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Addiction Is a Choice
Written for both lay and professional readers, this book offers new approaches to understanding addiction and the public policies necessary to successfully battle its detrimental effects on society. The author explains why current policies are ineffective and how they fail to cure the "problem." He argues that they actually encourage addiction by allowing people to feel blameless for the consequences of their choices.
256 pages, Paperback
First published December 21, 1999
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June 7, 2016
I need to start by saying I really appreciated this book. I think it's definitely worth our while to consider what we mean by "choice" and "losing control" when we talk about addiction. As Schaler points out, it is not the case that literally every time an alcoholic takes a drink they don't stop until they pass out.
My best understanding of addiction jibes with Paul’s understanding of sin: “For I do not do the good I want, but evil I do not want is what I do. Now if I do what I do not want, it is no longer I that do it, but sin that dwells within me,” (Romans 7:19 & 20, NRSV). That’s the powerlessness AA requires its adherents to acknowledge, and the reason why “Am I an addict?” quizzes often include questions about regret and guilt.
In fact, that aspect of addiction is the reason we consider it a societal problem. Both the addicts and the communities around them spend a lot of time on the question, “Why would you continue to do something that you know has a terrible impact on your life?” And to Schaler’s dismay, the answer comes back, “Because I can’t help it.” To which Schaler screams, “Of course you can! You ‘help it’ every time you stop bending your elbow, even for a few minutes!”
However, the fact that Schaler made me think about things does not excuse the fundamental flaws in this book, listed here in no particular order:
1) Ignoring inconvenient facts. As alluded to above, Schaler makes the bulk of his case around the behavior of addicts, as if the choice to abstain is as easy to make as the choice to partake. This could be a compelling argument, if one were to disregard physical withdrawal symptoms. So that’s what Schaler does. Early in the book he defines the term, mentions its importance to the disease model of addiction, and at one point mentions that the test subjects in a particular study were in “various stages of withdrawal,” but he never grapples with the difficulty of “choosing” a course that causes physical reactions ranging from mild discomfort to pure agony. I believe this is what allows Schaler to treat all forms of chemical dependency (tobacco, alcohol, pot, cocaine, and even heroin) as equally volitional.
2) Bad organization of material. I’m going to assume Addiction is a Choice was put together out of a series of articles or essays. It’s the only explanation I can come up with as to why there’s an appendix at the end of chapter seven in a book containing thirteen chapters.
3) Bad science. The aforementioned appendix contains a survey Schaler used in a study of addiction treatment providers. The instrument consisted of eighteen statements, evenly divided between those applicable to a disease model of addiction and those that fit with a free-will model, that respondents were supposed to answer on a Lickert scale of “Strongly agree” to “Strongly disagree.”
Quoting now from the book: “The highest possible score for each item was 5, and for all 18 items, 90 . . . The strongest possible belief in the free-will model of addiction is represented by a score of 5 for each of the nine free-will items and zero for each of the nine disease-model items (or a total of 45).”
Great, so strongly agreeing with any item nets you 5 points, right? Only a serious yes man would get a score of 90, because he would have to agree with every statement, no matter how contradictory. Therefore, one’s total score on the instrument would be irrelevant for determining which way one leaned in the free-will vs. disease dispute. Not according to Schaler. A note at the bottom of his table of results reiterates, “The highest possible score is 90,” then goes on to say “The higher the score, the stronger the belief in the disease model of addiction. The lower the score, the stronger the belief in the free-will model.” WTF?
There’s also the contention Schaler makes throughout the book that the treatment of alcoholism doesn’t work. I was looking forward to the evidence he would present to support this claim, and so was a little disappointed to find it summed up on page 98: “ . . . if a number of different treatments, dramatically at odds in their assumptions and techniques, achieve the same results, it seems reasonable to conjecture that the zero option, no treatment, will also achieve the same results.” Reasonable to him, maybe.
What’s worse is that the study he’s citing contends that all the treatments studied had excellent outcomes in terms of abstinence or reduction of intake of alcohol. How Schaler gets from there to “treatment doesn’t work,” I’m a little foggy on.
4) An entire subsection entitled How the Cult Attacks Its Critics. Translation: “People are mean to me.”
If you’re still reading this, I will go ahead and mention that I do agree with Schaler that court-ordered rehab, especially if it requires attending AA meetings, is a bad idea. His main argument against this stems from the fact that AA emphasizes reliance on a higher power in order to maintain sobriety, which I understand is problematic for atheists and therefore inappropriate for something that’s state-mandated. I’m opposed to it because AA was founded on the idea that a group of addicts comes together for mutual support when they’ve decided they need to change their lives. Being forced into it makes working the program much more difficult.
Finally, I’m grateful to Schaler for citing E.M. Jellinek’s The Disease Concept of Alcoholism, which he characterizes as “the book the popularized the idea of alcoholism as a disease.” I don’t know if that’s the case, but it does provide a fascinating history of the disease concept of alcoholism and its increasing acceptance in contemporary thought, as well as an examination of the implications of implementing that conception for public policy and medical practice. It’s a far more scholarly and nuanced book than Addiction is a Choice and I highly recommend it.
My best understanding of addiction jibes with Paul’s understanding of sin: “For I do not do the good I want, but evil I do not want is what I do. Now if I do what I do not want, it is no longer I that do it, but sin that dwells within me,” (Romans 7:19 & 20, NRSV). That’s the powerlessness AA requires its adherents to acknowledge, and the reason why “Am I an addict?” quizzes often include questions about regret and guilt.
In fact, that aspect of addiction is the reason we consider it a societal problem. Both the addicts and the communities around them spend a lot of time on the question, “Why would you continue to do something that you know has a terrible impact on your life?” And to Schaler’s dismay, the answer comes back, “Because I can’t help it.” To which Schaler screams, “Of course you can! You ‘help it’ every time you stop bending your elbow, even for a few minutes!”
However, the fact that Schaler made me think about things does not excuse the fundamental flaws in this book, listed here in no particular order:
1) Ignoring inconvenient facts. As alluded to above, Schaler makes the bulk of his case around the behavior of addicts, as if the choice to abstain is as easy to make as the choice to partake. This could be a compelling argument, if one were to disregard physical withdrawal symptoms. So that’s what Schaler does. Early in the book he defines the term, mentions its importance to the disease model of addiction, and at one point mentions that the test subjects in a particular study were in “various stages of withdrawal,” but he never grapples with the difficulty of “choosing” a course that causes physical reactions ranging from mild discomfort to pure agony. I believe this is what allows Schaler to treat all forms of chemical dependency (tobacco, alcohol, pot, cocaine, and even heroin) as equally volitional.
2) Bad organization of material. I’m going to assume Addiction is a Choice was put together out of a series of articles or essays. It’s the only explanation I can come up with as to why there’s an appendix at the end of chapter seven in a book containing thirteen chapters.
3) Bad science. The aforementioned appendix contains a survey Schaler used in a study of addiction treatment providers. The instrument consisted of eighteen statements, evenly divided between those applicable to a disease model of addiction and those that fit with a free-will model, that respondents were supposed to answer on a Lickert scale of “Strongly agree” to “Strongly disagree.”
Quoting now from the book: “The highest possible score for each item was 5, and for all 18 items, 90 . . . The strongest possible belief in the free-will model of addiction is represented by a score of 5 for each of the nine free-will items and zero for each of the nine disease-model items (or a total of 45).”
Great, so strongly agreeing with any item nets you 5 points, right? Only a serious yes man would get a score of 90, because he would have to agree with every statement, no matter how contradictory. Therefore, one’s total score on the instrument would be irrelevant for determining which way one leaned in the free-will vs. disease dispute. Not according to Schaler. A note at the bottom of his table of results reiterates, “The highest possible score is 90,” then goes on to say “The higher the score, the stronger the belief in the disease model of addiction. The lower the score, the stronger the belief in the free-will model.” WTF?
There’s also the contention Schaler makes throughout the book that the treatment of alcoholism doesn’t work. I was looking forward to the evidence he would present to support this claim, and so was a little disappointed to find it summed up on page 98: “ . . . if a number of different treatments, dramatically at odds in their assumptions and techniques, achieve the same results, it seems reasonable to conjecture that the zero option, no treatment, will also achieve the same results.” Reasonable to him, maybe.
What’s worse is that the study he’s citing contends that all the treatments studied had excellent outcomes in terms of abstinence or reduction of intake of alcohol. How Schaler gets from there to “treatment doesn’t work,” I’m a little foggy on.
4) An entire subsection entitled How the Cult Attacks Its Critics. Translation: “People are mean to me.”
If you’re still reading this, I will go ahead and mention that I do agree with Schaler that court-ordered rehab, especially if it requires attending AA meetings, is a bad idea. His main argument against this stems from the fact that AA emphasizes reliance on a higher power in order to maintain sobriety, which I understand is problematic for atheists and therefore inappropriate for something that’s state-mandated. I’m opposed to it because AA was founded on the idea that a group of addicts comes together for mutual support when they’ve decided they need to change their lives. Being forced into it makes working the program much more difficult.
Finally, I’m grateful to Schaler for citing E.M. Jellinek’s The Disease Concept of Alcoholism, which he characterizes as “the book the popularized the idea of alcoholism as a disease.” I don’t know if that’s the case, but it does provide a fascinating history of the disease concept of alcoholism and its increasing acceptance in contemporary thought, as well as an examination of the implications of implementing that conception for public policy and medical practice. It’s a far more scholarly and nuanced book than Addiction is a Choice and I highly recommend it.
July 27, 2015
I was a student of Jeff's and I lapped up everything he said when I took his class. With time however, I've realized that his work creates a false dichotomy. While he shows that addiction doesn't meet the disease model, he posits as a binary opposition a right-libertarian notion of choice and free will without at all justifying that as the only possible solution. Brilliant critique, terrible solution
August 19, 2021
I am in almost complete agreeance with Lynn. The general idea of this book, and the fact that it seems to be the only major work in the field of addiction in this separate line of thought, prompts me to give it 2 stars: it really is a sort of pioneering piece.But that doesn't excuse the quality of the book.
Schaler spends a lot of the book making claims that aren't backed up and speaking generally about all the woes he has suffered and about the general bad nature of the "disease model" proponents. There is one chapter that I actually laughed at multiple times, as the whole point was to take a loose definition of a cult and then try to apply it to AA. Listen, I get that AA has its problems, but a cult? Really? It's outlandish and reads more like a "they won't listen to me (and reason which is on my side) so they're a cult" and belongs on 4chan not in a supposedly academic book.
On top of this, something he fails to mention is that to swallow up a lot of his claims and rhetoric, you have to subscribe to what I will call the libertarian religion Schaler seems to be a part of. Schaler is a sort of libertarian to the extreme, where any sort of paternalism seems suspect and we should leave people to their own as their actions are entirely made up of free will. Take that as you will, he is not explicit or upfront about this, and I think it is more than a bit ironic.
As a quick note, I did find it astonishing, as Lynn mentions in her review, that he sweeps the physical symptoms of withdraw under the rug. Sure, maybe those symptoms don't mean that it's an addiction, but surely they are relevant? Surely they should be considered in why we might want to fund "treatment" where we atleast help people manage these symptoms?
Overall I think this is a solidly 2 star book. Being a pioneer on this subject warrants an acceptance of more mistakes than normal, but this book suffers from a great many mistakes that are hard to excuse, even if it is a breakout.
Schaler spends a lot of the book making claims that aren't backed up and speaking generally about all the woes he has suffered and about the general bad nature of the "disease model" proponents. There is one chapter that I actually laughed at multiple times, as the whole point was to take a loose definition of a cult and then try to apply it to AA. Listen, I get that AA has its problems, but a cult? Really? It's outlandish and reads more like a "they won't listen to me (and reason which is on my side) so they're a cult" and belongs on 4chan not in a supposedly academic book.
On top of this, something he fails to mention is that to swallow up a lot of his claims and rhetoric, you have to subscribe to what I will call the libertarian religion Schaler seems to be a part of. Schaler is a sort of libertarian to the extreme, where any sort of paternalism seems suspect and we should leave people to their own as their actions are entirely made up of free will. Take that as you will, he is not explicit or upfront about this, and I think it is more than a bit ironic.
As a quick note, I did find it astonishing, as Lynn mentions in her review, that he sweeps the physical symptoms of withdraw under the rug. Sure, maybe those symptoms don't mean that it's an addiction, but surely they are relevant? Surely they should be considered in why we might want to fund "treatment" where we atleast help people manage these symptoms?
Overall I think this is a solidly 2 star book. Being a pioneer on this subject warrants an acceptance of more mistakes than normal, but this book suffers from a great many mistakes that are hard to excuse, even if it is a breakout.
April 29, 2014
Very good for the most part; discusses well points of science and deeper psychological reasons for substance misuse/abuse/use. Extensive bibliography...not "moralizing", not preachy...actually very empowering vs the "helpless" disease model. Most of the book is great outlay of information, great discussion, and a chapter or two has a tone of "ax to grind", but the whole text flows well and is easy to understand, I would guess, for just about anyone.
December 31, 2020
This book is life-changing
If you think that you have no control over alcohol or drugs, read this book. If AA isn’t for you, then DEFINITELY read this book. I am now confident that I have a choice of what to put in my body—I am not a victim of a fictional disease—I have made some bad choices and this author brilliantly explains the right path to why we choose as we do. There’s no BS.
If you think that you have no control over alcohol or drugs, read this book. If AA isn’t for you, then DEFINITELY read this book. I am now confident that I have a choice of what to put in my body—I am not a victim of a fictional disease—I have made some bad choices and this author brilliantly explains the right path to why we choose as we do. There’s no BS.
December 29, 2007
I took this guy's class when I was at American University. It, and he, changed my life. Haha, that makes it sound like I'm an addict or something! No no, he just changed the way I thought about addiction, public policy, health care, mental health....
The book isn't a pageturner but I would say it is a must-read for anyone who is interested in addiction or mental health.
The book isn't a pageturner but I would say it is a must-read for anyone who is interested in addiction or mental health.
June 20, 2017
The author of this book has challenged me to think in some very different, sometimes uncomfortable, ways about dealing with addiction. I am still struggling with what I have read. I'm not struggling out of disagreement so much as the feeling of looking at something in a very new way that doesn't feel right emotionally yet but makes a lot of sense intellectually.
May 16, 2016
A very interesting book that attacks the disease model of addiction. Overall very well researched. The only complaints I had were that he occasionally tended to drift off into complaining about people who had wronged him in different movements. It isn't that these weren't actual concerns, they just seemed to come from out of nowhere at times. I loved his closing quote:
"Watch The Wizard of Oz, the original version with Judy Garland. Dorothy, the Scarecrow, the Tin Man, and the Lion all symbolize parts of you. You're suffering, in part, because you imagine there is a wizard out there who is eventually going to give you what you think you need-a home, a brain, a heart, and courage. That's all a myth, maya or illusion as the Buddhists would say. There are a few good wizards out there, and I'm lucky to have known some of them. What makes them good therapists is that when you have conversations with them you realize that everything you've ever really been searching for is already within you. The rest is up to you. The more responsibility you take for your own actions the more freedom you take too. You hold your life in your own hands, and what you do with it is your choice." ~Dr. Jeffrey Schaler
"Watch The Wizard of Oz, the original version with Judy Garland. Dorothy, the Scarecrow, the Tin Man, and the Lion all symbolize parts of you. You're suffering, in part, because you imagine there is a wizard out there who is eventually going to give you what you think you need-a home, a brain, a heart, and courage. That's all a myth, maya or illusion as the Buddhists would say. There are a few good wizards out there, and I'm lucky to have known some of them. What makes them good therapists is that when you have conversations with them you realize that everything you've ever really been searching for is already within you. The rest is up to you. The more responsibility you take for your own actions the more freedom you take too. You hold your life in your own hands, and what you do with it is your choice." ~Dr. Jeffrey Schaler
August 15, 2008
One of the reasons I enjoyed this book is it, "breaks the religious/disease model, (1930's Buchmanism/Oxford Groups)."
Excerpt from the book.
Chapter 8, "Busting the Disease Model Cult," begins, "Members of a cult behave like a colony of insects when disturbed. A challenge to the cult's beliefs stirs up a frenzy of activity, directed toward protecting the beliefs and attacking the outsider who has challenged them."
Dr. Schaler calls Alcoholics Anonymous (AA) a religious cult. He writes: "Alexander and Rollins describe how the eight brainwashing techniques employed by the Chinese Communists, identified by Linton, operate in AA. According to Alexander and Rollins, `AA uses all the methods employed by cults.' "
Excerpt from the book.
Chapter 8, "Busting the Disease Model Cult," begins, "Members of a cult behave like a colony of insects when disturbed. A challenge to the cult's beliefs stirs up a frenzy of activity, directed toward protecting the beliefs and attacking the outsider who has challenged them."
Dr. Schaler calls Alcoholics Anonymous (AA) a religious cult. He writes: "Alexander and Rollins describe how the eight brainwashing techniques employed by the Chinese Communists, identified by Linton, operate in AA. According to Alexander and Rollins, `AA uses all the methods employed by cults.' "
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