In polite society, one does not question the medical model of addiction. To do so is considered unkind and unscientific.
The author, Jeffrey Schaler, doesn’t care about being polite. Schaler shows his irreverence for conventional thinking in his book, Addiction is a Choice. Through science, logic, and empirical observation, Schaler shows that addiction is, in fact, a choice.
The Medical Model Stigmatizes
Schaler shows how the medical model of addiction can be used to stigmatize virtually every human behavior. Too much sex, gambling, smoking, drinking, internet, marijuana, or eating – virtually any behavior can be stigmatized by calling it an addiction. For Schaler, the word “addiction” is used as a weapon to stigmatize certain behaviors.
Hundreds of years ago, people exhibiting certain behaviors and minor skin lesions were ‘diagnosed’ as witches. That didn’t mean and doesn’t mean they were actually witches. Anyone is “diagnosable”.
Habits Can Be Hard to Break
Schaler recognizes that bad habits that can be hard to break. But this hardly means that addiction causes a person to lose his free will. Schaler points to studies that show that so-called “addicts” can routinely modify their behavior if incentivized to do so.
For example, in recent decades it has become unpopular to smoke cigarettes. In light of the popular opinion, millions of nicotine “addicts” have voluntarily stopped smoking, without any help whatsoever. How can this be?
Another example is veterans returning from the Vietnam war. A high percentage of them used heroin on a regular basis in Vietnam. The US government was concerned that these heroin addicts would have trouble transitioning to civilian life. It turns out, most of these heroin “addicts” simply modified their behavior when they returned from war. They voluntarily gave up their addiction.
The Loss of Control Theory is Incorrect
One of the main tenets of the medical model is that addicts lose control over their behaviors. This “loss of control hypothesis”, however, has never been shown in research. Schaler points to the voluminous research on alcohol that shows that alcoholics can moderate their drinking when they choose to.
In one study, alcoholics were rewarded with better living conditions if they moderated their alcohol consumption. This was despite the fact that alcohol was freely available at all times. The authors concluded:
Substantial evidence exists that loss of control following the first drink is not inevitable, even when the alcoholic has the opportunity to drink amounts of alcohol that approximate his customary intake outside the hospital.
People Make Poor Choices in Life
One may wonder, “if an addiction isn’t a bonafide medical disease, why do some people choose to drink to excess, smoke, take drugs, etc”?
In Schaler’s words:
It’s evidently hard to face the truth that millions of people endowed with free choice can make serious mistakes and screw up their lives 1.
For many of us, it is difficult to accept that some people simply prefer to live life in a way we find destructive. The key to understanding human behavior, says Schaler, is to realize that people have reasons for their choices. A person may take drugs to avoid dealing with a difficult situation, to improve their cognitive abilities (think Ritalin), or to silence their destructive inner self-dialogue.
The Medical Model is Existential Murder
I oppose the use of heroin for the same reason I oppose the use of Prozac: I think relying on these is an existential cop out – a way of avoiding coping with life2.
Schaler takes the existentialist view, that life is a challenge and we must find a way to deal with it. Life problems cannot be dispensed with under the guise of a medical model which views drug addiction as something that simply happens. Addiction is something a person chooses.
The medical model of addiction existentially murders the person. It turns the person into a Zombie, a neuronal soup of chemicals directing one’s life. It sees addiction as a happening, rather than a willful choice.
For the existentialist, the addict chooses drugs rather than choosing the more difficult existential challenge of creating meaning and becoming an authentic person.
For more on the choice model of addiction, check out this podcast by Philosophy for Our Times, where psychiatrist Theodore Dalrymple argues for the free will model of addiction.