In Addiction Is a Choice, Jeffrey Schaler combines very plausible but now familiar criticisms of Alcoholics Anonymous with an implausible alternative account of addiction. The book contains an odd mixture of theoretical argument with very particular criticism of the actions of individuals in the addiction treatment movement.
Schaler explains what he calls the Disease Model of addiction, which has nine features. These are: (pp 4-5).
- Most addicts do not admit they have a problem.
- Addicts cannot control themselves when they take drugs/alcohol.
- The only solution to addiction is treatment.
- Addiction is an all-or-nothing disease.
- The most important step in overcoming addiction is to acknowledge that you are powerless.
- Complete abstinence, not moderation, is the only way to control addiction.
- Physiology, not psychology, determines whether one person will become addicted.
- The fact the addiction runs in families means that it is a genetic disease.
- People who have been addicts are always in danger of relapsing.
Schaler does a good job of showing that the Disease Model as he has defined it is false on every count. The vital question he needs to address is who actually believes the Disease Model. The most obvious candidates are those who run Alcoholics Anonymous and other 12-Step models of recovery. The major trouble with Schaler’s book is that he tends to assume that anyone who endorses categorizing substance abuse as a mental disorder must therefore agree with the highly problematic Disease Model. But in fact most scientific researchers, psychiatrists, therapists, ethicists, and anyone else familiar with the experimental and sociological literature on addiction know that the tenets of the Disease Model are wrong, but nevertheless see a great deal of value in seeing addiction as a mental disorder. In short, Schaler seems to mislabel his target, and his attack on the psychiatric establishment misses its mark.
Although Schaler’s language is sometimes rather inflammatory – he insists, for example, that Alcoholics Anonymous is a cult – probably the most effective part of his argument is his criticism of the ways courts have forced people into Alcoholics Anonymous when there is very little good evidence that AA is an effective treatment, and there is strong reason to be concerned about the religious elements in AA. This argument is also made, for example, by Peele, Bufe and Brodsky in Resisting 12-Step Coercion, and Ogilvie in Alternatives to Abstinence. But those authors keep their target better defined, and focus on the idea that addicts should not be forced into questionable treatments without confusing the issue by criticizing the use of antidepressant medication for depression, criticizing the fight against the big tobacco companies, or bring up the checkered history of the Moderation Management approach to addiction treatment.
One of Schaler’s most interesting and controversial claims is that no addiction treatment currently available is effective; this includes AA and other 12-step approaches, psychotherapy, moderation management, and controlled drinking. None of these has any better success rate than no-treatment. Schaler argues that most people mature out of addictive behavior as they get older, and there is no evidence that treatment helps them. If this is true, it means that the whole industry of services for addiction treatment is a waste of time and money. There are of course many differing views on the usefulness of treatment for mental disorders more generally, and experts argue over the interpretation of the data. Treatment providers doubtless can cite different studies that point to a more optimistic conclusion, but it’s clear that this is a debate that has still to be settled.
It is worth comparing Schaler’s Addiction Is a Choice with another recent book, Depression Is a Choice, by A. B. Curtiss. Schaler has the advantage of being a far more concise writer than Curtiss, and at least part of his message – the criticism of AA – seems very plausible, while little of Curtiss’ book seems sensible. Both authors tie their views to libertarian ideologies that are far too broad to be plausible. Both authors raise important issues, but their philosophical outlooks are highly problematic. For people looking for solid discussions and criticism of current approaches to addiction treatment, I would recommend Resisting 12-Step Coercion or Alternatives to Abstinence instead; the views of Curtiss and Schaler are too closely tied to antipsychiatry for me to recommend their books to readers looking for useful advice. (I have addressed the claims of Curtiss at length in a different review.) Having said that, for readers who like controversy and are looking for provocative claims that force them to search for replies, Schaler’s Addiction Is a Choice will certainly fit the bill.
Jeffrey Schaler’s Home Page
© 2001 Christian Perring. First Serial Rights.
Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island. He is editor of Metapsychology Online Review. His main research is on philosophical issues in psychiatry. He is especially interested in exploring how philosophers can play a greater role in public life. He is available to give talks on many philosophical or controversial issues in mental health.