Crawling Out Of A Bottle

Eve Tushnet criticizes both the disease theory of addiction and those who react against it with contempt. She admits that, “When I was drinking my will really was damaged.” But that’s not the whole story:

I am convinced that there were times, within this compulsion and constriction, when I was capable of choice.  Sometimes I chose heaven—often tiny little choices which seemed pointless at the time, like the choice to read a book about addiction even though I was stressed and scared, or sincere prayers which were quickly swamped by rationalization, exhaustion, and fear—and a lot of times I chose the other place. But even in my own past, I doubt I could accurately gauge the depth of my own freedom in any individual moment. How can I hope to gauge it for others?

This is the point that both sides of the disease/choice divide get wrong. Of course your will is constrained. Your background, what you were taught (explicitly or implicitly) growing up, your brain chemistry, your mental health—a whole host of factors out of your control, unchosen and not always even noticed, constrain your choices. But within that landscape of constraint we often do choose. We make huge leaps or crawl tiny, painful inches up or down. You’re not trapped in your brain or your past—at least, not always. But even from the inside, you can’t always see the moments when you’re free.

Relatedly, Keith Humphreys offers an explanation of why programs like needle exchanges help addicts make better choices:

People are more prone to take care of themselves if they think that others care about them. If you are using drugs and sleeping rough, you can go through long periods where no one expresses any feelings toward you other than contempt, disgust or hostility. In contrast, when a stranger stretches an open hand into the cold night and offers to help you, it communicates something markedly different: You have worth. Knowing that you are not worthless after all provides a motivation to try to make changes that will improve your health and well-being.

Recent Dish on addiction here, here, here, and here.