Addiction – The Freedom Model vs The Control Model

In my work helping people with substance use problems, I am an instructor rather than a counselor, therapist, or medical professional of some kind. The people I work with read a textbook, complete written assignments, and come to class to review the reading, their work, and the ideas contained within. It is truly a unique approach and dynamic for helping people with such problems.

In the Saint Jude Program (which I offer in my NYC office, and at the St Jude Retreats in upstate New York), one of our first lessons is about two diametrically opposed ways of conceiving of human behavior – what we’ve dubbed the Freedom Model, and the Control Model. Here are some excerpts describing these ideas from the upcoming version of the Saint Jude Program textbook:

The Freedom Model…

All people have the natural right, the ability, and the inherent tools to think freely and to exercise those thoughts through free choice and free will, from birth to death, and at any and every given point in time a single drive motivates every human being: the pursuit of happiness.

The Control Model…

human behavior is essentially predetermined, or controlled, by genetic factors, brain chemistry, upbringing, conditioning, stress, triggers, etc…. Control Model programs prescribe particular codes of behavior, and consider any deviation from their codes of behavior to be evidence of sickness, powerlessness, or loss of control. Accordingly, they believe that a force outside the individual is needed to control the sick behavior.

Although we have always taught that people use drugs and alcohol because they believe it will bring them some kind of happiness (and this teaching has worked, with 60-70% of our students achieving long-term abstinence and many more achieving moderation), in the past, we approached this more as an alternative between the “disease of addiction” and free-will. Over the years, we realized it’s a fundamental philosophical issue, and not limited to substance use alone. That is, substance use isn’t a special case of any kind, we’re talking about how people make all choices in life. Either we’re freely choosing our behavior, doing our best with our available knowledge and beliefs to achieve happiness – or we’re automatons with no free-will, simply being pushed around by circumstances and our biology. Thus we refined our philosophy (The Freedom Model) to be an explanation of all human motivation and choice making: everyone is making the choices that they believe are their best options for acquiring happiness at any given time. We also looked at the core conceptual foundation of the treatment world to find that they’re not only claiming that “addicts” are “out of control”, but that they are also truly denying the very existence of free will (the Control Model).

You may think that it’s an extreme caricature of the other side to say that they deny free will, but with the furtherance of the brain disease model of addiction, they’ve really shown their hand. Don’t believe me? Just check the words of the top representative of the pro-disease, pro-treatment world, Nora Volkow, director of the NIDA. Writing in the book that accompanied the popular HBO special, Addiction: Why Can’t They Just Stop, she states it pretty clearly:

“The human brain is a complex and fine-tuned communications network containing billions of specialized cells (neurons) that give origin to our thoughts, emotions, perceptions, and drives. Often, a drug is taken the first time by choice – to feel pleasure or to relieve depression or stress. But this notion of choice is short-lived. Why? Because repeated drug use disrupts well balanced systems in the brain in ways that persist, eventually replacing a person’s normal needs and desires with a one-track mission to seek and use drugs. At this point, normal desires and motives will have a hard time competing with the desire for the drug.”

Her materialist view of humanity is laid bare for the whole world to see. She believes that thoughts and drives are purely the product of neurons. If this is so, then where is free will? If our mental life is nothing more than a bunch of biological interactions, where does choice exist? It would seem at first glance that she does believe in free will, because she apparently concedes that substance use is a choice at first, but then the power of choice is somehow lost. Where does she draw the line between chosen and unchosen behaviors though? She seems to delineate between normal and abnormal desires. But this standard is based on cultural norms, so she is essentially saying: if your behavior fits in with society, then you’re freely choosing it – if it doesn’t fit in, then it’s not freely chosen, it’s the product of disease.

This seems like a rather arbitrary unscientific line to draw, and it also seems to be at odds with the first sentence of her paragraph. If the brain is the cause of all thoughts and drives, then it is the cause of not only the “one-track mission to seek and use drugs”, but also the cause of the “normal needs and desires.” So either she is painfully dumb and can’t see this inherent contradiction, or her concession of some level of initial choice is simply a ruse designed to make her views more palatable for those of us who inherently know that we have free will because we witness our own inner mental life and feel ourselves freely making choices every day.

Perhaps her comments in the above passage don’t totally “lay bare” her anti-free-will (or deterministic) views. There is some reading-between-the-lines that’s needed to understand it. But of course, that passage was carefully crafted for a book. When she’s speaking off the cuff, it’s a little more obvious. Check what she told a New York Times reporter in their article A General In The Drug War:

We think we have free will, she continued, but we are foiled at every turn. First our biology conspires against us with brains that are hard-wired to increase pleasure and decrease pain. Meanwhile, we are so gregarious that social systems — whether you call them peer pressure or politics — reliably dwarf us as individuals. “There is no way you can escape.”

If this isn’t bald-faced determinism, then I don’t know what is. It’s the perfect example of the Control Model: you can’t escape your fate because your behavior is determined by your brain and your circumstances. There is no such thing as free will in the Control Model – a freely choosing human being with a mind and the ability to exert the effort to think and choose the behaviors that they believe to be in their best interest is never considered as a potential “cause” of behavior. Instead, only the firing of neurotransmitters and the pressures of environment (i.e. “social systems”) are considered to be the causes of human behavior.

I understand this is a little deep to go in an introductory article on the difference between the Control Model and Freedom Model, and that some readers will be a little lost with this talk of determinism, free will, and the role of the brain in behavior, but I promise you it’s important.

The Freedom Model informs everything we do in the Saint Jude Program:

• Instructors: If the Freedom Model is true, then you don’t need someone to tell you what choices to make (counsel you), and you don’t need to be treated for a disease (get medicine to alter your brain). You are not out of control or diseased, you are simply choosing the behaviors you believe to be your best option for finding happiness. Thus if you think you may want a lasting change in your behavior, you need to exercise your own mind and judgment, eventually reaching new thoughts and beliefs that result in new choices and behaviors. These things aren’t the product of medicine and they don’t come from outside forces, they’re the product of freely chosen personal effort. Thus instructors who present empowering information and ideas are a better fit than medical and mental health professionals whose very presence would implicitly communicate the idea that the cause of personal change is outside of the self (that someone else needs to “fix” you). (that we have instructors rather than counselors, is by design, in order to help our students orient themselves towards an internal locus of control)
• Curriculum: If the Freedom Model is true, then the educational materials should provide information that removes unnecessarily complicating beliefs that create a causal link between stress and life circumstances (as best exemplified by  the notion of “triggers” in Control Model programs), supports beliefs in self-control and self-determination. Next it should provide a method that the student can use to build awareness of how and why they’ve made choices throughout their life. It should also give them a method by which to expand their range of options to find out whether they truly believe that their current course of behavior is the best path to happiness, or whether they may be able to find better options for themselves. The educational materials should not simply tell them they have better options, such a judgment can only come from within the self – it should provide them with a method to make these judgments for themselves. New choices are facilitated by new evaluations of one’s options and awareness of new options. The St Jude Program curriculum provides a platform for the student to do all of this.
• Approach/Tone: If the Freedom Model is true, then instructors should not communicate their opinions of what is good or bad for the individual, as this could stand in the way of the individual fully exercising their own judgment. Instructors should provide an atmosphere in which the students are fully free to explore all options openly to discover what choices may bring them the greatest amount of happiness. Judgments from others can only cloud the issue and process. The choice to use substances is, and always has been driven by personal judgments about what will bring happiness. Thus people will only follow through on long-term behavior change if they judge it to be right for themselves.
• Support, Aftercare, and Relapse Prevention: These are inherently products of the Control Model philosophy, as they are based on the idea that the individual’s choice are caused by forces outside of the self. If the Freedom Model is true, then these are unnecessary distractions from the main issue: the individual freely chooses heavy/frequent substance use because they believe it will bring them the kind and quality of happiness they desire. The student should be taught to own their choices in this way. The Saint Jude Program doesn’t teach relapse prevention for a few reasons. First, the notion of relapse implies a domino effect process of loss of control which simply isn’t true. Second, it implies that “triggers” control the individual. The most effective way to find lasting behavior change is to find lasting belief change. If the troubled individual comes to believe that they would be happier with some lifestyle other than that which revolves around heavy/frequent substance use, then “relapse” ceases to be an issue. On the issue of “support” (i.e. support group meetings such as AA) and “aftercare” (i.e. ongoing treatment/counseling) we take the same basic stance – such things promote an external locus of control that distracts from the truly effective and causative internal factors. Of course our instructors are almost always available to talk to former students, but we don’t pretend to be the cause of anyone’s behavior nor do we have any formal aftercare arrangements. We have tested support groups, and at one time had meetings every night of the week in upstate New York near our retreats. We found that those locals who attended the meetings had a lower rate of successful long term change than those out-of-towners who simply attended the six week retreat and moved on with their lives. Paradoxically, the support group mainly supports the notion that support is needed! Again, “support” would only be needed if the Control Model were true and it were external environmental factors rather than internal factors that wield control over human behavior. External factors may influence, but they do not control people’s behavior.

One of the first things I tell people when they come into my office for a free consultation is that they don’t need me or my program. It may not be the best sales technique, but it’s true. People change their behavior when they come to believe that another course of action would bring them more happiness. The Saint Jude Program doesn’t hold the exclusive path to get there. People do this on their own every day. Some people do this while attending conventional addiction treatment programs and 12 step groups. Yet no outside force is responsible for their changes – they are responsible for their own changes internally, whether they recognize this fact or not. What’s going on when someone achieves lasting change in a 12-step program is that they are coming to believe that the 12-step lifestyle would make them happier than the heavy/frequent substance use lifestyle would. That’s all. The problem is that the Control Model programs such as 12-step groups are very prescriptive, promote beliefs that undermine self-confidence and self-efficacy, and offer essentially only one alternative to heavy substance use. The best application of the Freedom Model philosophy in the Saint Jude Program acknowledges that there are limitless possibilities for what one may find will bring them happiness, and for what one might judge to be more attractive the heavy substance use, and not all people will find the same lifestyles/activities equally attractive – so we teach the principles by which people can discover and evaluate options for themselves. However, this isn’t something that can’t be accomplished without us.

If you want to address a substance use problem:

• Start by throwing away the Control Model notion that you are controlled by outside forces, that a disease, triggers, genes, stress, upbringing, or environment/peer group are the “cause” of your substance use issues.
• Own the fact that you have used substances for the simple pleasures they provide.
• Ask yourself first: Would my life be better if I simply cut down or stopped using substances altogether?
• If that isn’t satisfactory or motivating enough, then ask yourself: Are there better ways I could be spending my time to achieve greater happiness in my life? Then get to exploring your options, setting and pursuing goals, and make it experiment to see if your life might be better refocused on activities other than substance use.
• That’s it. If heavy substance use isn’t working out for you, then simply stop it and move on to whatever you think will work better for you to bring you greater happiness. If it is working for you, then own it, do it, and love it – but please be safe, as it can be a dangerous game.

You don’t need a lifetime of support or treatment to change or control and save you from yourself externally – you need to examine your self, find your answers within, and proudly own whatever life path you choose for yourself (without any illusion of external control). It is your life after all!

Note: The Freedom Model does not hold explicitly or implicitly that people who use substances in large quantities or frequencies are “bad.” It simply says that they’re doing what they believe will bring them happiness, and that all personal choices are this way. It does hold that no one can determine what should make another person happy – and that this is a deeply personal matter. The Saint Jude Program (based on the Freedom Model) seeks to help all people with problems of personal choice to discover their best options from their own evaluations of what will bring them happiness – whether that may be to continue the culturally unaccepted yet personally gratifying behavior, or not. However, we do not sanction any behavior that brings harm to/violates the rights of others. I will be writing more about the Freedom Model and its application in future posts.

UPDATE: Since this post was written, myself, Mark Scheeren, and Michelle Dunbar have written a new book The Freedom Model for Addictions, and it will be released by the end of November 2017 (pre-order/buy the book at that link). We couldn’t be happier with the results. It’s the product of almost thirty years of research and experience teaching people to conquer their problems by way of choice aimed at greater happiness. It’s a tough, nuanced thing to convey, and I think we pulled it off. Our students have been loving the book which is already in use in our retreats and classes, and Stanton Peele gave us a great review, saying that we:

…have created an indispensable guide first, through the labyrinth of claims about the nature of addiction, and second, by explaining how this understanding leads to resolution of addiction, to overcoming it. Indeed, their thoroughly grounded scientific exploration of “the meaning of addiction” IS the basis for such personal resolution. To know that your enemy is not only your addiction, but more importantly how you think of it, is the key to freedom from addiction. And no volume in the world can put you in a better position for this resolution than The Freedom Model.