ADDICTION IS A CHOICE

By Jeffrey A. Schaler. Chicago and La Salle: Open Court Publishing
Company, 179 pages, $19.95 (paper), $42.00 (cloth

Drawing from the traditions of Alfred Lindesmith, Thomas Szasz, Stanton
Peele, and Herbert Fingarette, Jeffrey Schaler has produced a provocative,
irreverent, and sometimes ideological tome that is sure to add fuel to the
fire of the addiction wars. Addiction Is A Choice brackets debate
regarding the nature of "addiction" by comparing the disease (determinism)
and choice (free will) positions. Schaler's argument is not new (which he
clearly acknowledges) and has been more clearly and definitively
articulated by his predecessors, particularly Peele. What is new, however,
is that Schaler, as clinician, teacher, and activist, has chosen to expound
his argument on the street and in the trenches rather than through the more
polite and restrained approach of academic discourse.

Schaler systematically debunks the commonly accepted model that addiction
is activity that people are "physically unable to stop." He gleans
illustrations from well-known studies of users (humans and rats) of a
variety of drugs (alcohol, cocaine, tobacco, and heroin). Any objective
overview of this research reveals that users (including those who are
considered "addicted") either moderate or alter their drug use in
experimental as well as natural settings. Consequently, the notion that
there is some underlying physiological condition, or "addiction," that
controls the user's behavior is unfounded and a societal construction (p. xv).

When Schaler gets to the material he knows best-clinical work-he vehemently
attacks the treatment enterprise and those whose organization and funding
support and perpetuate it. I have personally witnessed situations in which
academicians and treatment providers have shared views, butted heads,
and/or screamed at each other. Generally, such discourse, like personal
argument, produces bad feelings, an entrenchment of personal positions, and
little progress or compromise. Schaler reports numerous
misinterpretations, attacks, and examples of "double-speak" in a variety of
communications with various stakeholders. While there is no reason to
doubt the accuracy of his interpretations, where such rancor, from one side
of the other, leads us is not a road worth traveling.

With respect to treatment providers, Schaler draws a convenience sample of
providers in the United States, Canada, and Australia. Respondents include
members of the National Association of Alcoholism and Drug Abuse Counselors
(NAADC) and the Society of Psychologists in Addictive Behaviors (SPAB), as
well as member/supervisors from Rational Recovery Systems (RRS). He
provides basic demographic characteristics of providers, measurement of
attitudes regarding disease or free-will models of treatment, and
measurement of spiritual dimensions of recovery. As expected, RRS
supervisors have a closer affinity to a free-will model of addiction, while
NAADAC members are most attached to a disease model. Given his modest
sample size, Schaler is only able to examine bivariate relationships but is
unable to statistically elaborate on them. It would be interesting to note
how gender, membership in Alcoholics Anonymous, religion, treatment
certification and other factors interact with and affect each other.

While Schaler, on the one hand, advances a free-choice model he
subsequently lists a series of social and psychological constraints that
impinge on the actor's ability to choose. In discussing Zimmer and
Morgan's Marijuana Myths and Marijuana Facts, Schaler cautions that the
authors do not mention the possibilities of marijuana's harmful effects. He
writes, "I have come to suspect through long experience counseling
marijuana users that marijuana consumption may adversely affect people's
ability to differentiate what they know versus what they imagine" (p. 27).
Schaler also suspects that these effects vary with self-esteem,
self-efficacy, guilt feelings, views of the world, and identity. One
obvious interpretation of this is that a person could choose to use
marijuana and choose to use it in a way which others may define as
habitual. However, is this really a choice based entirely on free will, or
a choice shaped, clouded, and partially determined ultimately by what the
early marijuana use has done to an individual's ability to differentiate?

Schaler is accurate in saying that addiction, drug use and drug abstention
are behaviors. But are these behaviors the result of choice or
determinism? The obvious answer is that they are both. The middle ground
isn't a safe cop-out; rather, it emerges from a rational and objective
assessment of the data. Neither polar position makes the most parsimonious
interpretation of the data. Addiction as behavior is much more accurate
than addiction as disease or choice. If, as Schaler argues, addiction is
behavior, then viewing it as a disease is a metaphor, and taking that
metaphor as reality involves constructing a myth.

Regarding addiction as choice, however, oversimplifies the complexity of
reality and choice. Human behaviors, as compared to animal behaviors, are
much more shaped by choice and perception; but choice and perception are
filtered through the lens of culture. Schaler's citations of studies in
which persons viewed as "addictive" or dependent and who have the ability
to regulate, alter and adapt their specific drug-related behaviors are not
sufficient to support his assertion that there no physiological or
pharmacological influences on behavior. Alcohol, cocaine and other similar
substances, are psychoactive; they alter perceptual, feeling, and
cognitive functions. However, even these are mediated and shaped by
physiology, set (psychology) and setting (physical and social environment).
The chemicallistic fallacy that specific drugs produce specific behavioral
consequences is simply wrong. Relativism, though, only goes so far. If you
use enough of a substance, it can kill you, regardless of what you
think. Drugs can also produce a host of diseases, which Schaler clearly
acknowledges; yet he also argues, following Szasz, that to confuse heavy
drug use (the cause of disease) with the disease itself is logically and
factually wrong.

Developing and implementing drug education and prevention programs in
schools that are based on the disease model-whether by independent
providers, the police or the government-are questionable activities, given
the data on their effectiveness. Prevention strategies, laws, and
treatments that are based on a model that views drug use as likely to lead
to drug abuse and addiction are as about as effective as they are correct.
This is not to say that treatment providers are the enemy; their models
and approaches have evolved due to broader societal currents that have
lessened social integration and diminished personal and social
accountability. Individual and social responsibility-not "defective" human
characteristics-has more bearing on levels and types of drug use. It is
the maintenance, strengthening and restoration of social relationships
between selves and others and between users and their social networks that
are intervention points at which to address what goes awry or reduces the
likelihood of dysfunction in the first place.

How we think about and treat addiction influence the development of
personal and societal drug issues more so than does the actual drug
consumed. Many people try drugs; yet most of them cease their use over
the short to moderate haul. Some become heavy users, habituated users, or
are designated as "addicts." Among these, many (if not most) eventually
cease their use. Of these heavy users, the majority stop because of
significant life changes: they choose to stop, their friends and families
help them, they hurt enough to stop, or they find another good reason to
stop. Some stop because of their connection to others through treatment.
While Schaler advocates a broader view of treatment, he would do well not
to throw the baby out with the bath water.

Drug use, whether recreational, heavy, or habituated, is best understood
from a lifestyle and/or career perspective. Careers involve behavior
systems, worldviews and identities. Early or experimental drug use is
situational and arises from diverse causes, sources, and explanations. As
drug use becomes more patterned it has greater consequence for the actor,
throughout life. Schaler's views are consistent with this approach but
occasionally lapse into a version of the "evil causes evil" fallacy. Like
most clinicians, he tends to view drug use as essentially bad, or at least
maladaptive (negative addiction). Drug use, whether recreational or
habitual, is behavior that is not intrinsically good or bad, but simply
behavior.

Like AA members who learned through AA involvement to understand, explain,
and reconstruct alcoholism and their alcoholism experience from the AA
perspective, Schaler also constructs and interprets his experiences with
others from clinical lenses. While his lenses are far more objective and
balanced than those of most observers, his objectivity is hampered by
seeing and talking primarily with those in treatment. His contributions in
this work are significant; like his predecessors, he paints a picture of
alcohol and drug maladies that are driven by choices, missed opportunities,
and a host of other factors. Getting people to understand that they are
active participants, in fact, the creators of their situations, has the
potential of empowering actors and their significant others to take stock
and change. Regarding self as a constant victim in a billiard-ball theory
of causation instead of an active agent is a trend that, if reversed, can
lead to a significant reduction of habituated drug use as well as other
human maladies-both personal and social.

David R. Rudy is professor of sociology and dean of the Institute for
Regional Analysis and Public Policy at Morehead State University. He is
the author of Becoming Alcoholic: Alcoholics Anonymous and the Reality of
Alcoholism and co-editor (with Jim Orcutt) of the forthcoming book Alcohol,
Drugs, and Social Problems.