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If addiction is really a ‘disease,' what does that say for conservatism?There is no more critical tenet of conservatism than the assumption of individual responsibility. As Dennis Prager wrote in a summative essay thirty years ago for The Heritage Foundation, “just as I am rewarded for my good behavior, I am accountable for my bad behavior. This belief was a result of … individualism … and of the Judeo-Christian ethic that also animated the founders of this country. Essential to Judaism and Christianity is the notion that you are accountable for your behavior-to God, ultimately. This has been under attack.”
Nowhere is this perspective under attack more than in the use of addiction and mental illness — namely, to
1. excuse and undermine assumed responsibility,
2. eliminate punishment for illegal and anti-social behaviors and actions, and
3. require “therapeutic” compensatory behaviors on the part of alleged and real miscreants in the United States and elsewhere.
One of us wrote a book titled Addiction is a Choice (2000), arguing contrary to the accepted truth of the country’s addiction lobby that “addiction” happens randomly to unsuspecting victims, like a virus or bacterium. Moreover, these sufferers of addiction are harmed by this allegedly serendipitous scourge that afflicts people who were in the wrong place at the wrong time.
And these myths are not limited to liberals or progressives. Since the heyday of Dr. Thomas Szasz and the conservatism that cast doubt on the existence of literal mental illness and stressed individual responsibility, the United States’ criminal justice system has gone, in the immortal word of Margaret Thatcher, “wobbly.”
As Phoenix Programmes, the widely respected and venerated addiction treatment center in Spain, puts it, and this is typical of establishment psychiatry and substance abuse psychology,
addiction is not your fault; whether it is to a substance such as alcohol or drugs, or a behavior such as gambling, online gaming, or sex; addiction is a disease that can drive a person to cheat, steal and manipulate to achieve their ‘fix’ and leaves their families and loved ones devastated by the destruction it causes. No one chooses to be an addict.
The devastating consequences of criminal culpability are manifold. Sometimes, it just disappears.
Another prototypical analysis from the National Institutes of Health News Letter leaves the decision-making of the addict completely unaddressed.
“A common misperception is that addiction is a choice or moral problem, and all you have to do is stop. But nothing could be further from the truth,” says Dr. George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism. “The brain actually changes with addiction, and it takes a good deal of work to get it back to its normal state. The more drugs or alcohol you’ve taken, the more disruptive it is to the brain”
If the above is true, how does an “addicted” person ever stop using drugs? Years ago, addiction experts were quoted in The Washington Post saying sex addicts were addicted to the chemicals released in their brains during orgasm. Does this mean a rapist should be exculpated because “his brain made him do it”?
Ideas have consequences, as conservative commentator Richard Weaver wrote. Nowhere is this more obvious than when putative addiction “experts” mistakenly refer to behavior as “disease.”
At this point, as with most analyses of addiction, mystification replaces serious evidentiary examination, since no one can understand human behavior without including individual choice. “Scientists don’t yet understand why some people become addicted while others don’t. Addiction tends to run in families, and certain types of genes have been linked to different forms of addiction. But not all members of an affected family are necessarily prone to addiction. ‘As with heart disease or diabetes, there’s no one gene that makes you vulnerable,’ Koob says.”
Just because a behavior runs in families does not mean the behavior is caused by genes. Extensive research on those persons considered addicted shows that environment is by far the more significant explanation or statistical predictor. Any true behavioral scientist knows this. Those asserting otherwise are politicians, not scientists.
The National Institute on Drug Abuse modifies its view to some extent as to whether there is any individual responsibility in the process of becoming addicted to drugs. “Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs” (emphasis added).
There is absolutely no evidence to support the idea that a gene or an allele causes people to consume mind-altering drugs such as heroin, cocaine, alcohol, and tobacco in ways they cannot control.
Let’s consider the facts about the meaning of addiction.
Addiction is a very old English word that has always meant “devotion” to something. Its association with “disease” is something negative and came about through the alcohol temperance movement and self-help groups such as Alcoholics Anonymous (AA) following repeal of prohibition. E.M. Jellinek, a researcher at Yale and author of The Disease Concept of Alcoholism (1960), coined the term “loss of control” to suggest that people could not control their consumption of alcohol. That theory, the cornerstone of the disease concept of addiction, has been consistently disproven by scientists ever since.
AA and Narcotics Anonymous (NA) are free self-help organizations for people who want help controlling their behavior. However, alternative self-help programs are now widely available for people who reject the idea that they have a disease and that they must “turn their lives over to a higher power.” Both organizations are shown by scientists to be no more helpful than leaving people to their own devices. The views of these 12-step organizations such as AA and NA have more to do with religious activity than secular science.
Twelve-step programs are also internally contradictory. Those who attend AA insist that adherents believe they cannot control their own behavior: “We admitted we were powerless over alcohol — that our lives had become unmanageable,” followed by a list of behavioral obligations tied to belief in a “higher power” — not a bad idea, but clearly not powerlessness.
Although adherents to AA philosophy are fond of saying the “higher power” can be anything a person wants it to be, there is one thing it cannot be: oneself. When self is in charge of addiction, the disease model crumbles.
Moreover, when the state coerces citizens into AA, as occurs in state-mandated attendance in AA for drunk driving, for example, the separation of church and state is violated. We assisted the ACLU in Maryland in establishing this fact through the circuit courts back in 1988 (Maryland v. Norfolk). That is only one of the consequences for viewing addiction and alcoholism as diseases instead of behaviors for which a person is clearly responsible.
Addiction in relation to drug use concerns behavior, not disease. Although behaviors can clearly cause disease, the two are different.
Behavior refers to deportment or a mode of conduct. As such, it is always the expression of a person’s values. How do we know what a person’s values are? By observing his behavior.
This is not to say that people who use drugs destructively or constructively are bad or good people. That is a misapplication of the meaning of moralism and addiction. All behavior is volitional. There is no such thing as an involuntary behavior. Reflexes, such as convulsions, are not behaviors, and we do not hold people responsible for them.
A drug addict is no more the same as a diabetic than a diabetic is the same as a drug addict. The popular analogy is neither true nor reciprocal.
Nevertheless, those who assert that addiction is a disease like diabetes, cancer, or amyotrophic lateral sclerosis distort these meanings for reasons that are important to them. They are also cruel and judgmental toward those with real disease. Those reasons have to do with imposing their morality on others, garnering money through addiction “treatment,” and enjoying power over stigmatized others.
A disease has a specific meaning: it refers to a cellular and biological abnormality. However, those asserting that addiction is a disease are deliberately obscuring things. Rudolph Virchow (1821–1902) was one of the 19th century’s foremost leaders in medicine and pathology. The meaning of disease as the expression of abnormal cells is the gold standard, attributed to his famous work.
We do not see addiction listed in a standard textbook on pathology for good reason. Behavior does not meet the nosological criteria for disease classification.
Our close personal friend Dr. Thomas Szasz’s writings on the difference between behavior and disease since the 1950s are solely responsible for the declassification of homosexuality as a mental illness. True scientists have agreed with our perspective for a long time. One of us debated these matters on William F. Buckley’s Firing Line along side Dr. Szasz.
Think about the confusing messages that those who believe addiction is a disease give to the public, and, importantly, to children. On the one hand, they assert that addicts cannot control their behavior because it is a disease, not the expression of their values. On the other hand, they are told they have the power to stop using drugs when it is important enough for them to do so.
The accepted view today is that everyone is equally vulnerable to the taking of drugs, and that no one can control his behavior. This is manifestly false.
Fortunately, the erroneous views of addiction as a disease and the ubiquity of mental illness are not accepted by all social scientists, experts on disease, political progressives, liberals, and conservatives in public media. Asserting that drug use in the form of addiction is both a disease and the expression of disease is wrong and dangerous. It is used to weaken self-efficacy, stigmatize good citizens, and ultimately enslave people by teaching them that they are powerless instead of powerful.
Courtroom debate and disputative base rhetoric are becoming undisputed but never indisputable. It is past time for people to demystify addiction and mental illness and see the truth about human behavioral choices and responsibility: addiction and other psychopathies are far from literal diseases. They are behaviors that people have always controlled, for reasons that are sufficiently important to them.
Jeffrey A. Schaler, Ph.D., M.Ed. is the author of Addiction Is a Choice (2000) and retired professor at American University’s School of Public Affairs and the psychology faculty at Johns Hopkins University.
Richard E. Vatz, Ph.D. is the distinguished professor of political rhetoric at Towson University. He is a well known critic of institutional psychiatry and its consequences for freedom and responsibility.
Both authors are widely published and the lead editors, with Zvi Lothane, M.D. of Thomas Szasz: The Man and His Ideas, published in 2017 by Transaction and Routledge.
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