Choice vs Disease
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This essay will look to outline the different arguments in that; addiction to a substance is a choice of one’s free will, or is it a disease element in our bio chemical or physical make up? It will consider, if addiction extends from genes inherited from parents or forefathers, or if it is a learned behaviour through day to day lifestyles, and changes through growth from tots to teens, to youths, then to adults. It will also seek to analyse how different approaches and points in this relevant argument can be debated in the academic and medical world, with the views and discussion of recognised professionals in the study of addiction. The definition of addiction ad-dic-tion (noun) is ‘the state of being enslaved to a habit or practice or to something that is psychologically or physical habit forming to such an extent that its cessation causes severe trauma (Dictonary .com, 2012) One valid stance is that addiction is a chemical imbalance in Deoxyribonucleic Acid (D.N.A) (Wachuku, 2003, p. 199); any toxin or chemical artificially entered into the bloodstream may have a more serious effect on certain human beings than others.
It could be argued that some are able to tolerate these toxins or chemicals without becoming addicted, whilst others quite easily fall into addiction, whether it is to alcohol, prescribed drugs, illegal solvents, stimulants, hallucinogenic or anti-depressants. Dr Robert West Professor of Health Psychology University College London States in his book Theory of Addiction that “dysfunctional motivation as a moment to moment control, through reflexes, impulses, inhibitions, desires, drives and emotions, are inherently unstable and subject to constant balancing” (West, 2006, p. 211). West also points to the ‘PRIME’ theory in, Plans, Responses, Impulses, Motives, and Evaluation. At every moment we act in pursuit of what we most want or need at that moment. (West, 2006). This would move towards the choice theory, stating that it is our own making and doing what we pursue to do at that moment of choice to fulfil our needs or desires for pleasure or fun.
However, the ability to make rational choices whilst in the throes of addiction could be open to debate. Another staunch 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 addict in charge of their own recovery. (Peele, 2004).
Further evidence has been stated by Heather and Robertson: Even the most severely alcoholic individuals “clearly demonstrate positive sources of control over drinking behaviour” so that “extreme drunkenness 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 Organisation (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, youths, and adults, thrill seeking for a good time, will turn to alcohol, or legal, or illegal highs to enhance their time at social gatherings. It could be said that when consumption increases in frequency or quantity that it becomes addiction or habit. The user can no longer make rational decisions on where and how much he or she should consume. “This may be the point where an alcohol or drug user is nearing full blown addiction” (Fleeman, 2004). Addiction to any substance whether it be alcohol ,drugs prescribed or illegal or even the new legal highs can have turbulent effect 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 compulsion through time and guidance, working towards a future clean and sober minded life. Drugs, alcohol, or any other chemical, artificially induced into the body, affects the way people see, speak, walk and hear. Albeit, theorists such as Dr Peele are staunch critics of the 12 steps model as advocated by Alcoholics Anonymous.
According to (Snel & Lorist, 1998) ‘This continuous habitual behaviour, including substances such as caffeine and nicotine, ultimately affects the cognitive system in the brain and causes differences in the way we live our life.’ Normal early morning rising habits such as, shower, teeth brushing, flossing, and often including coffee and cigarettes, are habitual in everyday life. Caffeine and nicotine contain chemical substances which enable the processes of the brain to accelerate; these stimulants then enhance alertness 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 alcoholism researcher, E.M.Jellinek documented the progression of “disease or choice” alcohol /drug addiction or recovery, “Disease; increase in alcohol tolerance, drinking bolstered with excuses, persistent remorse, moral deterioration, code of ethics breaks down; or Choice; insanity, loss of everything, death, or recovery, learning to live a fulfilling life without the need of alcohol” (drugs, 2003).
This academic put forward the modern thinking and body of the disease concept of alcoholism and the medicalization of drunkenness and alcohol habituation. The modern disease theory is evident in the 12 steps model preferred by the Alcoholics Anonymous (AA) on how something has taken over the power of thinking, and is controlling everyday actions and movements; how without help or guidance, life cannot be put on a stable and clean pathway, it has been said that, to know an alcoholic you have to be one. This is where the guidance and mentoring comes in through the 12 steps model. The choice an addict has to make is whether he can make the move into detoxification or rehab and seek medical or pharmaceutical assistance. It should also be considered whether the ‘choice’ is necessarily one belonging those in addiction. In many circumstances the choice is made by family, local authorities’ police or court order.
In his book regarding working with and understanding substance misusers, Senior Lecturer in Addiction Studies, Ayron Pycroft states, ‘What this disease conceptualisation of addiction provides us with is, a prototype bio-psycho-social paradigm, fused with religious perspective; within this model the biological components clearly refer to the physical compulsion, the psychological components to obsession, 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’. (Pyecroft, 2010, p. 47). As the compulsion 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 in both physical dependency, and bio psychological dependency, created by altered neurotransmitter balances and driven by millions upon millions of new living functional active neurological pathways which have been to sustain the conditions in the addicts brain, “what this really means is an addicts thought process and behaviours have been altered by the long term abuse of the substance” (.Hughes, 1997).
A persons tolerance and self-control comes into the factor of the certain ways in which they input the substance into their system, moderation, and self-efficiency, and not leading to gluttony or greed of the thing that is making the reward pathways, continually releasing dopamine into their brain (Snel & Lorist, 1998) and making them feel high or relaxed depending which substance they have taken. Another point on the addiction 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, alcoholism 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 shameful 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 simply common sense to stay away from the source of the allergy.” (Anonymous, 2012).
This point has mentioned illness, a progressive illness but not disease. An extension of this argument is the moderation and harm reduction point of view from Mark and Linda Sobell, who extol that ‘recoveries of individuals who have been severely dependent on alcohol predominantly involve abstinence; recoveries of individuals who have not been severely dependent on alcohol predominantly involve reduced drinking, and the association of outcome type and dependence severity appears to be independent of advice provided in treatment (Sobell, 2006). Conversely, this would indicate that addiction is a choice of the individual, as they must choose whether or not to seek and use the advice of professional’s experience in this field, or to continue on the spiraling downfall of consuming the chosen chemical.
Arguably, it is an individual’s choice to take drugs or alcohol, after repetitively making the same choice over and over to take the substance at hand, the brain then adapts to the choice made by the individual. If an individual’s choice is to take the substance, then it is their own self will and choice to take it, and without coherence and baiting into, it is initially, their own choice, closely followed by the dependence of addiction. Akin to the nature /nurture debate, are addictions inherited through our genes, passed on through generations; or is it a learned behavior, role modeling the behavior of others, (Bandura, 1977) through watching peers or parents consuming various amounts of alcohol or in some cases substances. It is normal learned behavior for them to get up and have a hit, sniff or drink, depending on the addiction. Some may defend the fact 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 ingest the chemical.
However once in active addiction the brain sees no other way than to ingest the chemical into the bloodstream to live, and get through on the high that has been produced. This type of learned behavior is normal to 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 on alcoholism, 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 guidance, advice and medical supervision. However, in some instances, the physical damage that the substance has done to the organs of the body cannot always be reversed, and may be life threating 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 help how and where they are born, or how they are raised into adulthood.
Rational choice is not always a choice that can be made, and is often dependent on the environment, genetics, and social learning. To summarize, many would argue that individuals make choices to use addictive substances, and it is only once the addiction, or ability to choose rationally, is lost, that the disease model and powerlessness takes control. Could it not be said to be questionable whether one would choose to be ‘enslaved to a habit or practice to such an extent that its cessation causes severe trauma’, or whether this does indeed lend itself to the ‘disease’ of addiction?
However, there is much scope in theories of social learning and rational choice itself. Ultimately, it could be said that regardless of the conflicting arguments whether addiction to a substance is a choice of one’s free will, or a disease element in our bio chemical or physical make up, fostered through genetics, learned behavior, disease or choice, fundamentally, it can only be treated through choice, a concept succinctly phrased by Savant, control what you have put into your body do not let it control you. Being defeated is often only a temporary condition giving up is what makes it permanent (Savant, 1946)
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