The Human Condition

Can Addicts Help It?

Piers Benn can’t resist finding out.

Are you an addict? Or do you just enjoy a certain substance or activity, and spend a lot of time indulging in it? What is the difference, and how could we tell? And if you are an addict, does that mean you literally cannot resist the things you are addicted to? These are important matters, since they relate to whether you’re responsible for succumbing to the addiction, or the misdemeanours you commit when in its grip. So they are also relevant to questions of legal and social policy.

Take an example. Sometimes you hear of people winning huge damages against tobacco companies for persuading them to smoke, thereby harming their health. But can this be right? The courtroom defence, “Your Honour, I shoplifted because a friend persuaded me to,” would be derided. Even if someone did persuade me, I should not have let him. That is why I am responsible. However, if the tobacco companies had me hooked – addicted – before I knew the risks of smoking, and once I knew, I was unable to give it up, might there not be a case against the companies or their advertisers? I continued smoking, but it wasn’t a free choice… I wanted to stop, but couldn’t. I was addicted. Putting aside the base thought that addiction to money is what makes litigation seem a good idea, is there also a morally defensible case?

Addiction

There is much scientific research on addiction. There are questions about how to diagnose it, whether or how it can be treated, what policies might reduce its harmful effects on society, and so on. But there are philosophical questions as well, which turn upon the concept of addiction and the related problem of free will. If addiction is a fact, is it true that addicts cannot control their addictive behaviour? For example, is there a qualitative difference between a ‘normal’ drinker and an ‘alcoholic’? Many people think there is: the normal drinker can control his drinking, whereas the alcoholic cannot. This belief forms the basis of most treatment programmes. But is it true? To find out, we need to investigate the true nature of addiction, and the assumptions underlying treatment programmes.

I propose that addiction is real, although with fuzzy boundaries. I also propose that addicts possess at least some control over their addictive behaviour. So I need to say in outline what I take addiction to be, since many people think it is part of the meaning of ‘addiction’ that the addict lacks control. We need not go down this route. But addictive desires appear, by definition, to be peculiarly insatiable, and gratifying these desires is central to the addict’s life. In consequence, he often seriously neglects other things that would normally be important to him. Take alcoholism, which involves a chronic and largely insatiable desire for alcohol. Drinking assumes a catastrophic centrality in the alcoholic’s life. However, this doesn’t imply that the alcoholic cannot control his drinking, even if going without it brings intense frustration and disappointment.

Alcoholism is described medically as ‘alcohol dependence syndrome’, and it involves such things as gaining an increasing tolerance to alcohol, and physical withdrawal symptoms if drinking is abruptly stopped, eg, tremors, anxiety, or seizures. But does even physical dependence entail a lack of ability to control drinking? Strictly speaking, no. Stopping without medical detoxification is unpleasant and can be dangerous; but even that doesn’t mean the alcoholic cannot stop drinking. (And if he dies in delirium tremens, then he has to stop. The dead don’t drink.)

Disease and Addiction

So why is it so commonly thought that addicts cannot control their addictive behaviour? One idea is that addiction is a disease. That is to say, the cause of the addiction is some disorder outside of your will which you cannot be expected to control. The ‘disease model’ has been much discussed in research literature. Recovery programmes like Alcoholics Anonymous’ Twelve Step program teach in this way that the addict lacks control over his addictive behaviour. Step One of AA’s Twelve Steps to Recovery reads: “We admitted that we were powerless over alcohol, that our lives had become unmanageable.” (Alcoholics Anonymous, Fourth Edition, Alcoholics Anonymous World Services, Inc, 2001.) This admission is seen as a blessed surrender, often made after many disastrous drinking sprees, mounting medical, legal, familial, social, psychological, financial or professional problems, repeated vows to give up or reduce drinking, and repeated relapse. AA folklore, much of it contained in the fellowship’s ‘Big Book’, Alcoholics Anonymous, contains narratives of desperate individuals who finally accepted that recovery was not possible on their own, but must rest in their turning to a Higher Power – ‘God as we understand Him’ (although nowadays the talk of God tends to be watered down). This can bring alcoholics back to ‘sanity’. AA also believes that alcoholics need to maintain lifelong abstinence, since their disease is literally incurable – as demonstrated by recovering alcoholics who drank again after years of abstinence, and quickly reinstated old behaviours. The disease is always there, waiting to delude them that they can have ‘just the one’ drink. But although there is no cure, recovery is possible – as shown in a re-oriented, abstinent life aided by a Higher Power – God, the ‘room’, sponsors, or, in practice, whatever you choose.

There are many people who swear by Twelve Step movements and who believe their lives were saved by them. And it is wise not to argue with them when they are so happy no longer indulging their previous addiction. Nevertheless there remain some real philosophical difficulties with this approach. I shall discuss some of these problems after briefly looking at some reasons why the disease model of addiction is so appealing.

More: http://philosophynow.org/issues/80/Can_Addicts_Help_It