Is Addiction Just a Matter of Choice?

April 21, 2003 -- Watching TV, you'd think the whole country is addicted to something: drugs, food, gambling — even sex or shopping.

"The United States has elevated addiction to a national icon. It's our symbol, it's our excuse," says Stanton Peele, author of The Diseasing of America.

There are conflicting views about addiction and popular treatments. So, we talked with researchers, psychologists and "addicts" and asked them: Is addiction a choice?

Publicity about addiction suggests it is a disease so powerful that addicts no longer have free will. Lawyers have already used this "addict-is-helpless" argument to win billions from tobacco companies.

Blaming others for our "addictions" is popular today.

In Canada, some lawyers are suing the government, saying it is responsible for getting people addicted to video slot machines.

Jean Brochu says he was unable to resist the slot machines — that he was "sick." He says the government made him sick, and his sickness led him to embezzle $50,000. Now, he's suing the government to restore his dignity and pay his therapy bills.

Psychologist Jeff Schaler, author of Addiction Is a Choice, argues that people have more control over their behavior than they think.

"Addiction is a behavior and all behaviors are choices," Schaler says. "What's next, are we going to blame fast-food restaurants for the foods that they sell based on the marketing, because the person got addicted to hamburgers and french fries?"

Well, yes, actually. Two weeks after he said that some children sued McDonald's, claiming the fast-food chain made them obese. They lost the first round in court, but they're trying again.

Uncontrollable Impulses?

"Impulse control disorder" is the excuse Rosemary Heinen's lawyer used to explain Heinen's shopping. Heinen was a corporate manager at Starbucks who embezzled $3.7 million, which she then used to buy 32 cars, diamonds, gold, Rolex watches, three grand pianos, and hundreds of Barbie dolls.

In court a psychiatrist testified Heinen was unable to obey the law, and shouldn't be given the seven-year prison sentence she was facing. The judge, however, did put Heinen behind bars, sentencing her to 48 months.

The "helplessly addicted" defense seemed to work better for the Canadian gambler. The judge gave Brochu probation and told him to see a psychologist. His mother paid back the $50,000 he stole.

Now Brochu and his lawyer are seeking $700 million on behalf of all addicted gamblers in Quebec, claiming the government is responsible for getting them addicted, too.

Calling Addiction a Disease

Many scientists say addicts have literally lost control, and that they suffer from a disease.

The National Institute on Drug Abuse calls drug addiction a "disease that will waste your brain." This is our government's official policy. And government-funded researchers, like Stephen Dewey of Brookhaven National Labs, tend to agree.

They say their studies of addiction in monkeys and rats show that addiction is a brain disease.

"Addiction is a disease that's characterized by a loss of control," says Dewey.

Dewey takes his message to schools, showing kids brain scans that he says prove his point. He tells students that addiction causes chemical changes that hijack your brain.

Genetic Destiny?

Dewey and other researchers say our genes predispose some of us to addiction and loss of control.

Researchers at Harvard University believe they may have found one of those genes in the zebrafish.

When researcher Tristan Darland put cocaine on a pad and stuck it on one side of a fish tank, fish liked the feeling they got so much that they hung around the area, even after the cocaine was removed.

Then Darland bred a family of fish that had one gene altered. These fish resisted the lure of the cocaine.

Darland says this shows that addiction is largely genetic. "These fish don't know anything about peer pressure. They either respond or they don't respond to the drug," he says.

At the Medical College of Wisconsin, Dr. Robert Risinger scans the brains of human addicts while they watch a video of people getting high on crack. It's what they call a "craving" video. He then shows them a hard-core sex film.

The brain scans show the addicts get more excited by the craving videos. The drugs become more powerful than sex — because addiction's a disease that changes your brain, says Dewey.

I asked Dewey if he was suggesting that drug users don't have free will.

"That's correct," he said. "They actually lose their free will. It becomes so overwhelming."

But if they don't have free will, how come so many people successfully quit?

Is the Disease Message Harmful?

Addiction expert Sally Satel acknowledges drug addiction and withdrawal is "certainly a very intense biological process." But she is one of many experts who say the addiction-as-brain-disease theory is harmful to addicts — and wrong.

She also thinks it's unhelpful to take away the stigma associated with drug abuse. "Why would you want to take the stigma away?" she asks. "I can't think of anything more worthwhile to stigmatize."

"People need to get rid of the idea that addiction is caused by anything other than themselves," says James Frey, author of A Million Little Pieces, a book about his experience as an addict.

Frey says he took just about every drug, from alcohol to crack. Yet Frey says he wasn't powerless. He scoffs at Dewey's claim that addicts' brains compel them to keep taking drugs.

Many doctors agree, saying you can still choose not to take drugs, even if they do cause changes in your brain.

"You can look at brains all day," Satel says. "They can be lit up like Christmas trees. But unless a person behaves in a certain way, we wouldn't call them an addict."

Environment and Choice

In fact, some researchers cite experiments that they say prove that addiction is a matter of choice.

In Canada, researchers gave rats held in two different environments a choice between morphine and water. The rats in cages chose morphine; the rats held in a nicer environment preferred the water.

Whether you get addicted also depends on how you're treated. At Wake Forest University, male monkeys lived together for three months, and established a pecking order.

The monkeys who'd been bullied by the "boss monkeys" banged a lever to get as much cocaine as they could. But the dominant monkeys, just by virtue of being dominant, had less interest in the drug.

"It's just like the human world," says Dr. Michael Nader, who conducted the experiment.

"Individuals that have no control in their job show a greater propensity for substance abuse than those that have control," Nader says.

These comparisons suggest that addiction is a choice — not a disease that takes away free will.

The message from the treatment industry is that drug users need professional help to quit. What they seldom say is that people are quitting bad habits all the time without professional help.

In fact, some studies suggest most addicts who recover do so without professional help.

For example, during the Vietnam War, thousands of soldiers became addicted to heroin.

The government tracked hundreds of soldiers for three years after they returned home. They found 88 percent of those addicted to narcotics in Vietnam no longer were.

Quitting Is the Rule, Not the Exception

Even tobacco companies now admit nicotine is addictive, but does that mean it really denies smokers' freedom?

You seldom hear about those people who just quit … on their own. No one's saying it's easy to quit. But it may surprise you that quitting is not the exception, it's the rule. Most people who've used heroin or cocaine have quit. Since 60 percent of smokers have quit — that's 50 million Americans — it seems obvious that people do have free will.

But the drug research establishment insists most addicts are enslaved, that they don't have free will.

Dewey says just because 50 million people have quit smoking doesn't mean that an addiction to smoking isn't a disease.

Yes, it does, says Schaler. Schaler also says the use of the word "disease" is important, particularly in terms of the money "addicts" are spending to get help. "If you say it's a choice not a disease, well then insurance companies may not reimburse for that. … If you say it's a choice, then the tobacco companies may not be slammed for millions of dollars."

Treatment Trap?

Some experts say the treatment industry is taking advantage of people in desperate situations.

"We're selling nicotine patches, we're selling the Betty Ford Center. We tell people, 'You can never get over an addiction on your own. You have to come to us and buy something to get over an addiction.' It's not true, and it's dangerous to tell them that," says Peele.

Former addict Frey agrees. His parents did pay for him to go to the expensive Hazeldon Treatment Center, but Frey says he didn't buy into the messages the center offered in counseling and therapy.

"I stopped because I have my own 12-step program and the first 11 steps don't mean [expletive] and the 12th is don't do it. And I didn't do it."

Frey and other former addicts say choosing is what it takes, making that decision.

"You can't tell people, 'This is all you're fault and there's nothing you can do about it,' " says Frey. "You have to tell them, 'This is all your fault and you can make it all better if you want to.' "

Frey says he still gets drunk. Now he just does it differently. "I get drunk on walking my dogs, I get drunk on, you know, kissing my wife. I get drunk on a good book. Getting drunk is just doing something that feels good."