Why would someone choose to be “addicted” when they know it will cause so much pain?

A popular talking point for those who proselytize the disease model of addiction is this, as stated by a recent commenter on the site:

Why would someone who has power over their addiction knowing the consequences of losing everything family, friends, wife, kids, and there own life continue to use???

I’ve seen this point a million times over, phrased countless ways. They think this is the end-all be-all ultimate gotcha argument supporting the idea that “addicts and alcoholics” are not in control of their actions. The assumption behind it is so grossly insane, that most of us never even think to question it. But let’s recognize exactly what it is. For the logic of this argument to be convincing, you need to accept the premise that people are fundamentally incapable of making choices that have clearly negative consequences. That’s what the statement proposes, isn’t it? – the notion that if a given behavior leads to easily predictable negative consequences, then it couldn’t have been freely chosen, and it must have been carried out involuntarily?

Let’s be clear and realistic about this. People make risky choices with high costs all the time. And these risks and high costs are often easily predictable, even dependable, in many cases. Yet people still make such choices, practically inviting or welcoming destruction. We should consider some examples that most people would readily acknowledge to be fully voluntary.

Addiction researcher and theorist Peter Cohen brought up the example of those who protected jews during WWII. Irena Sendler is a good example of this phenomenon. This 4’11” woman bravely saved over 2500 jewish children in Warsaw from 1942-43. She smuggled them out of the ghetto in boxes, bags, and even coffins – by whatever means necessary. She knew what could happen to her at the hands of Nazi forces if she were caught. Danger was right in her face as she saw 500,000 jews mistreated and confined to the ghetto in Warsaw. She worked as a nurse in the ghetto, and used her position to smuggle children out of there. She did this in the face of armed guards. She knew the danger to herself, but decided to pay it no mind.

Eventually she was caught and tortured, yet refused to inform on the whereabouts of the children, even though it resulted in her being sentenced to execution. Luckily she escaped, but then had to live in hiding herself, and was mistreated by communists who took over after the war, and labeled her a “subversive.” Her deeds went mostly unrecognized until very recently.

Was Irena “out of control” or “powerless” over her “rescuism?”

Most people today would credit her with making brave choices.

Or take the case of soldiers who desperately want to be sent back to the front lines, even after amputations:

From the moment his broken body was pulled from an armored vehicle in Iraq — after an enemy grenade, dropped through a hatch, detonated inches away —Army Ranger Joseph Kapacziewski vowed to be back in the fight.

“I don’t like people telling me I can’t do something,” he says.

Even if it meant choosing in the months ahead to have his leg cut off — so that with a prosthetic he could still jump out of airplanes, rope down from helicopters or fight along 10,000-foot mountain ridges.

Fast-forward five years to the morning of April 19, 2010, to a village in eastern Afghanistan.

With help from his false leg, Sgt. 1st Class Kapacziewski, 28, races down an Afghan road through enemy fire to reach a fellow Ranger who had been shot in the stomach. Along with another soldier, they drag the wounded man 75 yards to safety and administer first aid as insurgents with heavy machine guns try to kill them.

The story of Joe Kapacziewski’s rebirth as the only Army Ranger serving in direct combat operations with a prosthetic limb is more than a tale of will power and physical hardship.

…it is about a soldier who says his dream is just to be a soldier — and not a war hero-slash-amputee. LINK TO FULL STORY

Could anyone say that Kapacziewski was unaware of the potential consequences of going back into battle? He had seen plenty of death and destruction. He was willing to die. And not necessarily for the “noble” reasons usually mentioned in support of such choices. Reasons cited in the article are that he doesn’t “like people telling me I can’t do something,” and that “his dream is just to be a soldier.”

Most people wouldn’t say such soldiers are “out of control” or “powerless” over their “soldierism.” Most would say that they made brave choices.

When Kapacziewski says his ‘dream is just to be a soldier – and not a war hero-slash-amputee’, he is essentially saying that he’d be happier with the potential devastating consequences of going back to the war than he would be staying safely at home. He is willfully accepting the risk. It’s the price he’s willing to pay for his dream. Same thing goes for Irena Sendler, and anyone who chose to risk their lives to save people during WWII. They had safer options, but they willfully chose to take great risks of personal harm.

These aren’t the only examples available. We usually wouldn’t compare such choices with the choice to use drugs and alcohol, because we consider substance use to be “selfish” and the other examples used here to be “selfless” or “noble.” Sendler’s example seems to fit that selfless bill, and the soldier example usually fits the same bill, except that in this case, he clearly cited personal dreams and pride as motivations for his choice. Let’s look at a clearly utterly selfish example.

I watched a documentary about extreme skiers on ESPN late one night (and didn’t catch the title, so if anyone knows it, please let me know). It followed several guys who climb extreme mountains to ski fresh snow, and they do so religiously. They all personally knew of people who had died in avalanches and succumbed to the other dangers of the sport. They knew the risks, and made statements reflecting their total acceptance of the risk. They said that they loved their sport so much that they would rather die doing it than give it up. Indeed, by the end of the documentary, they had all died skiing. They interviewed some of their wives, who also said that they wouldn’t have wanted their husbands to give up skiing because it brought them so much happiness, even though they eventually died doing it, and at young ages I might add.

They willfully accepted death in order to attain the moments of happiness achieved through extreme skiing. Were they “powerless” to stop climbing mountains and skiing down them? Did they have the disease of “skiism?”

This is where a layer of moralization usually gets thrown into the mix. People are willing to see the heroes’ actions as freely chosen, but then they might call the extreme skiers sick. They would jump to saying the extreme skiers have “adrenaline addiction” or some such thing. But why are the skiers any different than the heroes? What is different about the two cases? As far as I can tell, it’s only that the skiing is considered selfish, while the other activities are considered noble and selfless. While I disagree with this distinction (that’s a bigger discussion for another time), how could such a moral distinction mark the line between voluntary and involuntary behavior, scientifically? It can’t. It’s just judgmental crap. There is nothing of substance there.

People do willfully take on risk and negative consequences in order to make the choices they see fit. Throw out your moralization, and that’s what you’re left with. This dismantles the entire “why would people choose to get arrested, lose their families, overdose, etc” argument for the powerlessness/loss of control/disease model of addiction.

“All men seek happiness. This is without exception. Whatever different means they employ, they all tend to this end. The cause of some going to war, and of others avoiding it, is the same desire in both, attended with different views. The will never takes the least step but to this object. This is the motive of every action of every man, even of those who hang themselves.”

-Blaise Pascal

I have personal experience with heavy substance use problems. I did many things that I wished wouldn’t end badly, even though I knew there was a big chance that they would – such as shoplifting to support my drug use. I also did things that I knew would definitely end badly – such as writing a string of bad checks, from my own cancelled account, with my own signature on them, in order to fund my drug use. There was no doubt in my mind that this would eventually catch up with me, yet I still did it. Essentially, I had agreed that it was worth the punishment I would receive later, in order to get high and be a little bit happier right now.

Don’t get me wrong, I wasn’t dreaming of being caught for the bad checks, but I knew it would happen. I willfully chose to endure those consequences as the price for my substance use. I don’t think Sendler dreamed of being tortured by Nazis and executed, nor did Kapacziewski dream of losing another limb or being killed on the battlefield, nor did the skiers dream of being smothered by snow. The skiers dreamed of the rush of extreme skiing, Kapacziewski dreamed of being a soldier, Sendler dreamed of saving some poor unfortunate souls, and I dreamed of being high. They didn’t want the negative consequences, but they accepted the possibility of said consequences as the price they were willing to pay in order to make the choices that they could feel happy with.

Why would “addicts” choose to endure such pain and negative consequences? They don’t choose it directly. They accept it as a potential price they must pay for their choices. They always freely choose to use substances, even when the negative consequences start kicking in. It really isn’t inconceivable that someone would take on such risks – and the fact that some outsider doesn’t think that substance use is “worth it” doesn’t change the fact that the substance user does.