Choice vs Disease Sample

This essay will look to sketch the different statements on whether dependence on a substance is a matter of one’s free will, or if it is a disease component in our biochemical or physical makeup. It will explore whether addiction extends from genes inherited from parents or if it is a learned behavior through daily lifestyles and changes through growth from toddlers to teens, young persons, and then to adults. It will also seek to analyze how different approaches and perspectives in this relevant statement can be debated in the academic and medical world, with the views and opinions of recognized professionals in the study of addiction. The definition of addiction – “addiction (noun) is ‘the state of being enslaved to a habit or practice, or to something that is psychologically or physically habit-forming, to such an extent that its cessation causes severe trauma” (Dictionary.com, 2012). One valid stance is that addiction is a chemical imbalance in DNA (Wachuku, 2003, p. 199). Any toxin or chemical artificially entered into the bloodstream may have a more severe effect on certain human beings than others.

It could be argued that some are able to tolerate these toxins or chemicals without becoming addicted, while others quite easily fall into addiction, whether it is to alcohol, prescribed drugs, illegal solvents, stimulants, hallucinogens or antidepressants. Dr. Robert West, Professor of Health Psychology at University College London, states in his book “Theory of Addiction” that “dysfunctional motivation, as a minute-to-minute control through physiological reactions, urges, suppressions, desires, drives, and emotions, is inherently unstable and subject to constant balancing” (West, 2006, p. 211). West also points to the ‘PRIME’ theory in Plans, Responses, Urges, Motivations, and Evaluation. At every moment, we act in pursuit of what we most want or need at that moment (West, 2006). This would support the choice theory, stating that it is our own making and doing what we choose to do at that moment of choice to fulfill our needs or desires for pleasure or enjoyment.

However, the ability to make rational choices while in the throes of addiction could be open to debate. Another firm advocate of the choice theory is Stanton Peele. Dr. Stanton Peele presents a program for addiction recovery based on research and clinical study, and grounded in science. His program utilizes proven methods that people actually use to overcome addiction, with or without treatment. In his book “7 Tools to Beat Addiction,” he offers in-depth, interactive exercises that show how to outgrow destructive habits by putting together the building blocks for a balanced, fulfilling, responsible life. Dr. Peele’s approach is founded on “Tools, Values, Motivation, Rewards, and Resources, Support, Maturity, and Higher Goals.” This is a no-nonsense guide aimed at putting the nut in charge of their own recovery (Peele, 2004).

Further grounds have been stated by Heather and Robertson: Even the most severely alcoholic individuals “clearly demonstrate positive beginnings of control over imbibing behaviour,” so that “extreme inebriation cannot be accounted for on the basis of some internally located inability to stop” (Heather & Robertson, 1981, p. 122). Intriguingly, controlled-drinking theorists like Heather and Robertson propose exceptions to their own analyses: Perhaps “some problem drinkers are born with a physiological abnormality, either genetically transmitted or as a result of intrauterine factors, which makes them react abnormally to alcohol from their first experience of it” (Heather & Robertson, 1981, p. 144). According to the World Health Organization (WHO), alcohol is the world’s third-largest risk factor for disease burden; it is the leading risk factor in the Western Pacific and the Americas and the second-largest in Europe (WHO, 2011).

Teens, young adults, and grown-ups who seek a good time will turn to alcohol, legal or illegal highs to enhance their time at social gatherings. It could be said that when consumption increases in frequency or quantity, it becomes dependence or habit. The user can no longer make rational decisions about where and how much they should consume. “This may be the point where an alcohol or drug user is approaching full-blown addiction” (Fleeman, 2004). Addiction to any substance, whether it be alcohol, prescribed or illegal drugs, or even the new legal highs, can have disruptive consequences on a person’s life, whether it be work, social, or family life.

It has been said that addiction in any form can be treated through intervention by relevant bodies, such as NHS Trust, Twelve Step Programs, Alcoholics Anonymous (AA), and Narcotics Anonymous (NA), to help the person overcome this urge over time and guidance, working towards a future clean and sober-minded life. Drugs, alcohol, or any other chemical unnaturally induced into the body affects the way people see, talk, walk, and hear. Although, theorists such as Dr. Peele are staunch critics of the 12-step model as advocated by Alcoholics Anonymous.

According to Snel and Lorist (1998), “This continuous accustomed behavior, including substances such as caffeine and nicotine, eventually affects the cognitive system in the brain and causes differences in the way we live our life.” Normal early morning rising habits, such as showering, teeth brushing, flossing, and often including coffee and cigarettes, are accustomed in everyday life. Caffeine and nicotine contain chemical substances that enable the processes of the brain to accelerate; these stimulations then enhance vigilance and performance, enabling users to progress in their day (Coleman, 2010, p. 199). There are many arguments over whether addiction is a rational choice or disease. Biostatistician, physiologist, and an alcohol addiction researcher, E. M. Jellinek, documented the progression of “disease or choice” alcohol/drug dependence or recovery. “Disease: increase in alcohol tolerance, drinking bolstered with excuses, persistent remorse, moral impairment, code of ethics breaks down; or Choice: insanity, loss of everything, death, or recovery, learning to live a fulfilling life without the need for alcohol” (Drugs, 2003).

This academic put forward the modern thought and organic structure of the disease concept of alcohol addiction and the medicalization of inebriation and alcohol addiction. The modern disease theory is apparent in the 12 steps model preferred by Alcoholics Anonymous (AA) on how something has taken over the power of thought and is controlling everyday actions and motions. Without help or guidance, life cannot be put on a stable and clean track. It has been said that to know an alcoholic, you have to be one. This is where counseling and mentoring come in through the 12 steps model. The choice an addict has to make is whether they can make the move into detoxification or rehab and seek medical or pharmaceutical aid. It should also be considered whether the “choice” necessarily belongs to those in dependence. In many circumstances, the choice is made by family, local government, police, or court order.

In his book regarding working with and understanding substance abusers, Senior Lecturer in Addiction Studies, Ayron Pycroft states, “What this disease conceptualization of dependence provides us with is a prototype bio-psycho-social paradigm, fused with a spiritual position. Within this model, the biological components clearly refer to the physical irresistible impulse, the psychological components to compulsion, and the social aspects to recovery from the problem. ‘Inherent within this model is the idea of the addict being different from the non-addict’.” (Pycroft, 2010, p. 47). As the irresistible impulse of addiction takes over everyday life, the addict finds that there has been a fine line between a social user of drugs or alcohol and crossing over to becoming a regular user. Addiction is based on both physical dependence and biopsychological dependence, created by altered neurotransmitter balances and driven by millions upon millions of new living functional active neurological tracts that have been sustained in the addict’s brain. “What this really means is an addict’s thought processes and behaviors have been altered by the long-term abuse of the substance” (Hughes, 1997).

A person’s tolerance and self-denial come into the factor of the certain ways in which they input the substance into their system, moderation, and self-efficiency, and not taking to gluttony or greed of the thing that is causing the rewards pathways, continually releasing dopamine into their brain (Snel & Lorist, 1998) and making them feel high or relaxed, depending on which substance they have taken. Another point on the dependence basis is the Alcoholic Anonymous take on how the disease model progresses. “Today we are willing to accept the idea that, as far as we are concerned, alcohol addiction is an illness; a progressive illness that can never be ‘cured’ but which, like some other illnesses, can be arrested. We agree that there is nothing black about having an illness, provided we face the problem honestly and try to do something about it. We are perfectly willing to admit that we are allergic to alcohol and that it is only common sense to stay away from the source of the allergic reaction.” (Anonymous, 2012).

This passage mentions unwellness, a progressive condition but not a disease. An extension of this statement is the moderation and harm reduction point of view from Mark and Linda Sobell, who assert that “recoveries of persons who have been badly dependent on alcohol predominantly affect abstinence; recoveries of persons who have not been badly dependent on alcohol predominantly affect reduced drinking, and the association of result type and dependence severity appears to be independent of advice provided in intervention” (Sobell, 2006). Conversely, this would indicate that dependence is a choice of the individual, as they must decide whether or not to seek and use the advice of professionals experienced in this field, or to continue on the destructive path of consuming the chosen substance.

Arguably, it is an individual’s choice to use drugs or alcohol, and after repeatedly making the same choice to consume the substance at hand, the brain adapts to the individual’s choice. If an individual chooses to consume the substance, then it is their own will and choice to do so, and without coercion and pressure, it is initially their own choice, closely followed by the dependence of addiction. Akin to the nature/nurture argument, are addictions inherited through our genes, passed on through generations, or is it a learned behavior, mimicking the behavior of others (Bandura, 1977) through observing peers or parents consuming various amounts of alcohol or, in some cases, substances? It is normal learned behavior for them to follow suit and have a hit, snuff, or drink, depending on the addiction. Some may argue that the user still has the choice to pick up the drink or the drug, and they still physically and mentally make the decision for the body to consume the chemical.

However, once in active addiction, the brain sees no other way than to consume the chemical into the bloodstream to survive and experience the high that has been produced. This type of learned behavior is normal in the everyday life of the addict. This would indicate that a person is not necessarily born an addict, but is susceptible to a far greater risk of abusing mind-altering substances. A plethora of theories pinpoint alcohol addiction; however, theories can be adapted to any substance or any addiction, and the end product may enable the user to abstain from the substance at hand through counseling, advice, and medical supervision. However, in some cases, the physical harm that the substance has done to the organs of the body cannot always be reversed and may be life-threatening or fatal. This can sometimes lead to the addict seeking help, realizing that if they do not address the addiction, it could be the end of the road in the journey of life. To contextualize this, an individual cannot control how and where they are born or how they are raised into maturity.

Rational choice is not always a choice that can be made and is often dependent on the environment, genetics, and social learning. To sum up, many would argue that individuals make choices to use addictive substances, and it is only once the dependence or ability to choose rationally is lost that the disease model and powerlessness take control. Could it not be said to be questionable whether one would choose to be “enslaved to a habit or pattern to such an extent that its cessation causes severe trauma” or whether this does indeed contribute to the “disease” of addiction?

However, there is much scope for theories of social learning and rational choice itself. Ultimately, it could be said that regardless of the conflicting arguments about whether addiction to a substance is a choice of one’s free will or a disease element in our biochemical or physical makeup, fostered through genetics, learned behavior, disease or choice, essentially, it can only be treated through choice. A concept succinctly phrased by Savant, “command what you have put into your body, do not let it command you. Being defeated is often only a temporary condition; giving up is what makes it permanent” (Savant, 1946).

Bibliography

1. Hughes, D. R. (1997). Addiction: A neurological disorder. Retrieved December 8, 2012, from www.medicalonline.com/addict.htm
2. Dictionary.com. (2012, December 8). Retrieved from Dictionary.com.
3. Anonymous, A. (2012, December 9). Newcomer to A.A about Alcoholism. Retrieved December 9, 2012, from Alcoholics Anonymous G.B.: http://www.alcoholics-anonymous.org.uk/newcomers/?PageID=69
4. Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
5. Drugs B.C. (2003). Enterhealth.com/docs/Jellinek. Retrieved December 9, 2012, from Enterhealth.com: http://www.enterhealth.com/docs/jellinek_chart.pdf
6. Fleeman, W. (2004). The Pathways to Sobriety Workbook. In W. Fleeman, The Pathways to Sobriety Workbook (p. 11). Alameda, CA: Hunter House Publications Ltd.
7. Peele, D. S. (2004). 7 Tools to Beat Addiction. New York: Crown Publishing Group.
8. Peele, S. (1996-2012). The Meaning of Addiction. Retrieved December 16, 2012, from The Stanton Peele Addiction Website: http://www.peele.net/lib/moa3.php
9. Pyecroft, A. (2010). Understanding & Working with Substance Misusers. Wiltshire: Sage Publications.
10. Savant, M. v. (1946). ThinkExist.com Citations. Retrieved December 10, 2012, from ThinkExist.com Citations: http://thinkexist.com/quotes/marilyn_vos_savant/
11. Snel, J., & Lorist, M. M. (1998). Nicotine, caffeine and social drinking: behaviour and brain function. Amsterdam: Harwood SAcademic Publishers.
12. Sobell, M. B. (2006, February 14). Obstacles to the acceptance of low-risk drinking goals in the treatment of alcohol problems in the United States: A commentary. Addiction Research and Theory, pp. 19-24.
13. Wachuku, K. (2003). Anthology of Monographs on Addiction Studies. Indiana: Authorhouse.
14. West, D. R. (2006, December). Prime Theory of Motivation. Retrieved December 16, 2012, from Prime Theory of Motivation: http://www.primetheory.com/
15. West, D. R. (2006). Theory of Addiction. In D. R. West, Theory of Addiction (p. 211). Oxford: Blackwell Publishing.
16. WHO. (2011). Media Centre Alcohol Fact Sheet. Retrieved December 10, 2012, from World Health Organization: http://www.who.int/mediacentre/factsheets/fs349/en/index.html