I have to admit that I feel some weariness as I wade into the ongoing argument about whether addiction (aka alcoholism, chemical dependency and so on) is a disease or a choice to drink or use alcohol or other drugs.
I can't speak for those who insist that addiction is simply a series of bad and selfish choices - stemming I suppose from some moral failure or weakness or bad character. But it seems to me that for them to accept that it is a disease means having to absolve addicts from responsibility for their actions - actions that have had personal, relational and social consequences throughout human history. And those consequences have been damaging, if not catastrophic.
Believe it or not, I get their argument. Anyone would be tempted to go there when faced with such inexplicable behaviour. "Can't you see what you're doing?" we plead, "why don't you just stop?"
But the behaviour doesn't get to the root of it ... that is, behaviour doesn't explain the nature of addiction as a disease. The drinker or other drug user has no volitional control over contracting addiction - any more than we have control over getting sick with diabetes, or hypertension and so on.
To help you understand what I mean, I'll call up the expertise of two medical professionals:
Dr. Raju Hajela is past president of the Canadian Society of Addiction Medicine, and chair of the American Society of Addiction Medicine's committee on the new definition of addiction.
Dr. Michael Miller is the past president of the American Society of addiction Medicine.
I'll quote Dr. Hajela to develop my argument that addiction is an illness and that the choices an addict makes - which are sick choices - are symptoms of the disease and not its cause.
Dr. Hajela: "There is longstanding controversy over whether people with addiction have choice over antisocial and dangerous behaviours ... the disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviours are a manifestation of the disease, not the cause."
If I understand Dr. Hajela correctly, the behaviours we see in addicts (all the crazy, self-centred, dangerous, thoughtless choices they make) are symptoms of the disease.
I agree, but I'll put it slightly differently: Simply having the disease is not a choice (a person is not responsible for being sick), but people are responsible for the choices they make (addictive behaviours).
[NOTE: A symptom is a characteristic sign or indication of the existence of something else. It is a sign or an indication of disorder of disease, especially when experienced by an individual as a change from normal function, sensation or appearance (Oxford English Dictionary)]
I have no problem agreeing that addicts active in their addiction make bad choices and behave badly. However, it is the biological, psychological, relational, spiritual nature of the disease that drives the behaviour - not innate moral weakness, sin, or bad character.
The good news is, no matter how sick an addict is, he or she can also make choices that make recovery from the disease possible.
Dr. Hajela again: "Choice still plays an important role in getting help. While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviours is necessary.
Because we are a materialist culture that looks to the evidence of our senses and the findings of science to determine what is real and true, we are fascinated by the neurobiology of addiction. I don't have any quarrel with the discoveries of neuroscientists that are revealing how the chemical reactions in an addict's brain are different than those of a so-called normal person.
But it is interesting to note that choice - and consequent behaviours - plays a role in the field of biochemistry. While it is true that chemical processes in the brain cause behaviour - whether healthy or sick - it is an established, scientific fact that is works the other way around too: Behaviour causes a change in brain chemistry. In other words, addicts can put their disease into remission - get into recovery - through the choices they make.
The last word goes to Dr. Miller: "Many chronic diseases require behavioural choices, such as people with heart disease choosing to eat healthier or begin exercising, in addiction to medical or surgical interventions ... So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment."
And by treatment I'm sure he doesn't mean surgical or pharmacological treatment, but behavioural treatment that is about learning to make healthy choices - behavioural treatment focused on honesty, with self and others, responsibility to oneself and others and forgiveness of self and others.
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