Perhaps the answer lies in this article:
Addiction Is a Choice, by Jeffrey A. Schaler, Ph.D. Open Court, 2000, 179 pages.
---------------------------------------------------------------------------------------------------
Hooked on Addiction
By Jeff Riggenbach
Liberty Magazine
September, 2000, pages 65-66
Most people who oppose the War on Drugs - including, alas, most libertarians - never question the propaganda that is used to justify it. "Yes," they say, "it's true: drug use destroys the user's health and, not infrequently, his entire life. We stipulate to that. But, after all, people have a right to destroy themselves." Or, alternately, they say, "But, after all, the results of attempting to prohibit these drugs are even worse than the (undeniably horrible) effects of the drugs themselves."
The question is whether the effects of drugs like marijuana, cocaine, or heroin really are all that horrible. And the answer is no, they aren't. The history of the War on Drugs, which goes back more than a hundred years to the first drug prohibition laws adopted in San Francisco and other localities in the late 19th century, is overgrown with the exaggerations, oversimplifications, and outright lies of anti-drug propagandists. The result is a tangled thicket of mostly baseless myths. Anyone interested in the truth about "dangerous drugs" and the American war to stamp them out must hack his way through the thicket in order to find the truth. There's the myth of "addiction," the myth of the "heroin overdose death," the myth that "drugs cause crime," the myth that "drugs cause poverty and ill health," and the myth of "drug treatment," to name just a few of the more pernicious.
Jeffrey Schaler, a psychologist in private practice who counts teaching posts at American University and Johns Hopkins among his academic credits, explodes two of these myths: "addiction" and "drug treatment." Anyone who labors under the delusion that drug addicts are helpless to control or change their bad habits without "drug treatment" desperately needs to read his new book Addiction Is a Choice.
Schaler begins his line of inquiry by asking the fundamental question, "What is addiction?" He answers that until about two hundred years ago, the word "addiction" was universally understood in English-speaking countries to mean "commitment, dedication, devotion, inclination, bent, or attachment." He beings his Introduction and eleven of his thirteen chapters with quotations, many of them charming, from writers of the 16th through 19th centuries. In each quotation, the word "addiction" is used in its original sense. Thus we read of addiction to virginity, to melancholy, to the dance, to hot countries, to sports, to other people's money (written, not surprisingly, of members of the ruling class), and, inevitably, to vice.
In the late 18th and early 19th centuries, Schaler explains, activists and writers in the Temperance Movement (and certain medical doctors too - the American Benjamin Rush and the Scot Thomas Trotters among them) began speaking of addiction as something quite different. Now, suddenly, one was addicted, not to, say drunkenness, but to alcohol itself. And this addiction was to be looked upon as a disease, from which the addict was suffering.
Schaler writes:
"Neither Rush nor Trotter offered scientific evidence to support this new claim, but Rush was a powerful rhetorician and exerted an influence on public opinion. The newly invented medical language grew to be accepted as fact."
Schaler examines this new theory, which he calls the "disease model," in detail. "If addiction is a disease," he writes, "it's either a bodily or a mental disease." There is a problem with regarding addiction as a physical disease, however. It doesn't have the right characteristics. As Schaler puts it, "pathology . . . requires an identifiable alteration in bodily tissue, a change in the cells of the body, for disease classification." This is the reason that "a simple test of a true physical disease is whether it can be shown to exist in a corpse. There are no bodily signs of addiction itself (as opposed to its effects) that can be identified in a dead body. Addiction is therefore not listed in standard pathology textbooks."
Schaler acknowledges that "a doctor might conclude that someone with cirrhosis of the liver and other bodily signs had partaken of alcoholic beverages heavily over a long period, and might infer that the patient was an 'alcoholic,'" but this doesnot show that there are bodily signs of addiction. As he observes a few pages later:
". . . diseases are medical conditions. They can be discovered on the basis of bodily signs. They are something people have. They are involuntary. For example, the disease of syphilis was discovered. It is identified by specific signs. It is not a form of activity and is not based in human values. While certain behaviors increase the likelihood of acquiring syphilis, and while the acquisition of syphilis has consequences for subsequent social interaction, the behavior and the disease are separate phenomena. Syphilis meets the nosological critera for disease classification in a pathology textbook. Unlike addiction, syphilis is a disease that can be diagnosed in a corpse."
Well, then, is addiction a mental disease, a "mental illness"? The American Psychiatric Association, Schaler tells us, does not list addiction in its Diagnostic and Statistical Manual of Mental Disorders IV. The Association does list certain "substance-related disorders" in the manula, but, as Schaler comments, "they would not fit the category of organic disorders because they are described in terms of behavior only. They would conceivably fit the functional disorder category but probably would be subordinated to one of the established [functional] disorders such as discouragement or anxiety." These "functional disorders," Schaler writers, "are mental in the sense that they involve mental activities." But "as [Thomas] Szasz has pointed out, they are diseases only in a metaphorical sense."
Perhaps the most telling comment Schaler makes on the "disease model" comes during his first references to Alcoholics Anonymous, whose Twelve Step Program is the basis for almost all of the "drug treatment" programs into which local, state and federal governments in this country pour taxpayers' money. Alcoholics Anonymous, he maintains, is nothing more nor less than a "religious cult."
To say that Alcoholics Anonymous is a religious cult is not, of course, to say that it is ineffective. But, in fact, it is. As Schaler puts it,
"treatment generally doesn't work. "Ill repeat that: addiction treatments do not work. This doesn't mean that individuals never give up their addiction after treatment. It's simply that they don't seem to do so at any higher rate than without treatment. One treatment tends to be just about as effective as any other treatment, which is just about as effective as no treatment at all."
In Schaler's view, addiction is not a "disease" that requires "treatment"; it is a choice that requires individual responsibility. "Drugs don't cause addiction," he writers. "No thing can 'addict' any person. Moreover, addiction doesn't mean you can't control your behavior. You can always control your own behavior. Drugs are inanimate objects. They have no will or power of their own."
Why, then, do people choose to use drugs? "People use legal and illegal drugs like Prozac and heroin," Schaler answers, "to avoid coping with their lives. The reasons people avoid coping with their lives may be judged good or bad. Addiction is the expression of a person's values. Therefore, whenever we talk or write about addiction we are dealing with an ethical issue, not a medical one. Addiction is not a disease, nor is addiction a public health problem. Addiction is a choice."
The myth of addiction has made ignominous contributions to public issues other than the War on Drugs, of course. It is, after all, the nonsensical concept of the addictiveness of tobacco that has been used to justify the recent financial assault on cigarette manufacturers by larcenous state governments and unscrupulous personal injury lawyers. Jeffrey Schaler's crusading little book is poised to do a whole world of good, if only it can reach and persuade a broad enough public. Let us fervently hope that it does so.
Copyright, 2000, Liberty Magazine
