Drugs of Choice. - Review - book review

Reason, Oct, 2000 by Jacob Sullum

Addiction Is a Choice, by Jeffrey A. Schaler, Chicago: Open Court, 179 pages, $42.95/$19.95 paper

How to Stop Time: Heroin From A to Z, by Ann Marlowe, New York: Basic Books, 297 pages, $24.00

Jeffrey Schaler and Ann Marlowe probably would not get along very well. He is an addiction psychologist whose unabashed libertarianism clashes with the leftish sensibilities of other drug policy reformers. She is a rock critic who writes for The Village Voice and views capitalism with ambivalence. He seems to spend a lot of time online, vigorously defending his iconoclastic views against all comers. She hangs out all night in hip, grungy New York clubs. He likes "a glass or two of wine or scotch, and occasionally more than two." She doesn't much care for alcohol; until about five years ago, her drug of choice was heroin. His writing style is relentlessly logical and straightforward, while hers is impressionistic and elliptical.

Despite the stark differences in their perspectives and approaches, Schaler's polemic, Addiction Is a Choice, and Marlowe's memoir, How to Stop Time: Heroin From A to Z, come to strikingly similar conclusions about the nature of addiction, a term that is hauled out with alarming frequency these days to explain away irresponsibility and justify paternalism. "I deny that there is any such thing as 'addiction,' in the sense of a deliberate and conscious course of action which the person literally cannot stop doing," writes Schaler, who deals with drug problems as a psychotherapist, college instructor, writer, and expert witness. "People are responsible for their deliberate and conscious behavior." Marlowe, a Harvard graduate who started snorting heroin in her early 30s and continued for seven years, using it almost every day for months at a time, is no less adamant about individual responsibility. "Not for a minute can I subscribe to the popular view...of addiction as uncontrollable need," she writes. "Still le ss can I take addiction as an excuse for bad behavior."

Much of what Schaler and Marlowe have to say about addiction will be familiar to readers of theorists such as Thomas Szasz and Stanton Peele. All see addiction as a pattern of behavior that can be understood only in the context of a person's values, circumstances, and choices. In this view, addiction is about much more than pharmacology.

Indeed, for Schaler, "addictions are dispensable." Harking back to the original meaning of the term, he defines addiction as "a fondness for, or orientation toward, some thing or activity, because it has meaning, because it is considered valuable or even sacred." Addiction, then, is not inherently good or bad. "Addictions--and only addictions--can open us up to all that makes life rich and fulfilling," Schaler writes. "Yet addictions can also have appalling consequences. The moral is clear: Choose your addictions carefully!..Addictions we approve of are called 'virtues.' Addictions we disapprove of are called vices.

Schaler's approach sweeps away a fog of pseudoscientific obfuscation and reveals the moral issues at the heart of this subject. "Addiction is the expression of a person's values," he writes. "Therefore, whenever we talk or write about addiction we are dealing with an ethical issue, not a medical one. Addiction is not a disease, nor is addiction a public health problem. Addiction is a choice."

Recognizing that the average reader will have a hard time accepting that assertion, Schaler cites an impressive body of research that contradicts popular notions about drug habits. He shows that experimenting with reputedly irresistible drugs such as heroin and cocaine generally does not lead to addiction and that addicts commonly moderate or stop their drug use on their own. He debunks studies that are said to demonstrate the overwhelming power of drugs and systematically attacks the disease model of habitual intoxication promoted by Alcoholics Anonymous. "The idea that addiction is a disease," he declares, "is the greatest medical hoax since the idea that masturbation would make you go blind."

In taking on the prevailing wisdom, Schaler shows a sharp eye for contradictions, non sequiturs, and unfalsifiable claims. "Addiction is a 'disease' to be 'treated,' yet 'treatment' consists of talking sessions aimed at changing the addict's beliefs and motives," he observes. "Ironically, the fact that addiction treatment does not work helps to convince people in the addiction treatment field that addiction is a disease. What else could account for the tenacity with which addicts cling to their addictions? Could it be that people sometimes freely choose to do foolish and self-destructive things? Inconceivable! It must be a disease that makes them do it."

Marlowe is not nearly as wary of talking about addiction as if it were a medical condition. Growing up in New Jersey, she saw her father, a research chemist and patent attorney, succumb to Parkinson's disease, an experience that colors much of her memoir. At one point she tentatively likens her habit, "with its intimations of loss of bodily control," to her father's condition (though she admits, "I always could, and finally did, simply walk away from my illness"). Conflating the flu-like symptoms of withdrawal with addiction itself, she calls heroin use a "sickness," a "disease," an "illness." She does not pause to reflect on the implications of such language--surprising for someone who otherwise seems keenly aware of loaded terminology, whose book is organized as a faux dictionary, with each section tied to a resonant word. Still, she clearly does not believe that addiction is something that happens to you. "My addiction, such as it was, was chosen," she writes. "Getting a habit isn't an accident, or the re sult of the 'power of the drug'; it's what you were after."