March 26, 2010—It used to be that someone who regularly drank or ate to excess was simply considered a glutton. A person who tried to get rich by gambling instead of working was greedy, or slothful, or perhaps envious. One who was overly preoccupied with sex was guilty of lust. For their lack of control over their outsized appetites, such incontinent individuals were thought to have sinned against God.
It was imperative that they repent and make amends, lest they face eternal torment in Hell after shedding their mortal coils.
In our increasingly secular world—flashes of fundamentalism notwithstanding—we are less and less likely to condemn the glutton, the gambler, and the letch as sinners. Their excesses are still recognized as problematic, but this is due more to their self-destructive potential here on earth rather than to some fiery punishment expected in the afterlife.
This move away from mysticism toward a more reality-based view of the world is all well and good. Along with this shift, however, we have adopted an addiction mentality. First alcohol and other drugs, and now food, gambling, and sex as well have come to be seen as things one can become addicted to. And far from condemning addicts, contemporary, modern society has a tendency to absolve them of all personal responsibility for their predicaments.
The best known addiction treatment group is Alcoholics Anonymous (AA). The very first step of their famous twelve is: “We admitted we were powerless over alcohol—that our lives had become unmanageable.” Granted, AA is not a secular group, but its religiosity is distinctly modern in that it jettisons the notion of wickedness deserving of punishment and replaces it with the notion of helplessness deserving of treatment. Some people who seek to improve their lives through participation in AA groups do succeed in staying sober. But given the emphasis on powerlessness, it is hardly surprising to find, as recent studies have, that the numbers are not actually all that impressive.
The new, hyper-medicalized model of behavior discounts individuals’ abilities to reassert their wills.
For a truly secular, medicalized picture of addiction, the National Institute on Drug Abuse (NIDA) offers this statement : “Addiction is a chronic disease similar to other chronic diseases such as type II diabetes, cancer, and cardiovascular disease.” NIDA’s website offers PowerPoint-type graphics showing that, like cardiovascular disease, addiction has genetic and environmental contributions.
NIDA also states, in bold letters: “No one chooses to be a drug addict or to develop heart disease.” Admittedly, it does acknowledge that people sometimes do “choose behaviors that have undesirable effects” and that “[p]ersonal responsibility and behavioral change are major components of any credible treatment program.” By and large, though, it is much more interested in pushing the idea that addiction is a disease, and in undermining the idea of personal responsibility.
Heart disease and addiction may have some similarities, but they also have one important difference evaded by groups like NIDA: while your risk of contracting standard diseases may be exacerbated by certain behaviors, addiction is a behavior. Nowhere is this more evident than in the latest craze among celebrities, sex addiction, whose latest poster child is one of the greatest golfers ever to play the game: Tiger Woods.
Groups like Sexaholics Anonymous explicitly state that sex is something one can become addicted to , and argue that a sexaholic “no longer has the power of choice, and is not free to stop.” Although sex addiction is not currently recognized as an official diagnosis, Dr. Dan Zucker, who heads a working group dealing with the next edition of the American Psychiatric Association’s diagnostic manual, apparently expects it to contain a listing for “ hypersexuality disorder ” soon.
To his credit, Woods (who has not actually specified what kind of “treatment” he has undergone) has resisted the temptation to couch his behavior in medical jargon. In his apology last month , he seemed straightforward and sincere. “I knew my actions were wrong. But I convinced myself that normal rules didn’t apply,” he said. He spoke about feeling “entitled” to enjoy all the temptations that surrounded him because of how hard he had worked all his life, but then concluded, “I was wrong. I was foolish. I don’t get to play by different rules… I brought this shame on myself.”
Gene Heyman, a research psychologist and Harvard lecturer, published a book last year provocatively entitled Addiction: A Disorder of Choice, reviewed recently by Sally Satel , psychiatrist and resident scholar at the American Enterprise Institute. Both Satel and Heyman admit that repeated use of drugs like heroin, alcohol, and nicotine alter the brain. But the important question, Satel writes, “is not whether brain changes occur (they do) but whether these changes block the influence of the factors that support self-control.”
The evidence clearly indicates that drug addicts can reassert self-control by modifying, either by themselves or with outside help, the incentive structure that influences their behavior. Recovery rates for addicted pilots and physicians, who benefit from strict oversight and have a lot to lose should they relapse, are remarkably high. Participants in drug courts who face prison if they fail drug tests (the stick) and exoneration if they complete rehab (the carrot) fare considerably better than counterparts who go through regular courts. In contrast, truly autonomous biological conditions do not respond to incentives. “Imagine bribing an Alzheimer’s patient to keep her dementia from worsening,” Satel writes, “or threatening to impose a penalty on her if it did.”
Free will is not omnipotent. There are genetic and environmental factors that influence how likely a person is to become addicted. But it also matters what you do with what you’ve got. There is a large element of choice involved in the step-by-step process of becoming an addict, and—crucially—there is a significant element of choice in beginning and maintaining a program of sobriety as well. Condemning people as wicked sinners is not the best way to help them clean up their acts, and so it is good to see the old-time religious model of behavior fading away. The new, hyper-medicalized model of behavior, however, short-changes individuals’ abilities to reassert their wills. What we need is a truly rational perspective that supports, rather than undermines, people’s efforts to take responsibility and improve their lives. Step One: “We admit we are powerful—that we can make our lives manageable once again.”