Choice Remarks on Addiction

In his article “Making Better Choices is Key” (Tri-Cities News, July 3, 2009) Terry O’Neill writes:

“… half the truth is often a whole lie. So it is with the prevailing notion that addiction is a disease. On the surface, this interpretation seems to be at least half right, in that addicts appear to be afflicted by a disorder over which they have no control.

“However, this half truth distorts the reality that, unlike cancer, addiction can be cured by a choice that is at once simple and profound — an exercise of free will and resolve that is not available to sufferers of actual diseases.

“…But the simple and whole truth is that, while drugs such as alcohol and heroin may, indeed, exert a powerful hold over people’s lives — and destroy their health in the process — addictions are not at all like other diseases because the sufferer, through determination sparked by a ‘bottoming out,’ counseling, or a commitment to a recovery program, can cure themselves. This is impossible with cancer.

“It’s evident to me that our society’s determination to treat addiction as a disease ends up enabling addicts …”

Mr. O’Neill’s so-called “simple and whole truth” is but another simplistic (and irrelevant) half-truth.

We can indeed accept that addicts can get there along a path of bad choices. But it is also widely accepted that health problems for all of us are in large measure due to our own choices: bad diet, lack of exercise, and many others.

Lifestyle choices can lead to hosts of ailments, such as diabetes, heart and liver disease, and yes, even cancer. Must we deny that these are diseases, or trivialize them because a lifetime of bad-choices brought them on? If we treat them, are we merely enabling bad choices? Can we not be counseled, so that with sufficient strength of will and determination we can just overcome these bad choices and cure ourselves?

Addiction takes many forms, involving complex physical, psychological and emotional inter-dependencies. It can mean anything from innocuous cravings (anybody need a coffee to get them going in the morning?) to gut-wrenching, soul-killing torment.

And, though bad-choices can lead to addiction, such choices are often dominated by pain, abuse, stress, depression, mental illness, poverty, homelessness, hopelessness, and other social, community, and even physical factors. Eventually, they can be overwhelmed by the addiction itself.

To suggest that it’s really all about personal responsibility and that addicts should just make better choices is breathlessly naive. It’s like withholding a lifeline from a drowning man because it would just enable him, while helpfully counseling that he really should make better choices but that, luckily, by “exercise of free will and resolve” and a rousing chorus of support, he can surely save himself.

Mr. O’Neill himself admits that “addicts appear to be afflicted by a disorder over which they have no control.” The disorder to which Mr. O’Neill here alludes, is addiction. (Apparently we can accept this as “dis-order,” but not “dis-ease?”) Having no control, how then, by dint of any amount of “will and determination,” can addicts be expected to “cure themselves”? And even if they can, how does this translate into it not being a disease?

Even when the immediate crushing burden of addiction can be relieved, it is not necessarily gone. The gnawing craving, compulsion, and pain can perhaps be abated, but the addiction remains. Ask a recovering alcoholic if he or she is “cured.” The choices are not the addiction, nor are the problems behind the choices.

After trivializing the problem, Mr. O’Neill then takes a swipe at harm reduction approaches as “enabling” addiction, particularly noting Vancouver’s safe injection site, Insite.

Mr. O’Neill’s bizarre argument aside, the fact remains that harm reduction works; it reduces harm. And, in particular, Insite works, too — at least twenty reputable peer-reviewed scientific studies have confirmed this.

Far from enabling addiction, Insite enables recovery. Insite provides a pathway to counseling and treatment, and a doorway to a better life; it has been shown to help reduce substance abuse, related crime, and infectious disease, and to help keep people alive long enough to be able to make those better choices.

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