiatric condition that forces anyone to use drugs or alcohol in any quantities. Environment and family background most likely play some part in influencing the choices individuals make about their use or abuse of chemicals, as they do in nearly every other decision one can possibly make. The simple truth, however, is that if one examined ten people of similar background and experience, all patronizing the same bar on the same night, they would all exhibit different patterns of alcohol use. The reason for this, according to sociologist Ole-Jorgen Skog, has nothing to do with any sort of mysterious disease and everything to do with free will. Humans are hardly perfect and rarely consistent, and neither are the decisions they make. When faced with a homework assignment, some students will choose to complete it, and some students will choose to watch television, even though they are aware that failure to turn in homework will result in a lower grade. It is highly unlikely that all of these students will make the same choice every time, and it is ridiculous to conclude that those students who, on any given occasion, choose to watch TV are sick and those who choose to study are not. The bar patrons who decide to stop after two beers and go home, and who then end up drinking two pitchers and throwing up are not sick, they are, as Skog explains, simply people who “do not stick to their original plans, but tend to give in to temptation. Prior to drinking, they were planning to consume only one or two drinks. After two drinks, they have changed their minds.” (Skog 1311) These individuals are not suffering from any illness; they are experiencing the negative consequences of their choices, in the same way that students who choose to watch television rather than study experience the negative consequences of bad grades.
Over the past several years, evidence for the element of free will in substance abuse problems has grown steadily, and proponents of the disease theory have taken to arguing that what appears to be a matter of choice is actually a symptom of the illness that is addiction. This is a claim that is both irrational and illogical. One cannot have symptoms without a disease, and, despite nearly a century of searching, no medical basis for an “addiction disease” has ever been identified. Everything from nutritional deficiencies to an allergy to the grains from which alcohol is distilled has been examined at one time or another as a possible medical cause for alcoholism, and nothing has been able to withstand the test of scientific scrutiny (McKim 84). Without any root cause, the claim that addiction is a disease of which substance abuse is merely a symptom falls flat. Few patients would appreciate a doctor telling them that they had the flu because they had the flu, and diagnosing an individual with drug addiction or alcoholism because they are a drug addict or alcoholic is every bit as unreasonable.
The abuse of drugs or alcohol is, like anything else taken to excess, a matter of overindulgence rather than illness. It is only natural for an individual to want to repeat an activity or experience that they find enjoyable, particularly if there is little else to do, and it has long been recognized that addictions are most likely to develop in individual whose first experience with drug or alcohol use is pleasant, especially in an environment where there are few other activities to choose from. (West 5) Whether or not a chemical dependence actually develops, however, will ultimately be determined by that individual’s actions, rather than any biological force of fate. Addiction is hardly inevitable, and to claim that an individual placed in such an environment has no choice about whether or not they will develop a substance abuse problem “reduces this individual to something less than a full person. It implies that his or her behaviour is governed by causal mechanisms beyond volitional control, and reduces the individual to a consumption robot—a helpless spectator to his own body’s movements.” (Skog 1310)
America has spent a great deal of time and money attempting to treat drug and alcohol addiction as if it were one more disease, and this policy has resulted in a great deal of frustration and little success. A specific medical cause of addiction has never been identified, and probably never will be, but the behavioral cause can be easily broken down to individual choices, actions, and consequences. It may or may not be possible to change the percentage of people who are able to overcome chemical dependency, but it is clear that until there is a fundamental shift in the way problems of addiction are approached there can be no change at all.
[1] R. Reinert, “The Concept of Alcoholism as a Bad Habit,” Bulletin of the Menniger Clinic
32 (1968): 35-36
Works Cited
McKim, William. Drugs and Behavior: An Introduction to Behavioral Pharmacology. New Jersey: Prentice-Hall, 2000.
Orford, Jim. “Addiction as Excessive Appetite.” Addiction 96 (2001): 15-32.
Reinert, R. “The Concept of Alcoholism as a Bad Habit.” Bulletin of the Menniger Clinic 32 (1968): 35-36.
Skog, Ole-Jorgen. “Addict’s Choice.” Addiction 95 (2000): 1309-1315.
West, Robert. “Theories of Addiction.” Addiction 96 (2001): 3-13.
For several decades American courts have frequently made mandatory attendance of Alcoholics Anonymous and other 12-Step programs a regular part of sentencing for drug and alcohol offenders, despite the fact that these programs are statistically no more effective at ending addiction than is anything else, including doing nothing at all
(Orford 26). The underlying philosophy of AA is that drug and alcohol dependency is a medical problem, a disease that forces its victims to abuse substances in a way they cannot control. According to this theory, 12-step programs offer the only legitimate treatment for the “illness” of addiction, and while they do help approximately 20-30% of the people referred to them, so do the decidedly non-medical approaches of herbal treatments, abstinence pledges and Buddhist prayer rituals (Orford 26). The American judicial and health systems have been treating substance abuse as a medical problem for years, with no particular success, because it is in fact not a disease. Addiction is often compared to such chronic illnesses as diabetes, but this is wildly inappropriate because while a disease is an involuntary condition caused by a physiological dysfunction, chemical dependency is the unfortunate result of a series of voluntary choices, however poor.
The theory that alcohol and drug abuse are diseases was conceived by a researcher named Jellinek in 1960, in part in response to a series of conversations with Alcoholics Anonymous members (Skog 1310). Jellinek describes alcoholism as involving “loss of control” and the “inability to abstain”, both terms borrowed from the AA rhetoric (Skog 1310). According to Jellinek, those individuals who are afflicted with the disease of addiction are unable to control their own actions. Jellinek paints a Dr. Jekyl and Mr. Hyde type scenario in which individuals find themselves forced into terrible binges against their will, and a single alcoholic drink causes them to become absolutely “unable to adhere to their [original] intention to ‘have one or two drinks only’ but continue to ingest more and more—often with quite some difficulty and disgust—contrary to their [own] volition.” (Skog 1310)
The concept of chemical dependency as medical problem may at first glance appear to explain why some people are able to enjoy drinking a moderate amount of alcohol, and then stop before suffering any ill effects, and other people are not, but under more intense scrutiny it quickly becomes absurd. There is no known physiological or psychiatric condition that forces anyone to use drugs or alcohol in any quantities. Environment and family background most likely play some part in influencing the choices individuals make about their use or abuse of chemicals, as they do in nearly every other decision one can possibly make. The simple truth, however, is that if one examined ten people of similar background and experience, all patronizing the same bar on the same night, they would all exhibit different patterns of alcohol use. The reason for this, according to sociologist Ole-Jorgen Skog, has nothing to do with any sort of mysterious disease and everything to do with free will. Humans are hardly perfect and rarely consistent, and neither are the decisions they make. When faced with a homework assignment, some students will choose to complete it, and some students will choose to watch television, even though they are aware that failure to turn in homework will result in a lower grade. It is highly unlikely that all of these students will make the same choice every time, and it is ridiculous to conclude that those students who, on any given occasion, choose to watch TV are sick and those who choose to study are not. The bar patrons who decide to stop after two beers and go home, and who then end up drinking two pitchers and throwing up are not sick, they are, as Skog explains, simply people who “do not stick to their original plans, but tend to give in to temptation. Prior to drinking, they were planning to consume only one or two drinks. After two drinks, they have changed their minds.” (Skog 1311) These individuals are not suffering from any illness; they are experiencing the negative consequences of their choices, in the same way that students who choose to watch television rather than study experience the negative consequences of bad grades.
Over the past several years, evidence for the element of free will in substance abuse problems has grown steadily, and proponents of the disease theory have taken to arguing that what appears to be a matter of choice is actually a symptom of the illness that is addiction. This is a claim that is both irrational and illogical. One cannot have symptoms without a disease, and, despite nearly a century of searching, no medical basis for an “addiction disease” has ever been identified. Everything from nutritional deficiencies to an allergy to the grains from which alcohol is distilled has been examined at one time or another as a possible medical cause for alcoholism, and nothing has been able to withstand the test of scientific scrutiny (McKim 84). Without any root cause, the claim that addiction is a disease of which substance abuse is merely a symptom falls flat. Few patients would appreciate a doctor telling them that they had the flu because they had the flu, and diagnosing an individual with drug addiction or alcoholism because they are a drug addict or alcoholic is every bit as unreasonable.
The abuse of drugs or alcohol is, like anything else taken to excess, a matter of overindulgence rather than illness. It is only natural for an individual to want to repeat an activity or experience that they find enjoyable, particularly if there is little else to do, and it has long been recognized that addictions are most likely to develop in individual whose first experience with drug or alcohol use is pleasant, especially in an environment where there are few other activities to choose from. (West 5) Whether or not a chemical dependence actually develops, however, will ultimately be determined by that individual’s actions, rather than any biological force of fate. Addiction is hardly inevitable, and to claim that an individual placed in such an environment has no choice about whether or not they will develop a substance abuse problem “reduces this individual to something less than a full person. It implies that his or her behaviour is governed by causal mechanisms beyond volitional control, and reduces the individual to a consumption robot—a helpless spectator to his own body’s movements.” (Skog 1310)
America has spent a great deal of time and money attempting to treat drug and alcohol addiction as if it were one more disease, and this policy has resulted in a great deal of frustration and little success. A specific medical cause of addiction has never been identified, and probably never will be, but the behavioral cause can be easily broken down to individual choices, actions, and consequences. It may or may not be possible to change the percentage of people who are able to overcome chemical dependency, but it is clear that until there is a fundamental shift in the way problems of addiction are approached there can be no change at all.
[1] R. Reinert, “The Concept of Alcoholism as a Bad Habit,” Bulletin of the Menniger Clinic
32 (1968): 35-36
Works Cited
McKim, William. Drugs and Behavior: An Introduction to Behavioral Pharmacology. New Jersey: Prentice-Hall, 2000.
Orford, Jim. “Addiction as Excessive Appetite.” Addiction 96 (2001): 15-32.
Reinert, R. “The Concept of Alcoholism as a Bad Habit.” Bulletin of the Menniger Clinic 32 (1968): 35-36.
Skog, Ole-Jorgen. “Addict’s Choice.” Addiction 95 (2000): 1309-1315.
West, Robert. “Theories of Addiction.” Addiction 96 (2001): 3-13.
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