A reader, objecting to my article on how addiction is a choice, makes the following complaints:
As a therapist you should know that addiction is generally associated with a disregulation of the reward centers in the brain — i.e., the individual pursues activation of this reward center in a compulsive repetition of behaviors and/or drug use.
Dr. Hurd’s comments:
No, this is your interpretation of data. Interpretation is not the same as proof. The biological theory of determinism starts
with the premise that everything humans say, think, do and feel is caused by biological factors. This is clearly your starting premise. It’s not mine, and there’s reason for assuming that the brain does NOT do everything. The human psyche is far too vast and complex to isolate an entire behavioral problem in one location of the brain. This is nothing more than wishful thinking. Plus, you cannot evade the existence of thoughts, ideas, philosophy of life and basic premises. These determine much if not most of why people do, think and say what they do, including addiction.
The reader:
While individuals are responsible for taking action in managing this medical condition, they are not responsible for having the condition …
Dr. Hurd:
Well, of course not — if the brain determines everything. You’re asserting, without proof, that the brain is the cause of a person’s choice to abuse alcohol, cocaine or anything else. If this is true, how do you explain the fact that some people stop? If the brain chemistry is making them abuse the substance, then it would presumably take some sort of intervention within the brain — through surgery, medication, or other medical intervention — to stop the person. But you have groups of people that stop soon after recognizing their abuse, years after recognizing their abuse, or never.
The reader:
… all humans are vulnerable to it to more or less of a degree. There are several significant consequences to addiction however, and these tend to create vicious circles in the person’s life.
Dr. Hurd:
All of this is, or may be, true. How does any of it prove that addiction is a medical illness, inevitably guaranteed by a person’s biological make-up?
The reader:
For example, a person who is identified as an addict will typically lose status (which makes sense — their behavior is often destructive); however, high status has been shown to be a protective factor in preventing dopamine disregulation. Thus the loss of status makes it all the harder to kick the habit since shame, blame and guilt tend to become the norm in the person’s life (in other words the ONLY rewarding experience the person gets is the drug/behavior).
Dr. Hurd:
You haven’t defined any of your terms. Your arguments are not scientific. They’re not even part of the standard conceptual lexicon of psychiatry, psychotherapy, or even Alcoholics Anonymous. What do you mean by “status?” Do you mean one’s relationship to other people, or one’s economic situation? Actually, all kinds of people abuse drugs. I have met alcoholics, for example, who only abuse alcohol when in the presence of other people; other alcoholics who abuse it alone and with other people; and still others who drink only alone, in some cases even secretly. There’s no basis for saying there’s one kind of alcoholic, or any other kind of addict. They come in all shapes and sizes, personality-wise, just like everyone who’s not an addict. The common thread uniting addicts is that they’re trying to run away from reality, and they’re going about it in a self-defeating, even self-destructive way. So long as they believe they can evade this hard fact, they will keep drinking. If they start to recognize that they cannot evade what they’re doing to themselves — that their addictive behavior has destructive consequences whether they ignore them, or not — then the psychological stage is set for change. An addict’s viewpoints or beliefs determine the outcome; once false views are replaced with valid ones, and once the valid views are acted upon, change immediately begins.
The reader:
There is a big social component to this, so your assertion that ‘addiction is a choice’ is too simplistic.
Dr. Hurd:
I’m simplistic? You’re the one who’s simplistic. You’re saying that addiction is caused solely by brain chemistry — that it’s literally a medical illness. I’m saying it’s due to what the person thinks, and consequently does and feels. Thoughts, ideas and feelings are far more complex than a single section of the brain which might be altered by medication or surgery, in the process eradicating addiction overnight.
Interestingly, you contradict yourself. Initially, you rely on the premise that substance abuse is medical in origin, residing in the brain. Then you criticize me for not recognizing that addiction is “social.” But you should criticize yourself, because you’re the one who initially insisted that addiction is biological in origin — not social.
Addiction does usually take place within a social — i.e., interpersonal — context. But this does not mean social causes are the reason people abuse substances. People might be encouraged to drink or abuse drugs by others, and they usually choose to hang out primarily or exclusively with fellow addicts. But this choice of friends is a result of the addictive behavior. The addictive behavior, in turn, is a result of the choice to escape unpleasant emotions or difficult facts of reality in a habit-forming, self-defeating or self-destructive way.
It’s not simplistic to state a fact, that people who abuse substances do not have to do so, and are capable of changing their choices by changing their thinking, behaviors and habits. It happens every day. Talk to anyone who has been a former drinker or drug user, or gambler, for a year or more — possibly even for decades. Is it simplistic to say that these people prove my point, that different choices will lead to different results for people who make them?
Lastly, I’ll ask you this: If former addicts are not responsible for their cessation of alcohol/drugs, then who or what is?
The reader:
Anyone who has worked in the field of addiction medicine knows that community is a HUGE factor in stopping drug use.
Dr. Hurd:
But you’re claiming that addiction is not a choice, because it’s an illness — an illness in the brain, one for which there is no proof but you say I should be aware of since I’m a psychotherapist. Are you a psychotherapist? Please tell me of the research studies which isolate the area of the brain which is responsible for making a person drink or abuse drugs. And then please tell me of the medical intervention which eradicates or alters that section of the brain so as to make people stop abusing drugs or alcohol.
Now you’re ignoring your previously unfounded claim and contradicting yourself by saying the cause is social. “The brain makes them do it,” you’re initially saying. “Other people make them do it,” is your second assertion. Which is it, and what is the proof for either? Does the addict have nothing whatsoever to do with the addictive behavior? You don’t even hint at a reply. It’s just a belief. Actually, your belief is known as determinism. Whether it’s biological determinism, or social determinism, the error is the same: You’re holding people blameless for their own self-defeating, self-destructive behavior. It’s ironic. Your false belief is the same false belief held by most addicts — before they stop using. I sure hope you’re not a therapist or an “addiction treatment” professional. If you are, you’re feeding ideas to addicts which are false and toxic.
The reader:
Besides, you choose behaviors — addiction is a consequence of behavior — and not always a foreseeable one.
Dr. Hurd:
Which behavior is addiction a consequence of? This makes no sense at all. The act of drinking alcohol or taking a drug — one time, or a thousand times — IS a behavior. It’s a behavior which can become habit-forming, but it doesn’t change the fact that it’s still behavior. What behavior forces a person to engage in the behavior of abusing drugs or alcohol? And if behavior is the cause of addiction, what happened to your previous theories of biology and other people causing addiction?
The reader:
Finally, you promote rational choice as a solution; compulsive behavior is by definition a failure of rational choice.
Dr. Hurd:
Not all choices are rational. Just because somebody does something irrational doesn’t mean it’s not a choice. This is typical liberal, mental health professional thinking. “That behavior is so irrational. Nobody in his right mind would do such a thing. It must be caused by something external.” Oh, really? That’s your belief, but it’s false.