From the abstinence-advocation of Bill Wilson and Bill White, to the late Moderation Management founder Audrey Kishline, who rejected the disease theory of alcoholism, it's a hotly contested question: Just how much "choice" does an addict have over their addiction? Can they be held responsible for their actions or do they have an uncontrollable medical disorder?
The answer has important moral, legal, medical and treatment implications, which are not black-and-white.
Audrey Kishline, who tragically hanged herself in 2014, never experienced alcoholic withdrawal symptoms or Delerium Tremens, suggesting that she was never severely alcohol dependent, although she did receive several DUIs, including a terrible collision which killed a man and his young daughter. She came out of prison and resumed "controlled" drinking, This is where the line regarding personal responsibility becomes blurred.
What Do We Know About Addiction?
In truth, most addiction knowledge has so far been either from animal testing (breeding drunk-swilling rats and cocaine-addicted monkeys), educated scientific guesswork based on genetics (promising, but flawed), or from dogma and hearsay. That doesn't mean the conclusions are incorrect, but they are limited in scope. Science is imperfect. And hearsay is just that - it needs to be tested in order to understand its underpinnings, if it can ever be reliably replicated. As we conduct our 'research', numerous addicts have sadly passed away.
In short, we don't know enough.
So What is The Answer?
'Addiction and Choice: Rethinking the Relationship' (eds. Prof Nick Heather and Prof and Gabriel Segal) take a novel and broad-minded approach in their latest book, by including papers from a range of fields, including philosophy, neuroscience, psychiatry and psychology.
Despite many contributors holding different viewpoints, this makes the book a special read for students who can read many behavioural, cognitive, biological and psychological tools at play in addiction. There are also helpful sections for treatment if the reader is already seeing clients.
The Oxford University Press book also includes essays on the implications of perceiving addiction as a matter of choice - including how law, politics, and public perception could be influenced. By allowing free debate, this book is a marked shift into "what if" territory, including several camps of thought, something sorely lacking from most academic tomes about addiction.
This book belongs on the shelf of anyone studying or working with addicts, but most of all those trying to find real solutions to what is now an epidemic. We don't need morse tragic cases like Kishline - and for that to be avoided, we need to come together to understand what addiction really is.
Lead photo courtesy of earl53
Book cover available from the publisher, Oxford University Press