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.

Ayn Rand

The world will change when you are ready to pronounce this oath:  I swear by my Life and my love of it that I will never live for the sake of another man, nor ask another man to live for the sake of mine.

-   John Galt from Ayn Rand’s Atlas Shrugged

My philosophy, in essence, is the concept of man as a heroic being, with his own happiness as the moral purpose of his life, with productive achievement as his noblest activity, and reason as his only absolute.

The givers are never blessed; the more they give, the more is demanded of them; complaints, reproaches and insults are the only response they get for practicing altruism’s virtues

- Ayn Rand

Ayn Rand, to say the least, was a complicated lady.  At her funeral, a 6 ft. floral arrangement stood next to her casket - in the shape of a dollar sign!  Even in death, she knew how to stick it to her critics.  Her philosophy,  objectivism,  while mostly misunderstood, has somehow become much clearer to me.  Since my father’s death five months ago, things have happened that have caused me to question my life’s philosophy, my moral-code, if you will.  In the past, I’ve scoffed at Ayn Rand’s belief that “altruism is immoral”.  Instead, I believed that the unselfish concern for the well-being of others is the measure of a life well-lived.  That, in fact,  a love-filled life can only come through sacrificing for others, and not just for those you love.  We’re not just talking about being kind and helpful to people, but sacrificing the enjoyment of your own life to do good.  Under this code, I have sacrificed career, financial security, and a lot of leisure time.  I have been the altruist that Ayn Rand despised.

Why Care?

My mother has Alzheimer’s Disease. It is a death sentence unlike any other.  Slowly, her memory will fade.  Eventually, she will not recognize her loved ones, her body will shut down, and she will die.  The process may take years.  In just 5 months, I have seen my mother deteriorate.  She now needs help walking and bathing.  She can’t make any of her own meals or do household chores.  She is often confused about time and place and is repetitive in conversation.  Most of the time, however, I still fully see her as the vibrant, loving, and beautiful woman, I have known my entire life.  But this will not last too much longer.  My wife and I are her primary caregivers and she now lives in our home with our three children.

So what is my future?  What is the future of the millions of caregivers like me, who will see their loved ones descend into darkness?  Ayn Rand said we should only sacrifice for things that we value.  But what value can I place on a person that is losing their mind?  On a person that one day will not even know who I am, and whose behavior will only become increasingly more annoying, nonsensical and unsettling.  When the only thing I know for sure, is that no matter how much more help I give, my mother will only get worse, how much of my life should I sacrifice for her?  How much of my health, financial well-being, peace of mind, and enjoyment of family and life, should I give up for my Mom?  In the end, she will not even be able to express a modicum of gratitude.  Life is short, haven’t I already wasted too much time trying to do good?

Ayn Rand warned altruists that they would ultimately be held in contempt.  I know this to be true.  Living your life for others?  What a waste of a life.  Nobody wants to compare their daily routines to that of an altruist.  People with challenging, time-consuming careers, work hard to enjoy the holidays, houses, toys, and fun they deserve.  They don’t want any guilt directed their way, especially from those that don’t have the gumption to rationally focus their energy on creating their own happiness.  On the other hand, I know more than a few altruists that question the divine justice that bestows lives of leisure on the selfish and hardship on the unselfish.  Contempt becomes a two-way street between altruists and the rest of society.

My Mom’s Alzheimer’s Disease has forced me to come face to face with the reality that my altruism may be immoral.  Doesn’t God want us to enjoy his creation?  Why is the sense of duty for the altruist so different from the duty that others are beholden to?  The German philosopher, Immanuel Kant, believed that true goodness could only come from doing the right thing with no consideration for satisfying other desires.  That our goodwill should arise not from any good feeling we might get from being of service to others, but rather from fulfilling a duty  out of respect for an ever-reaching moral law.  Kant viewed this moral law as our knowledge of good and evil and that rational people acted in accordance to inner convictions which dictated the good they ought to do.  But altruists believe they are more aware of the moral law.

Altruism has a way of snowballing.  What begins with a few altruistic acts of kindness, can become an all-encompassing lifestyle.  The broader the sense of duty and responsibility an altruist has, the more he is willing to sacrifice.  Eventually the true altruist will take on more and more duties.  Inevitably these duties will end up completely absorbing the life of the altruist, and the altruist will lose the very things he values the most.  All of a person’s values exist on a hierarchy and eventually the hierarchy of the altruist’s values will end in complete shambles.  One only has to look at the burnout of humanitarians and caregivers to see the toll that altruism takes.

In 2007 and 2008, Ayn Rand’s 1957 novel, Atlas Shrugged, ranked 542 on Amazon’s online bestseller list.  However early this year, it shot up to number 33, surpassing Barack Obama’s, “Audacity of Hope”.  Why the surge in interest in the philosophy of Ayn Rand?  The fallout from the financial crisis is definitely peaking some interest, but isn’t it possible that a generation of altruist are also turning to a belief in “rational self-interest”?

A new report from the American Alzheimer’s Association, predicts that the 5 million Americans currently suffering from Alzheimer’s Disease will rise to 7.7 million by 2030 and 11-16 million by 2050.  The annual cost for caring for a person with Alzheimer’s today is a staggering $33,007.

God help us if the battle for the caregiver’s soul is won by Ayn Rand.