The Fantasy of Addiction

I never meant to start an argument about addiction. I had carried my private doubts on the subject around in my head for years, in the “heresy” section where I keep my really risky thoughts. And I don’t recommend disagreeing in public with Hollywood royalty, either, which is how it happened. In such a clash, most people will think you are wrong and Hollywood is right, especially if your opponent is Chandler Bing, the beloved character from Friends. Of course, he wasn’t really Chandler Bing, just an actor called Matthew Perry—but an actor with an entourage so big it filled an entire elevator at the BBC’s new studios in central London where we quarreled.

Our debate wasn’t even supposed to be about addiction. I’d been asked onto the corporation’s grand but faded late-night current affairs show Newsnight to talk about drug courts, one of many stupid ideas suggested by the idea of addiction. I reckoned my main opponent would be the other guest, Baroness (Molly) Meacher, whose name sounds like something out of The Beggar’s Opera. While she looks like the sort of harmless, kindly housewife who knits next to you on the bus, she is in fact a campaigner for the wilder sorts of drug liberalization. If this Chandler Perry wanted to horn in, well and good. Who cared? Yet when I began to sense sarcasm mingled with unearned superiority oozing from the character from Friends, I decided to let my impatience show.

Hence my rash, irreversible plunge into an argument which has been going on ever since, consuming billions of electrons on social media, and which will probably still be going on when I die. I heard myself using the words “the fantasy of addiction.” There. I’d done it. Let the heavens fall.

Chandler Bing called me various names and was even more sarcastic than before. He is extremely good at sarcasm, even if he understands very little about the drug problem. I have never heard the words “your book” pronounced with such eloquent contempt. The final “k” seemed to contain two whole syllables. Is this a Canadian thing? He was referring to my modest volume on the topic The War We Never Fought, so energetically ignored by reviewers and booksellers that it is known among London publishers as The Book They Never Bought.

I took a while to realize what I had done. Only for a moment did I feel that chill in the innards which always follows any sort of dangerous speech. The more I thought about it, the more pleased I became. It was a bit like the long-ago days when I had begun to change my mind about revolutionary socialism. I was wholly liberated. I had found the courage to say what I really thought, and so was more fully human than before.

Words are congealed thought—in some cases, very congealed indeed. Some words are congealed lack of thought. When we use words badly, it is because we are too lazy, or too hurried, to think about what they mean. This is most of the time, which is George Orwell’s greatest point in his matchless essay on “Politics and the English Language.” If the words that come out of your mouth or your keyboard do not make a picture in your mind, then they will certainly be dull and will probably be wrong.

But if we pause to let words unfold and grow, then we understand and use them better—or abandon them, as we abandon clichés and exploded theories.

The chief difficulty with the word “addiction” is the idea that it describes a power greater than the will. If it exists in the way we use it and in the way our legal and medical systems assume it exists, then free will has been abolished. I know there are people who think and argue this is so. But this is not one of those things that can be demonstrated by falsifiable experiment. In the end, the idea that humans do not really have free will is a contentious opinion, not an objective fact.

So to use the word “addiction” is to embrace one side in one of those ancient unresolved debates that cannot be settled this side of the grave. To decline to use it, by contrast, is to accept that all kinds of influences, inheritances, and misfortunes may well operate on us, and propel us towards mistaken, foolish, wrong, and dangerous actions or habits. It is to leave open the question whether we can resist these forces. I am convinced that declining the word “addiction” is both the only honest thing to do, and the only kind and wise thing to do, when we are faced with fellow creatures struggling with harmful habits and desires. It is all very well to relieve someone of the responsibility for such actions, by telling him his body is to blame. But what is that solace worth if he takes it as permission to carry on as before? Once or twice I have managed to explain to a few of my critics that this is what I am saying. But generally they are too furious, or astonished by my sheer nerve, to listen.

So let us approach it another way. The English language belongs to no state or government. It is not ruled by academies or even defined by dictionaries, however good. It operates on a sort of linguistic version of common law, by usage and precedent. And the expression “addiction” is very widely and variously used. There are people who claim, seriously, to be “addicted” to sex or to gambling.

It is now impolite to refer to habitual drunkards. They are “alcoholics,” supposedly suffering from a complaint that is not their fault. The curious variable ambiguity of Alcoholics Anonymous on this point has added to the confusion. AA, to begin with, asked its adherents to admit they had no control over themselves, as a preliminary to giving that power to God. Somehow I suspect that God plays less of a part in modern AA doctrine, but the idea of powerlessness remains. Members of the organization quietly moved from calling alcoholism an “illness” or a “malady” to describing it as a “disease,” round about the time that the medical profession began to do the same thing.

We are ceaselessly told that cigarettes are “addictive.” Most powerfully, most of us believe that the abusers of the illegal drug heroin are “addicted” to it. Once again, the public, the government, and the legal and medical systems are more or less ordered to believe that users of these things are involuntary sufferers. A British celebrity and alleged comedian, Russell Brand, wrote recently, “The mentality and behaviour of drug addicts and alcoholics is wholly irrational until you understand that they are completely powerless [my emphasis] over their addiction and, unless they have structured help, they have no hope.”

Brand is a former heroin abuser who has by now rather famously given up the drug. But how can that be, if what he says about addiction is true? The phrase “wholly irrational” simply cannot withstand the facts of Brand’s own life. It will have to be replaced by something much less emphatic—let us say, “partly irrational.” The same thing happens to the phrase “completely powerless.” Neither the adverb nor the adjective can survive. Nor can the word “addiction” itself, which is visibly evaporating. We have to say “they struggle over their compulsion.”

Or you might turn to this definition of addiction from the American Society of Addiction Medicine:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

This definition prompted one writer at Alternet, an influential pro-addiction website, to say:

If you think addiction is all about booze, drugs, sex, gambling, food and other irresistible vices, think again. And if you believe that a person has a choice whether or not to indulge in an addictive behavior, get over it. . . . Fundamental impairment in the experience of pleasure literally compels the addict to chase the chemical highs produced by substances like drugs and alcohol and obsessive behaviors like sex, food and gambling.

In other words, conscious choice plays little or no role in the actual state of addiction; as a result, a person cannot choose not to be addicted. The most an addict can do is choose not to use the substance or engage in the behavior that reinforces the entire self-destructive reward-circuitry loop. So even if the supposed “addict” ceases (as many do) to be “addicted” in practice to the addictive substance or activity, he remains “addicted” in some spiritual, subjective way, which cannot actually be seen in his behavior.

The defender of the concept of “addiction,” confronted with evidence that many “addicts” cease to be “addicted,” will say that of course he didn’t mean to suggest the phenomenon was wholly irresistible and could not be mastered by will. Oh no, he will say, reasonable people quite understand that it is not like that at all. In any normal argument, this would be the end of the matter. Anyone who confesses to using a word in one sense when it suits him, and in a wholly contradictory sense when it also suits him, has expelled himself from the company of all reasonable people and admitted that he respects neither truth nor logic.

And yet, though he has lost the point, according to the rules, a higher umpire grants him the victory. I am still pestered weekly by peeved and affronted correspondents, with demands that I “prove” that “addiction” does not exist. Like Kipling’s Gods of the Copybook Headings, I limp up to explain it once more: It is the proposer of any such concept who has to provide a testable and falsifiable theorem. But because the existence of “addiction” is assumed, the rules of normal science and discourse are reversed.

The consequences of this usage, in medical practice and law, are huge. Actions once punished or scorned are sympathetically treated as if they arose from diseases rather than choices. Persons repeatedly caught in possession of illegal drugs (a crime that in theory attracts a prison sentence of several years) are not punished according to law, but supplied by the authorities with clean needles, put into the care of doctors, and, in some jurisdictions, given free substitute drugs at the expense of the taxpayer.

It is no longer acceptable to disapprove of certain selfish and inconsiderate actions, some of them illegal. Of these alleged “addictions,” only the smoking of cigarettes is still disparaged by polite liberal-minded persons. This is probably because of its undoubted anti-social stink and foul mess, the huge shared cost of treating smokers for the diseases they voluntarily contract, and the alleged danger to nonsmokers exposed to its fumes.

As a result, huge numbers of supposed cigarette “addicts,” forced out of workplaces and bars and compelled to stand outside in pathetic gaggles, and frowned and coughed at when they light up in the privacy of their homes, have in recent years overcome their “addiction” and stopped smoking altogether. I personally know many such people. Several have been glad of the pressure to stop. It is interesting that the habit (as it used to be called) now tends to be commonest among the hopelessly poor, the ill-educated, and young women driven by fashion into seeking those tricky gifts which cigarettes still offer them—sexual allure and a pleasure that does not make them less thin.

But the fundamental point should not be lost. Supposed “addicts” can and do give up their supposed addictions. It is not only smokers who do this. I also know several formerly very heavy drinkers who have done it, generally because of fears for their health or their professional standing. Even heroin abusers, and gamblers, can and do just stop. Reason has overcome desire. In which case the whole idea of “addiction,” as a power greater than will, is overthrown. Once again, if “addiction” exists, these people cannot exist. If they exist, “addiction” cannot exist. Since we know that such people do exist, the riddle is solved.

Scan the drug abuser’s brain as you will, you will not be able to demonstrate that any part of it has forced him to take his drug of choice, or is stopping him from giving it up. Recently the psychologist and former “addict” Marc Lewis attacked this scientistic determinism in a book The Biology of Desire. Yes, the brain of the drug user changes physically and observably (so, it might be noted, does the brain of the London taxi-driver who must learn by heart the streets of London before being given his license). But this is the sign of an organ adapting to conditions, not a disease. The same brain can go on to adapt to a life without the drug involved, or a life without taxi-driving.

What sustains the continuing belief that “addiction” is a physical disease is presupposition, based upon conventional wisdom, allied with desire. People feel a near-superstitious terror that mere contact with the “addictive” substance is enough to bring ruin. This belief long predates the current era of drug abuse. A character in Somerset Maugham’s The Razor’s Edge, recently rescued from a dissolute life of servitude to substances, is lured back into alcohol-sodden doom by a bottle of Zubrowka bison-grass vodka purposely left on a table by a rival in love. It is absurd. But millions believe that some such process happens. They think, especially, that the merest brush with heroin will imprison its user for life, just as the reformed “alcoholic” will be sent flying down the chute of doom by a single sip of wine or even the whiff of it in a sauce. In the 1975 movie French Connection II, the American narcotics cop “Popeye” Doyle (played by Gene Hackman) is shown being turned into a junkie by repeated forced injections. In the 1996 movie Trainspotting, withdrawal from heroin is portrayed as a nightmarish struggle. Are these fictional arguments, which have left powerful impressions in many minds, truthful?

As for the power of heroin to enslave people against their will and afflict them with terrible withdrawal, I must turn to an author whose book on drugs (unlike mine, so disdained by Chandler Bing) has been a critical and commercial success. This is perhaps because he is largely on the side of decriminalization. Johann Hari’s Chasing the Scream is devastating on the subject of “addiction,” yet what he writes has not gotten him into any trouble at all.

Hari cites the complete blockade of the heroin supply in Vancouver during the 1970s, when supposed “addicts” carried on taking the inert powders that dealers continued to sell for several weeks. They suffered no “withdrawal symptoms.” Hari goes on to quote the medical researchers John Ball and Carl Chambers, who, he says, studied medical literature from 1875 to 1968, and found that nobody had died from heroin withdrawal alone in that time. “The only people who are killed by withdrawal,” Hari says, “are people who are already very weak.” But the myth of addiction requires the myth of withdrawal, a logical consequence of the idea of physiological dependence.

The desire to maximize the effects of “withdrawal” and minimize the effects of long-term abuse also features in the parallel argument about alcohol. Modern medicine, for instance, likes to say that the terrible affliction called delirium tremens is a symptom of “withdrawal” from alcohol. By “withdrawal,” by the way, they do not mean total stoppage, just a reduced intake. But older reference books (the DTs were first described and defined in 1813) clearly attribute DTs to long-term alcohol abuse, not to withdrawal, partial or total, from it. No doubt a total or partial cessation of drinking can bring it on. I would be interested to see any research work showing that people who have not done serious long-term damage to themselves by drinking are susceptible to DTs under any circumstances.

According to research cited by Hari, from The Archives of General Psychiatry, some 20 percent of U.S. soldiers serving in Vietnam had “become addicted to” heroin while there. The study showed that 95 percent of these men had stopped using heroin within a year of returning home. “Treatment” and “rehabilitation” made no difference to this outcome. As Hari writes, “If you believe the theory that drugs hijack your brain and turn you into a chemical slave . . . then this makes no sense.”

Indeed it doesn’t. I could also cite the millions of hospital patients given medical morphine (effectively the same as heroin) during illness or recovery from injury, who do not become dependent upon it. Or I could note the view of Anthony Daniels, who often writes under the pseudonym Theodore Dalrymple. He was for many years a prison doctor, and constantly encountered heroin abusers. He describes their withdrawal symptoms as being similar to a fairly bad bout of influenza.

But it makes little difference. The belief is implanted in the modern mind, taught to the young not by explanation, experiment, and example but by being repeatedly and universally assumed. First of all, it is conventional wisdom, built into thousands of sentences, newspaper articles, TV and radio programs, sermons, speeches, and private conversations. Secondly, it is what we desire. Which of us, indulging in some pleasure, is not secretly relieved to find that others are weaker than we are, have nastier and more selfish pleasures, and that these things are generally excused because of a vast, universal thing that we cannot control or influence? Indulgence, like misery, seeks company for reassurance. Unlike misery, it generally finds that company. Beliefs spread in this way cannot really be challenged. Jonathan Swift rightly observed that you cannot reason a man out of a position he was not reasoned into in the first place.

It was the triumph of the Christian religion that for many centuries it managed to become the unreasoning assumption of almost all, built into every spoken and written word, every song, and every building. It was the disaster of the Christian religion that it assumed this triumph would last forever and outlast everything, and so it was ill equipped to resist the challenge of a rival when it came, in this, the century of the self. The Christian religion had no idea that a new power, which I call selfism, would arise. And, having arisen, selfism has easily shouldered its rival aside. In free competition, how can a faith based upon self-restraint and patience compete with one that pardons, unconditionally and in advance, all the self-indulgences you can think of, and some you cannot? That is what the “addiction” argument is most fundamentally about, and why it is especially distressing to hear Christian voices accepting and promoting it, as if it were merciful to call a man a slave, and treat him as if he had no power to resist. The mass abandonment of cigarettes by a generation of educated people demonstrates that, given responsibility for their actions and blamed for their outcomes, huge numbers of people will give up a bad habit even if it is difficult. Where we have adopted the opposite attitude, and assured abusers that they are not answerable for their actions, we have seen other bad habits grow or remain as common as before. Heroin abuse has not been defeated, the abuse of prescription drugs grows all the time, and heavy drinking is a sad and spreading problem in Britain.

Most of the people who read what I have written here, if they even get to the end, will be angry with me for expressing their own secret doubts, one of the cruellest things you can do to any fellow creature. For we all prefer the easy, comforting falsehood to the awkward truth. But at the same time, we all know exactly what we are doing, and seek with ever-greater zeal to conceal it from ourselves. Has it not been so since the beginning? And has not the greatest danger always been that those charged with the duty of preaching the steep and rugged pathway persuade themselves that weakness is compassion, and that sin can be cured at a clinic, or soothed with a pill? And so falsehood flourishes in great power, like the green bay tree.

Peter Hitchens is a columnist for the Mail on Sunday.