ADDICTION IS A CHOICE

There is no such thing as an involuntary addiction, according to Mr. Schaler, a psychologist and adjunct professor of justice, law, and society at American University. People choose their addictions -- whether to opera, prayer, or heroin. The idea, which grew out of the temperance movement, that addiction is a disease "is the greatest medical hoax since the idea that masturbation would make you go blind," he writes.

Q. Doesn't the terrible physical experience of someone trying to quit heroin show that he is addicted and can't simply choose not to inject?

A. The fact of the matter is, research consistently shows that the best explanations for heroin use are the environment and mindset of the user. Eighty-seven percent of the confirmed heroin-using American soldiers in Vietnam gave up heroin soon after they came back to the U.S., without any treatment or intervention. In other words, the terrible pain and craving was simply not enough to keep them from quitting. There are physiological changes associated with everything we do. That's not the same as saying the physiology causes us to do things.

Q. So you don't think a behavior can be compulsive if it has no physiological basis?

A. No, because even philosophically or logically, to speak of a behavior as involuntary is really a contradiction. A behavior is something that a person chooses to do.

Q. That makes it sound so simple. Clearly, many people struggle very hard to stop a behavior that diminishes their sense of well-being and happiness. If the behavior is so painful to them, how can it be a choice?

A. We all make choices that have good and bad consequences, and just because there are negative consequences doesn't mean it's not a choice. I don't mean to say that changing your behavior is easy, but the fact of the matter is that every single person who ever stopped using any number of drugs in self-destructive ways only stopped using by making a choice to stop. Now, there may be certain situations or environments that are more conducive to making that choice. Ultimately, what we need to look at are the things going on in the person's life.

Q. Might using the term "illness" to describe addiction be a useful way of talking about how difficult it is to change certain behaviors, even if "mental illness" and "physical illness" have different meanings?

A. I don't think lying is ever useful when it comes to helping people solve existential problems. I don't think there's any utility to it other than to justify insurance reimbursement and federal research dollars.

Q. You're very critical of Alcoholics Anonymous in your book. But if people find it useful in their lives, is there anything wrong with their continuing to go to A.A. meetings?

A. I think people should be allowed to go to whatever meetings they want to. But my concern is twofold. One, I object to government involvement with Alcoholics Anonymous because Alcoholics Anonymous is a religious activity. You have court-ordered treatment for drunk driving, and you also have state support for treatment programs that are essentially religious in nature.

From a psychological point of view, what people learn in A.A. goes against what we know to be the best approach to helping yourself based on contemporary psychological research. The more you believe you can do something, the more likely you are to try to do it. And the more you believe that you can't do something, the more likely you are to prove that to be true. My concern about A.A. is that they teach people that they're powerless.

Q. How do you treat people for addiction?

A. There's no such thing as treatment, other than metaphorical treatment. I talk to people. All therapy is conversation, a particular type of conversation. That can be tremendously useful to someone, but I don't call it a form of medicine. It's more a form of secular ethics. When we call these behaviors diseases, basically what we're doing is literalizing a metaphor, and engaging in moral management masquerading as medicine.