Addiction Is A Choice, by Jeffrey Schaler Ph.D, was published in 2000, so why am I reviewing it 13 years later? Well for one, I wasn’t writing reviews back then, but more importantly, this is still, to date, the best book I’ve found refuting the disease theory of addiction. If you have any interest in the topic, this is a must-read.
Going into this book you should know that it is not a presentation of an alternate plan of “recovery from addiction.” It is first and foremost a simple refutation of the disease theory. However, it is an amazingly clear, concise, and thorough refutation of the disease theory containing several points that most of the author’s contemporaries have missed.
Schaler, a psychologist, is an avowed admirer of the work of Thomas Szasz, the legendary psychiatry skeptic whose monograph “The Myth of Mental Illness” presents the view that mental illnesses are only metaphorical illnesses – and that they mainly represent deviant, or culturally unacceptable behavior. Society, wanting to control and change such behavior, labels it as mental illness. Schaler applies this same radical thinking, like a razor, to addiction:
Forms of antisocial behavior categorized as psychiatric illness include crime, suicide, personality disorders, and maladaptive and maladjusted behavior. Some people consider these ‘disorders’ because they vary from the norm and involve danger to self or others. According to Szasz, however, they are “neither ‘mental’ nor ‘diseases’” (Szasz 1988, pp. 249-251). If addiction qualifies as an antisocial behavior, this does not necessarily imply that it is mental or a disease.
If we continue to use the term ‘alcoholism’, however, we should bear in mind that there is no precisely defined condition, activity, or entity called alcoholism in the way there is a precise condition known as lymphosarcoma of the mesenteric glands, for example. The actual usage of the term ‘alcoholism’, like ‘addiction’, has become primarily normative and prescriptive: a derogatory, stigmatizing word applied to people who drink ‘too much’. The definition of ‘too much’ depends on the values of the speaker, which may be different from those of the person doing the drinking.
Calling addiction a ‘disease’ tells us more about the labeler than the labelee. Diseases are medical conditions. They can be discovered on the basis of bodily signs. They are something people have. They are involuntary.
For Schaler, addiction truly is a choice. He makes no bones about the fact that there is no physical pathology to the behavior, and clearly pegs it as a choice that people make because of what they believe they’ll get out of it, or in his words, because of the “meaning” they find in using:
Once we recognize that addiction cannot be classified as a literal disease, its nature as an ethical choice becomes clearer. A person starts, moderates, or abstains from drinking because that person wants to. People do the same thing with heroin, cocaine, and tobacco. Such choices reflect the person’s values. The person, a moral agent, chooses to use drugs or refrains from using drugs because he or she finds meaning in doing so.
His meaning becomes clear – that there is a clash of values between the “addict” and society. The “addict” at the time when they are using drugs, sees the choice as worthwhile, and thus is freely choosing it, exercising the acquisition of their values. Society disapproves, does not see the behavior as worthwhile, and proceeds to pathologize it as illness that must be “treated” out of the person. Thus society is forcing their values upon the “addict”, because they disagree with the costs or risks the “addict” is taking on with their behavior, as evidenced by the following passage:
Many people will point to the fact that drug consumers sometimes die from the consequences of their drug use, and conclude that anyone who self-destructs through the use of a drug, such as cocaine, must be doing so involuntarily.
Such a conclusion would be hasty. People engage in all kinds of risky behavior which may sometimes lead to their deaths: skiing, sky diving, marathon running, mountain climbing, stock car racing, and horseback riding all entail high risks of personal injury. Other people ruin themselves financially by taking risks, either in gambling or trading in financial markets. Having ruined themselves financially, they sometimes kill themselves. Others run high health risks through promiscuous, unprotected sex. Yet others get into fights, either on their own account or that of the rulers of their country, or set themselves up as martyrs by joining some despised religious movement.
Points like this are where Schaler’s brilliance really shines. It’s so obvious, yet he seems to be the first to identify it. One of the top arguments used to justify the disease theory is the one that essentially says “would people really make a bad choice?” To this, Schaler has obviously answered with an emphatic: YES! This is why I think the book is a must read, his style of argument cuts right through the nonsense that has been staring us in the face all along.
Beyond the brilliant nuggets presented above, Schaler thoroughly debunks the loss-of-control theory; presents evidence of moderate use of all the major drugs; presents a concise “free will model of addiction”; deconstructs the history of the disease theory; and examines AA’s cult status and practices. All of this will prove very helpful to anyone wanting to deprogram themselves from the “common knowledge” of addiction and recovery. And, while he isn’t really presenting an alternative plan of recovery, coming to such a new understanding of addiction as he so masterfully presents in 6 of the first 8 chapters of the book may be the perfect foundation for a privately initiated change of one’s habits.
The rest of the book may be more valuable to academics – this may be viewed as a weakness or a strength of the book, depending on what you’re looking for. One thing he accomplishes that most pundits on the topic (myself included) haven’t done, is that he carried out his own original research on the opinions and proclivities of treatment providers, and includes all of this original data in the book. The latter part of the book is highly infused with Schaler’s Libertarian proclivities, with which I personally tend to agree, but which may not be of much interest to the general reader.
All in all, this is a brilliant work, and as I said up top, a serious must-read for anyone seeking the truth about this behavior we call addiction. The short length of the book and chapters, combined with Schaler’s clear concise style of writing and argument make it an easy read as well.