The disease framework, he asserts, is:

...an excuse for people to not take responsibility for their own actions. They [scientists?] say, "Addicts can't control their behavior because of the wiring of the brain and the dopaminergic system, and the amydgala...ect, ect ,ect." (sic)

Are liberal dreamers using scientific findings as an excuse to coddle addicts with blanket exculpation and thereby harm us all?  Engaging Rugged's concern requires a few clarifications:  

First off, evidence for drug addiction's medical pathology is extensive, not scanty. There's not much room for debate about addiction's ability to re-shape motivational and learning brain circuits ("dopaminergic pathways") and to impair in some brains whatever passes for individual autonomy.  Emphasis here on the word "some." What could make Rugged's case is that there are people who are able to recover while others can't; and we don't yet understand entirely what distinguishes one from another.

People who don't consciously control their minute-to-minute decisions---a group that neurobiology suggests includes all of us, still seem to be able to make apparently free choices about what directions to take. If we hold ourselves responsible for our actions, Rugged predicts, we will be more likely to get a grip on self-direction. This is very possibly so, even though it isn't a fully tested hypothesis.

But taking responsibility for one's actions is not always a matter of exerting one's will when it comes to addiction. Weirdly, what AA members do when they surrender to a higher power is to take the issue of willpower off the table. They hand over a will driven by an intoxicant and cluster of toxic habits to an entirely different set of intentions nominally not their own: they adopt an external compass---that of a group, a god, a 12 Step Program. This doesn't work for everyone, but it's worth noting that it seems to work for many. (Paradoxically, AA, the group most ardently pushing the disease metaphor and the insufficiency of individual will, nevertheless counts taking responsibility for your actions among the Twelve Steps." Go figure.)

R.I. also errs in claiming that "science" calls addiction a disease. AA does, as do many of the liberal drug reformers and media chatterers he opposes, but "science" is inclined to describe addiction more as a syndrome---a complex of factors that include not only genetics, early training and neurobiology, but also environmental factors including, provisionally, the sort of social pressures Rugged is eager to see preserved. 

Certainly addiction, meaning serious addiction to illegal substances, is NOT a disease the way measles is a disease, something you catch from a kid on a bus.  Much like smoking-induced emphysema it is the serious medical consequence of risks knowingly, if compulsively cultivated by the victim, or some victims anyway, until the beast gets big enough to tear down the tent.

The threat of moral blame or even legal punishment doesn't appear to deter most committed addicts from using---especially not those behind bars, where drugs are easily obtainable. But lots of abusers of everything from cupcakes to cocaine aren't technically addicts, just hedonic, impulsive, curious, self-centered. We "problem" users are not so addicted that we can't be persuaded to moderate our behavior by social pressures like disapproval ("Junkies lose their humanity!") or fear of consequences ("I'd love to  lose my humanity, but I don't want to end up eating prison food"). We are probably fortunate to have Rugged Individualists around to hold our feet to the fire.

R.I. would be wrong, though, to over-rate the power of public opprobrium to protect the most vulnerable among us from ourselves. A reliable amount of research has shown that addicts are not usually like the rest of us. A majority start out with fewer dopamine receptors than other people, so that their first drug experiences make them feel joy, or even "normal" for the first time. They have what amounts to a structural deficiency, if not a disease, and while hard drugs aren't their best option for treating it, intoxicants are likely to provide the only relief they've ever had and to provide an experience few things can rival and few threats, scowls or sensations of guilt can overshadow.

Could treatment make more sense than punishment for this sort of person? Rugged doesn't think they exist. He continues:

These so called scientists don't take into consideration real men, who drive sledgehammers all day in the heat until their arms feel like they're crawling with fire ants; their hands are blistered and bleeding underneath their gloves, and they keep going, one stoke at a time. If a man can drive a sledgehammer all day in pain, a junkie should be able to hold himself back from taking another hit by means of the same sort of will power despite the shakes, vomiting, and hallucinations.

Hmmm. R.I. seems to think drug addiction is primarily a lack of manhood. He also seems to be equating the ability to quit drugs cold turkey with the ability to stay clean. I hope he (or she)  will take personal responsibility for the fact that neither is accurate.  

Not only are many addicts women (Heidi Fleiss, Sean Young, Lindsay Lohan please raise your hands!), but R.I. has forgotten that many of the men he describes, when not busy sledgehammering are busy geting thoroughly waste-faced.

Self-control, as numerous well-designed experiments suggest, turns out to be a limited resource. It burns a lot of brain glucose. So people who over-use it, often lose it. whether they believe in personal responsibility or not. (we discussed this some in my third column)

I'm sure that the addict whom Mr. Individualist imagines exists---a man whose refusal to quit is based solely on his fear of withdrawal's pain and his unmanly reluctance to endure it. But plenty of junkies have the moral brawn to go through withdrawal. In fact they do it over and over: it's saying "no," all day every day that makes them stumble.

Fans of self-control will, however, be pleased to learn that many scientists have begun to imagine willpower as a muscle that can be strengthened through systematic self-discipline even though it is  depleted by spasmodic use. For example, children who are born with or acquire the ability to defer gratification become addicted less frequently as adults.

But please let the words "less frequently" sink in. The ability to defer gratification isn't evenly distributed. It can, to some extent, be learned, and we can reasonably hold people responsible for doing their best to master themselves. We just can't determine by fiat what that best might be.

 Whether or not any of us has as much free will as we feel we do, or is as individual as our lonely minds assure us we are, holding people responsible for the paths they choose strikes me as a useful delusion most of the time---the way it is useful to call what we see and feel "reality," even though it's at best an amusement park mirror's version of it. That said, there comes a point at which we need to replace our intuitive perception ("Obviously, the sun revolves around the earth,") with better available information, however partial, and I hope that Rugged Individualist will figure out how to do this about addiction, without pulverizing his  moral spine.

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PHOTO CREDIT: Bob R. L. Evans all rights reserved: