Addiction - Choice?

Addiction is everywhere.  While psychological dependencies of the mind are primarily associated with physical dependencies of substances such as drugs and alcohol, they also include uncontrollable behaviors relating to gambling, self-mutilation, overeating, cosmetic surgery, the internet, and just about anything else.  What I want to focus on is addiction as it relates to drugs and alcohol.

A Harvard psychologist, Gene Heyman, has written a book that is causing quite a stir in the world of addiction treatment.  In , “Addiction: A Disorder of Choice”, Heyman argues that contrary to conventional wisdom, addiction is not a disease, but rather a lack of individual self-control, an inability to take a long term perspective.  Not a disease, but a choice.  Wow! If this is true, it should throw a large wrench into the workings of a whole host of treatment programs and health-care policies.

Science appeared to have supported the view that addiction was a disease.  Neuroscience showed that the brains of addicts were uniformly abnormal.  Surely, this was evidence that addicts were just unfortunate souls, victims to the same sort of life lottery that claimed other victims of other diseases.  The uncontrollable behaviors of addicts had to be viewed sympathetically because these behaviors were beyond the influence of rewards, punishments and societal expectations.  But were the poor choices of addicts coming from their brain abnormalities or were the brain abnormalities coming from the poor choices?  For Heyman, the disease model of addiction just wasn’t adding up.  Why were addicts that never entered treatment programs more successful in achieving sobriety than addicts that went through treatment programs?  Why did 70 - 90% of addicts going through standard treatment programs, relapse within the first year of completing treatment?  Why did some treatment programs, such as those for airline pilots, which threatened job termination if the pilots were unsuccessful in their recovery, have success rates of over 80%.  For Heyman, the explanation for the poor success rate of treatment centers, came from research that showed that many of these addicts also suffered from other mental disorders.  As Heyman delved into the case histories of recovered addicts, the common thread for recovery was some cataclysmic event that ultimately led them to make the choice to quit their addiction.  Whether it was a car crash, a DUI charge, or their spouse leaving them, something occurred that made the addict realize they could no longer sacrifice the long term for their short term pleasure.

Heyman’s book reminded me of a Stanford University study involving marshmallows, four-year-olds, and choice.  Walter Mischel,  a Stanford professor of psychology, conducted the experiment on campus at the Bing Nursery School in the late 1960’s.  In a small room with a desk and a chair, the children were taken individually and asked to select a treat from an assortment of goodies.  Most chose the marshmallow.  Then the experimenter told the children they could eat the one marshmallow right away, or they could wait until the experimenter left the room to run a small errand, and when they returned, the child would get not one, but two marshmallows.  If, while attempting to wait for the second marshmallow, the four-year-old decided he or she couldn’t wait any longer, they just had to ring a bell and the researcher would return to the room, allow the child to eat the one marshmallow, but the second marshmallow would be denied.

Video tape of the experiment is quite revealing.  Some children ate the marshmallow right away.  Some agonized over the marshmallow, hiding their eyes, playing with their hair, kicking at the desk, until finally ringing the bell and eating the one marshmallow.  Most of the children lasted 3 minutes before ringing the bell and succumbing to their temptation.  However, 30% of the children held out for the required 15 minutes, and received their second marshmallow.  They delayed their gratification, and it paid off.

Starting in 1981, Mischel went back to locate the 653 children used in his experiment.  The children were now in high school.  He sent questionnaires to their parents and teachers and requested their S.A.T. scores.  There was evidence that children who delayed their gratification, had less behavioral problems at home and in school, dealt with stress better, had better relationships, concentrated better, and had higher S.A.T. scores than those children who could not wait to eat their marshmallow.  A child that waited 15 minutes to eat their marshmallow, on average, had an S.A.T. score 210 points above the child who waited only 30 seconds before eating his marshmallow.

Mischel tracked the subjects into their late 30’s, and found that the four-year-olds with little self-control, grew up to be adults with little self-control.  They had significantly higher body-mass indexes and often had problems with drugs.  Mischel’s research continues, but his findings say something about choice and delaying gratification.

But just what does it say?  Only, that we should be cautioned about making choices for the short term at the expense of the long term.  That, while we seek the freedom to do what we want, the desire for immediate gratifications often makes us irrational about the long term.  Lung cancer doesn’t enter the mind of a smoker as the next cigarette is lit up; addiction seems irrelevant as the next drink is downed by the border-line alcoholic; a troubled marriage is a distant thought as a spouse looks lustfully into the eyes of a stranger.  Our world today offers us more pleasure than ever before in history.  Unfortunately, without a little self-control, these pleasures will become curses.

Bird on a Wire

Like a bird on wire

Like a drunk in a midnight choir

I have tried in my way to be free

…. Leonard Cohen

I was fascinated to learn that the songwriter, Kris Kristofferson, wanted to have these lines as his epitaph.  Abandoning all of his own great lyrics, written over a 55 year career, he found more meaning in these 21 words.

Few of us really try to be free in our own way.  The bird on a wire is alone, apart from the world, and yet connected to it.  The drunk in the midnight choir is a symbol of the small rebellions against conformity we attempt.  The bird is not caged but free, the drunk is not reserved but free.

Life is short.  We resign ourselves, unwittingly,  to the expectations of others, to the duty of our responsibilities, and to doing the comfortable.  In Henry David Thoreau’s words, “The mass of men lead lives of quiet desperation”.  Our individual liberty is stifled by what goes on between our ears and by government.  I suspect Kristofferson has led an interesting life.  Undoubtedly, he has pissed off some people, shirked some responsibilities, made some colossal mistakes and will take some regrets with him to his grave.  But I also suspect he has inhaled life fully.  In his own way, he has tried to be free.  Words to live by.