IS ADDICTION A CHOICE?

Q&A: Psychologist Jeffrey Schaler

Dr. Jeffrey Schaler

If you're addicted to something, whose fault is it?

As ABCNEWS' John Stossel reports, "don't blame the addict" is the message
we often hear from treatment facilities.

But psychologist Jeffrey Schaler says we're stronger than we think, and
that overeating, smoking and other so-called addictions are things we can
choose to control.

"Addiction is a behavior and all behaviors are choices," says Schaler,
author of the book Addiction Is a Choice.

Schaler joined a live discussion with our viewers on Tuesday, April 22. The
transcript follows.

Is Addiction Just a Matter of Choice?

Moderator

Welcome to our live chat with Dr. Jeffrey Schaler, a psychologist and
author of the book, Addiction Is a Choice.

Irene Soble asks:

How do you define a disease? How does addiction to a drug such as alcohol
or heroin compare to diseases such as adult onset diabetes or heart
disease? Many of our chronic diseases are caused by multiple factors
including lifestyle choices, diet, exercise, etc. Why is one a disease and
the other not when choices play a major role in the development of both?

Dr. Jeffrey Schaler

Let's slow down just a bit. Let's be careful not to confuse the cause of
the disease with the disease itself.

For example, smoking is a behavior that may cause lung cancer. Drinking
excessive amounts of alcohol is a behavior that may cause cirrhosis of the
liver. The causes are behaviors in these two cases. The diseases are
different from the causes. A disease, according to the standard textbooks
on pathology, refers to a physiological lesion.

Another way that we can look at this is to see that diseases are something
that are present in the cadaver at autopsy. Behaviors are something that
living people do. Diseases are something that people have.

Smoking and drinking, like addiction, are not found in standard textbooks
on pathology because they are not diseases -- they're behaviors. While we
are always able to control the behaviors that lead to diseases, diseases
are something we cannot control by choice; they are involuntary.

Tom George writes:

It seems to me there is a difference between different addictions. Heroin
addicts go through very real and painful withdrawal symptoms when they give
up heroin. But if I give up my nightly bowl of ice cream, I may whine and
feel sorry for myself, but other than that I do not suffer ill affects.
Would it be better to reserve the term "addiction" for cases where there
are serious withdrawal symptoms?

Dr. Jeffrey Schaler

This is a good question. Let's consider love as an addiction. When you end
a love relationship, you often may experience terrible withdrawal symptoms;
these may include insomnia, great emotional distress and gastrointestinal
problems. The person may become so despondent that they commit suicide.

Here we have an example of a person addicted to a love relationship. There
is nothing that the person is physiologically addicted to. Yet the
withdrawal symptoms, or the ending of the addiction, is very painful and
distressing.

Many people would consider the pain associated with the breaking off of a
love relationship far greater than the pain associated with heroin
withdrawal. Many heroin users report that the ending of their use of heroin
was no worse than a bad case of the flu.

In order to achieve anything good for ourselves, we have to struggle in
life. Giving up drugs is no exception. Changing behaviors and breaking
habits is often difficult. If you look back on your life, every decision
you made to better yourself included some experience of discomfort.

We accept this as a matter of fact in life; the giving up of drugs is no
exception. Dr. Stanton Peele and Archie Brodsky have written about this
extensively in their book about addiction to love.

What we know for a fact is that many people give up heroin despite painful
withdrawal symptoms. Every drug has an effect on the body and the effects
may vary by the person's constitution and by the chemical properties of the
drug. Many people experience very few painful withdrawal symptoms. There is
no evidence to support the idea that the withdrawal symptoms, in and of
themselves, cause the person to continue to use the drugs in an addictive
manner.

Leigh writes:

I think blame is the least important thing here! The important thing is to
get over the habit. I've gotten over some addictions with help and some on
my own -- it's horrible either way, and no matter what, you're bound to
blame yourself. Chastising the addict, however, claiming that they are to
blame and that it was their intention to ruin their life, is not the
confidence-building tool that the person will need to get back on their
feet and turn it around. There are genetic predispositions, psychiatric,
psychologic, medical, and socio-economic reasons for impulse control
issues. I really don't think anyone wants this for themselves, truly. 'Give
me a break' John Stossel; this is a sensitive issue that you are treating
very insensitively.

Dr. Jeffrey Schaler

I would like to differentiate between viewing addiction as a moral and
ethical issue, and making a moralistic judgment about a person who uses drugs.

When we say a person chooses to engage in addictive behavior, we are not
passing judgment on that person insofar as they are a good or bad person;
what we mean to say is that they engage in certain behaviors for reasons
that are important to them. These reasons may be psychological, social,
emotional, cultural and existential.

Saying that a person is not in control of his or her behavior impresses me
as decidedly disrespectful of their humanness. People do things and behave
in certain ways for reasons; they are not things that are caused by
chemicals or brains.

There is plenty of evidence to show that genes have everything to do with
our physiological makeup, but that's very different from saying genes cause
us to behave in certain ways. After all, we are all genetically programmed
to die, but that does not mean that life is a disease.

I firmly believe that in order to be free, a person must accept
responsibility for his or her behaviors. A myth perpetuated by people who
believe addiction is a disease, is that you can be free if you just say a
disease or gene made me do it.

My view on why people use illegal drugs and legal drugs and psychoactive
prescription drugs is that they want to change the metaphorical lens of
perception; in other words, they want to change the way they view
themselves and the world.

In order to understand why someone continues to use these drugs, we must
take a look at what it is existentially that the person wants to avoid
dealing with.

A mistake in many of our addiction policies today is to focus solely on the
availability of the drug, the chemical properties of the drug, and the
physiology of the person. As long as we focus on those factors instead of
the existential factors, we will never resolve the key issues.

The research consistently shows the best explanations for drug use have to
do with the values of a person, their mind set and the environment they
live in. People often use drugs in a self-destructive manner as a way of
avoiding coping with some experience in life.

What they may need to do is muster up the courage to face some difficult
facts about themselves and their existential predicament. When they do
that, they are unlikely to rely on drugs as a way of coping with life.

Kate asks:

What about people who have multiple "addictions" or lose one and start another?

Dr. Jeffrey Schaler

As Professor Bruce Alexander at Simon Fraser University has written, there
are positive and negative addictions, neither of which have anything to do
with not being able to control one's behavior.

Positive addictions are activities we engage in that enhance our sense of
well-being; negative addictions are activities we engage in that detract
from our sense of well-being.

What we call a positive or negative addiction is something that varies from
person to person. The population of people we call addicts is a
heterogeneous one, not a homogeneous one. In other words, people use drugs
in different ways, for different reasons, with different results. No two
people are identical.

The fact that people may transfer their addiction from one activity or
substance to another is nothing particularly unusual. Hopefully, people
will transfer their negative addictions to positive ones. People engage in
multiple negative and positive addictions all the time.

All addiction really means is that you are moving towards something, you
are saying "yes" to something, you are consenting or are devoted to some
erson or activity.

The idea or meaning of addiction as devotion dates back hundreds and
hundreds of years. The idea that addiction means you can't control your
behavior came out of the alcohol temperance movement in the early part of
the 20th century.

The idea of addiction as involuntary is not only illogical but has been
consistently disproved in scientific experiments. There is no such thing as
an involuntary behavior.

These experiments are well documented in my book Addiction is a Choice and
in numerous writings by my friend and colleague Stanton Peele.

Moderator

Dr. Schaler, do you have any final thoughts?

Dr. Jeffrey Schaler

I think it's important to remember that what we call addiction is not the
symptom of a weak will but the expression of what I call an iron will.

In other words, it's not that the person can't change his or her behavior;
we need to recognize that what they do is continue to engage in a
self-destructive behavior at any cost for reasons that are important to them.

The people we call "drug addicts" are not weak, but strong. What we need to
recognize is that they themselves are the higher power.

Moderator

Thanks to Dr. Jeffery Schaler, and all those who joined this chat session.