Is addiction a choice?


You couldn't hope to meet someone more together than Catherine. She's smart and she's got a PhD in history to prove it. She's on the cusp of an exciting career in the world. Last month, she got married.

And, oh yeah, she used to be a binge-drinking heroin addict. Until she decided not to be anymore.

In a world addicted to addiction myths, Catherine is a myth buster. The biggest myth of all? That addiction is a disease that robs you of the ability to choose, that your biochemical hunger for your drug of choice overrides your ability to, in the forever-mocked words of Nancy Reagan, just say no. We used to blame the devil when people couldn't control their use. Now we blame bad genes and beta-endorphins: a new study suggests some people may produce more feel-good endorphins when drinking than others do, increasing their likelihood of overindulging.

And we've extended the model from booze and drugs to emotions, shopping and other destructive behaviours. "I'm not responsible," claimed a murder suspect on an episode of NYPD Blue. "I'm a diagnosed rage-aholic." In March, a British Columbia arbitrator ruled that heavily addicted smokers have a disability comparable to alcoholism and drug addiction, entitling them to protection from discrimination under B.C.'s Human Rights Act.

By blaming biology, it might seem that we're giving the addict a free ride -- hey, it's not your fault you've got the heroin or nicotine gene. But the problem, at least for now, is that it's a ride to nowhere. Perhaps one day the researchers scrambling to identify biological addiction triggers will come up with a magic bullet to cure the urge. In the meantime, addicts face the challenge of finding a cure within themselves.

"I tried AA but I was deeply repelled by that first step, the one that says you're powerless over your addiction," says Catherine, knowing full well her admission means she'll be accused of being "in denial." Instead, she turned to talk and body therapy (the latter aimed at expunging emotional pain by physically working it out) -- and gardening. "Gardening became a way for me to connect with moments of beauty and stop chasing the pleasure of the chemical highs. I made a choice to stay sober -- and sometimes I had to make that choice every five minutes, all day long."

Writer Ann Marlowe echoes Catherine's language of choice in How to Stop Time: Heroin From A to Z (HarperCollins), her gripping account of heroin addiction. "My addiction was chosen," she writes. "Getting a habit isn't an accident or the result of the 'power of the drug'; it's what you were after."

What you were after -- the pleasure of that chemical high -- has to be seen in the context of how little pleasure there is in the rest of your life. If smoking is the only way you can get five minutes for yourself or if self-loathing robs you of the ability to find pleasure in the non-chemical world, maybe an addiction seems like a rational choice.

And given our puritan roots, it's no surprise that North Americans view the pain of withdrawal as central to addiction treatment -- so central, in fact, that many reject chemical detox treatments that allow addicts to skip over withdrawal because we're afraid it makes it too easy for addicts to get clean. We'd rather try to scare addicts sober than explore the possibility that finding new healthier pleasures might be a more effective way to help them make better choices. (Still, we're not ready to give up chemical pleasure altogether: cartoon dad Homer Simpson may have summed up our collective ambivalence best, toasting alcohol as "the cause of -- and solution to -- all of life's problems.")

How do addicts quit? One day, they decide to -- and they find the support that helps them keep deciding to. They join AA, enter a residential treatment program or quit on their own. (The truth is, it doesn't really matter which option you pursue -- all have about the same success rate.) Is it easy? Of course not -- biology, habit and crippling regret about the choices you've made in the past all complicate the struggle.

There's another complication that stays hidden when we view addiction solely in biochemical terms. When poverty, isolation or abuse erode your ability to find non-chemical pleasure, it's hardly surprising you'd seek numbness in a bottle or a needle. And if it's just about bad genes, the rest of us don't have to feel guilty for ignoring your pain as an isolated child, accepting a world where unemployment robs able workers of dignity or averting our eyes from the homeless on our streets.

It makes you wonder who's really getting a free ride on the blame-the- genes train: addicts -- or the rest of us.