The argument as old as time, Addiction = disease, or choice? With the factual evidence showing that addiction is in fact a disorder, or disease, does that relieve users of their free will? Are they absolved of their responsibility for their actions while during their use?
Withdrawal symptoms are physical symptoms of the dependence, chills, spasms, excessive sweating, vomiting and mental confusion all come with going “cold turkey.” But unlike cancer, diabetes or heart disease, there is no escape from the symptoms of mainstream diseases, there is no cold turkey for schizophrenia.
Addiction is recognized as a chronic, relapsing disease, similar to other chronic diseases by the National Institute on Drug Abuse (NIDA). Dr. Nora Volkow, the current director NIDA, said that drugs “rob the brain of the capacity to exercise free will.” Even if addicts want to stop taking drugs, they can’t. Before her, Alan Leshner, wrote something similar, saying that drug use throws a “metaphorical switch” in the brain, resulting in compulsive, involuntary use.
Duke University professors of pharmacology Wilkie Wilson and Cynthia Kuhn eloquently summarize addiction this way:
“… addiction is far more than seeking pleasure by choice. Nor is it just the willingness to avoid withdrawal symptoms. It is a hijacking of the brain circuitry that controls behavior so that the addict’s behavior is fully directed to drug seeking and use. With repeated drug use, the reward system of the brain becomes subservient to the need for the drug.”
So which is correct? The thought that by “going cold turkey” one can abstain from drugs or the claim that drugs rob users of their free will?
The answer to this concern is crucial to our understanding of addiction and approaches to drug policy. Since NIDA’s creation in 1974, drug upsurges have followed one upon the other, and the most current one is without a doubt the most fatal. In 2017 more than 60,000 Americans were killed by drug overdoses. Perhaps what is needed is a re-examination of NIDA’s guiding assumption that addiction is a disease. Well established research studies on drug habits and advances in the understanding of the time course of dependency provide the means for screening whether addicts can say no to drugs.
All types of drugs that are capable of abuse, both legal and illegal, reward the brain with floods of dopamine to the brains reward regions (Nucleus accumbens) and the prefrontal regions that control our senses like judgement, decision making and self-control. Once these sections have been surged with dopamine, the brain reacts by becoming less reactive to dopamine, in a process called receptor downregulation. This results in ordinary every day interactions like positive social and physical behaviors that are part of everyday living, become irrelevant to the brains motivation. More than the just the norm is needed to maintain an even level of reward the brain has become used to. It becomes an endless cycle of trying to keep dopamine levels at a high reward level just to feel okay.
Measuring voluntary behaviors and free will
Habits vary in the degree of which theyare affected by impinging stimuli, as those take place in reflexes, and by costs and advantages, as occur through learned activities. Consider the causes and reaction in everyday occurances, kicking a ball and the patellar reflex, causing one to kick the ball back. A blink of an eye and the reopening of the lid to keep continuous sight. The previous reaction guided by the reactionary feedback from the original task. One is a cost, the other the advantage, or reward from the action. Obviously more complex activities, are a mixture of elicited processes and feedback-driven choices like drug use that requires more planning and deception, as well as action to obtain the drug to begin the process of using. Therein lies the question of choice over response related behavior, “Is drug use in addicts more like a series of elicited responses or more like a series of consequence-guided choices?” To answer that question, one must consider the two variables that predict the course of addiction.
According to the American Psychiatric Association’s (APA) criteria for “substance use disorder” the negative consequences of drug use must outweigh its positive ones. As if to compare shooting heroin daily is the same as a daily dose of prescribed medication and drinking daily is just a part of long term self-care. In terms of drug abuse, the common denominator of all abused substances is the immediate reward slowly followed by negative consequences that prove to be problematic in the long run.
The argument between economists and psychologists debates the delayed consequences versus the more likely outcomes from continued drug use, and which one of those outcomes are the driving force to seeking sobriety. But if drug use is then explained as voluntary, and the benefits from drug use become less rewarding than the “cost” of the drug use, that means addicts should be capable of quitting on their own, without outside intervention. Self-destructive behaviors discontinue due to the havoc reached within the person’s life. Outside interventions then only speeds up the process of recovery instead of being the only chance of improvement.
But if addicts are then slaves to involuntary decisions due to chemical dependence, just how much power does the dependence have over the brain, and at what point does drug use become compulsory?
Most studies have been practiced on addicts that sought treatment in clinics and recovery centers. But many do not seek treatment, which makes it hard for clinic-based studies to provide the best picture of addiction for all addicts. Researchers took this information into account and conducted nation wide studies that spoke to a larger array of subjects, including thouse who had never sought treatment.
Prior to the first of these studies (1991), the editor of the Archives of American Psychiatry wrote, “Here then is the soundest fundamental information about the range, extent and variety of psychiatric disorders ever assembled.”
One of the key conclusions answers the question regarding the timeline of addiction: 76 to 83% of those who met the APA’s criteria for a lifetime addiction to an illicit drug had discontinued use by 42. Further to show that addicts have more free will than involuntary reaction, most of those ex-addicts who quit drugs did so without the aid of professional help.
Which leads one to think that those who quit drugs on their own were not, in fact, addicts. That relays the old adage, once an addict, always an addict. But that is where further investigation is needed. There is little information to compare to show the difference between addicts who make use of treatment and those who do not. With the evidence that is available, addiction usually persists because of two reasons, drug availability and the absence or presence of other psychiatric disorders. For instance, the most recent national psychiatric survey shows that dependence on cigarettes and alcohol persists for much longer than does dependence on illicit drugs, and that among the illegal drugs, dependence on marijuana is most persistent, both due to its accessibility.
Understanding Free Will
The philosopher Harry Frankfurt argued that among the many creatures susceptible to the influence of costs and benefits, humans are unique in that they can evaluate whether they have the desires that they want to have and can change their behavior to better match the desires that they desire (so-called “second-order” desires and “second-order” volitions). Further research on addicts offers an opportunity to test the “second-order” ideas.
In a study conducted some years ago at the McLean Hospital in Massachusetts, evaluated whether heroin addicts can modify their cravings for heroin. The experiment manipulated drug availability, allowing addicts to use as much heroin as they wished on some days (with a two-hour break between injections); on other days, heroin was removed or was combined with an opioid competitor or similar substance. On days that heroin was consistently available, craving increased; on days that heroin was unavailable, or its effects blocked, craving decreased. Depending on the circumstances, heroin addicts were able to regulate their drug cravings.
Who is right?
According to the aforementioned study, addicts can say no to drugs and even regulate their cravings. Both are affected by the availability of the drug of choice and the alternative availability of equally rewarding non-drug of choice options. If free will requires the capacity to make choices and reflect upon them while also regulating their desires, addicts still possess free will.
Addicts and the public need to know that although addiction is a disease, addicts still retain the capacity to say no to drugs. To assist those suffering from addiction, preventative programs and interventions should focus on the availability of opportunities for rewarding nondrug activities and promote taking advantage of nondrug opportunities.
In conclusion, yes, drugs “hijack” the brain. But the extent of which is not reserved to just illicit drugs, as there are other things that can affect someone’s mood, thought and action. While addicts may be at the mercy of their disease, free will is not completely taken away.
Source : The Recover Newsroom
Also published on Medium.