Addiction: Choice vs. Disease
January 16, 2010
Johnny's heart is beating at over a hundred and thirty beats per minute. He can't sleep again and is sweating profusely. Johnny hears a voice saying "Don't do it Johnny. You know how this will end." Then he hears another louder, more insistent voice saying to him, “Come on Johnny, no one will know. Just one more time and then we will stop”. Johnny is disgusted with himself as he reaches for the phone to make that call to his drug connection. How do we help someone like Johnny? Some people would say that all Johnny needs is to make a conscious decision to not use and to punish or threaten him until he stops. This is the crux of what is known as the choice argument: Addiction is a behavior and therefore is a choice not a disease. To be honest the choice argument is a strong argument and is the best reason for not calling addiction a disease. To call addiction a disease and not a choice, evidence will need to show the flaws in calling addiction a choice, show how drugs of abuse work, how addiction fits into the disease model, identify what organ is primarily affected, and be able to recognize what the symptoms of drug addiction are. There are some very educated individuals who believe that addition is a behavior and that behaviors are a result of choices. According to Gene Heyman, a Harvard psychologist, drug addiction is a choice, not a disease. In his book, Addiction: A Disorder of Choice, Heyman states that addiction is not a disease and that it is a pattern of persistent but optional self-destructive behaviors (2009). He disputes Alan Leshner, former head of the National Institute on Drug Abuse, who has stated that "drug use starts off voluntary and becomes involuntary" (Gillis, 2009) Heyman bases this upon, what he calls, "biographical information". Heyman states that he has read reports where the addict makes the statement, "Well, it was a question of getting high on cocaine or putting food on the table for my kids" (Gillis, 2009). Those who subscribe to this philosophy are able to drive home their argument by using the following scenario: Put an addict's drug of choice in front of him and tell him, "Go ahead, it is on the house." An addict, they say, will gladly take you up on this offer, however, this is when they challenge the addict's behavior by saying-"but if you do choose to use, I will pull out a gun and shoot you" (McCauley, 2009). It should be fairly obvious that faced with these choices the addict will indeed choose not to use. Choice theorists draw a line between behaviors and symptoms. With diseases such as cancer and diabetes the patient cannot be coerced into not having the symptoms of his or her disease. This would appear to be a great argument but is this all there is to addiction? Simply find a big enough deterrent to force the addict to make the right choices? If behaviors are choices and if free will exists punishing and/or coercing the addict is appropriate. The behaviors of addicts are revolting, frustrating, offensive, and sometimes criminal and can easily be seen as bad behaviors i.e. choices. While this might be true, does this mean that because you have a bad act you necessarily have a bad actor or some sort of intrinsic badness in a person? According to Dr. McCauley, doctors have been making this mistake for centuries, believing that the behaviors that they are seeing in their patients are due to a moral failing, ethnicity, race, personality disorder, or gender only to discover that what they are seeing is actually symptoms of a disease (2009). Remember Johnny's situation, there are no drugs around him at the moment and yet all he can think about is using his drug of choice. There is no sleep for Johnny, no rest, only craving. This is the...