Disease vs. Choice -- Neither Is Correct

I was recently struck by part of this entry at Naltrexone Confidential:

I’m talking specifically about the determinism vs. free will argument here -  or, to simplify it,  the “disease vs. choice debate” and The Sinclair Method’s place in it… hence why I’ve found myself being harangued by a number of different individuals about how I shouldn’t be “advocating pills” because alcoholism is just “a choice” and blah, blah, blah.

Yeah.  Some of the "it's a choice" folks are almost as militant as the Steppers.

I can see where they're coming from.  Addiction isn't a disease.  Nobody is literally born an addict.  Some people think they were because they fastened on to alcohol immediately after discovering it, but that's not the same thing.  The only way to develop an addiction is through practice.  Even thought I sought alcohol with great determination almost as soon as I discovered it, that was an immature way of coping with pain rather than a true addiction.  The true addiction came later, gradually, as I trained myself into alcohol-seeking behavior.

If addiction isn't a disease, then what is it?  Some conclude that it must be a choice.  Addicts must be choosing their addiction out of a misguided belief that it's their best option for happiness at that time.  This fits some people's experience in that they either matured out of their addictions or stopped through willpower, but (again) it's not the whole story.  I admire people who decide to ditch an addiction and plow through the cravings and deprivation effect by sheer willpower, but that doesn't mean everyone can do it.  For people whose addictions have progressed far enough, changed lives and determination are often not enough.

Put simply, addiction is conditioned behavior.  We humans are different from rats in many ways, but some things are universal, and that's one of them.  Once we're conditioned to drink heavily on a regular basis, we'll keep doing it until something changes.

That something may be as simple as a realization that this life sucks and we'll do whatever's needed to change it.  For most of us, it isn't.

You know how 6% of ex-smokers quit cold turkey and never go back?  You know how the other 94% point out that they're lucky jerks, and the 6% keep insisting that anyone can do it since they did it themselves?  It's sort of like that.  Anyone who passes through youthful smoking and becomes a "real" smoker is likely to have great difficulty quitting.  That doesn't mean that smoking is a disease, but it sure as heck isn't a simple preference, or even a considered choice for personal happiness.

Alcohol addiction is similar in some ways.  No, it's not a disease.  Yes, it's possible to quit just by knocking it off.  That doesn't mean that everyone will be able to do it.  Many won't.

For those people, the thoroughly conditioned who can't just knock it off because they've decided they want a better life, deconditioning is a rather obvious approach which is too often overlooked.