Why Sally Satel is Wrong About Addiction

Earlier this year, presidential candidate Sen. Joe Biden (D-Del) sponsored a bill called “Recognizing Addiction as a Disease Act of 2007.” The bill proposes that the National Institute on Drug Abuse (NIDA) be renamed the National Institute on Diseases of Addiction and that the National Institute on Alcohol Abuse and Alcoholism (NIAAA) be renamed the National Institute on Alcohol Disorders and Health. Today, it is self-inflicted, because it encourages resignation among addicts and because it dowplays the role of free will.

The first reason is incoherent, as many widely recognized diseases involve elements of self-infliction (diabetes, lung cancer etc). The latter reasons have some merit, but still face serious critiques. Moreover, they neglect the original intent of the bill: to combat the stigma associated with medical treatment.

As I have mentioned before, I quit cigarettes with a little help from Pfizer. Since then, I have encountered many people who have expressed a desire to quit. But when I offer my leftover Chantix prescription, the suggestion is invariably met with a look of disdain. Often they will tell me that they don’t need a pill to quit, an argument that bears disturbing similarity to the smoker’s tired mantra: “I can stop anytime I want.”

This stubbornness is nothing more than the simulacrum of free will. Many of my friends have quit cold turkey, but in reality, most heavy smokers cannot and will not quit on their own.

Satel implies that drug use is just like any other bad habit. But the difference here is one of degree. If a new study showed that people get lung cancer from biting their fingernails, most would have the self-control to stop immediately. Yet millions of smokers continue their behavior in spite of such information. Addiction, by definition, severs the natural mechanisms that allow our better judgment to control our behavior. Banking on free will to escape addiction is ill-conceived if addiction specifically impairs free will.

Perhaps some people can restore control with the help of God, but for most, this is not enough. Conceptualizing addiction as a moral crisis has the unfortunate effect of reducing the likelihood that addicts will seek medical treatment. Though today’s anti-addiction pills are only marginally better than quitting cold turkey, more effective treatments are on the way.

I never viewed my visit to the doctor’s office as defeat. In fact, I think of my request for Chantix as an exercise of willpower. Far from lulling me into resignation, conceptualizing my problem as a disease empowered me to seek out a cure.

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2 responses to “Why Sally Satel is Wrong About Addiction

  1. Pingback: The Rational Addict « Brain In A Vat

  2. From the perspective of someone who has been without health insurance for years, it is amazing to me that anyone who claims to want to quit smoking, would turn down any help. I am giddy with anticipation, at the notion that I will soon have insurance and be able to get a script to help me quit.

    I find it troubling when people try to claim that addiction is not a disease. Especially when they rant about self-infliction. I have a very addictive personality, goes with the territory of ADHD and bipolar. Not just chemical dependencies either. I am capable of great feats of addictive/compulsive behavior – not because I choose to be, it’s just the way my brain works.

    As for the free-will aspect of the discussion, I don’t think for one minute, that recognizing addiction is a disease, as well as a symptom of other diseases, in any way detracts from that. I have addiction problems. After recognizing that, I have made a lot of choices to attempt to counteract that or at least lessen the impact of it on my life and health. I made the decision to stop using LSD (yes, that was my major drug of choice) and though it is hard sometimes, I have stuck with it – with the help of friends and initially the help of other drugs, but largely by force of will. It is only by exerting our will over our addictions, that we can defeat them.

    I would presume that your pills were a big help in quitting smoking, but I am equally certain, that if you didn’t want to quit smoking, if you didn’t have the will, you would still be a smoker today.

    Recognizing that one is sick, is the first step in exerting one’s will to helping defeat the illness. This is true of purely physiological illnesses too, giving up is a surefire way of not getting better.

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