The reader’s comments are listed in quotes and italics, and my response follows.
Comment 1: “I would like to point out that Mr. Orma is neglecting, probably unintentionally, the biological aspects of addiction and alcoholism…the brain and biochemical processes which accompany alcoholism and addiction are very powerful. One can die from withdrawal to opiates and alcohol…Anyone who drinks or uses certain drugs [the word “excessively” was added later] will eventually have their power stripped. An alcoholic or opiate addict will have to receive drugs to prevent death from withdrawal. This is as powerless as you can get. So the whole point of the diagnosis (insert substance here) dependence as opposed to abuse or intoxication diagnosis is because we acknowledge that the body physiologically changes.”
My response: I did not neglect to mention the biological aspects of addiction and alcoholism. This was not the point of my last article (or of my critique of AA’s 12-Step model). My point was despite the biological effects of alcohol, one still has the power to choose not to ingest it or to stop ingesting it. This commenter provides some good information about the dangers of the biological impact of excessive alcohol use on the body, and how difficult it can be to stop drinking. This is valuable information and could be used to encourage people to stop drinking excessively (however one defines “excessive”). But, the danger here is confusing powerlessness over the effects of alcohol with powerlessness over one’s ability to choose to stop drinking it. I think this distinction gets lost, convoluted, or deliberately distorted (not necessarily by this commenter) when the concept “powerless” is used in the discussion of alcohol or drug abuse/dependence. But, one never loses his power of choice unless he voluntarily (implicitly or explicitly) gives it up.
Let’s define our terms. There’s a difference between being powerless over the effects of a substance we have ingested, and powerless over our choice to ingest the substance in the first (or second, or third, etc.) place. This is something I clearly stated in my previous article: “Alcohol does not have any effect on the body unless you voluntarily pick up the bottle, raise it to your lips, and drink it. The alcohol does not get in there by itself. Once the alcohol is in the body, it’s true you are powerless over its effects. The more you drink, the more it affects your system. If you drink enough you will get intoxicated, blackout, or even die. The question is, do people have power over whether they pick up the bottle or not, and when and how much they drink?” Anything we ingest (alcohol, nicotine, cookies, water, dirt) will have a physiological effect on our system. Once we ingest it, we are powerless to these physiological effects. Having the diagnosis of “alcohol dependence” does not mean losing the power to quit; it means that when one stops ingesting alcohol or reduces the amount ingested, his body will have to adjust to the physiological effects of the alcohol not being in the body anymore (i.e., he will go through withdrawal). This adjustment can be extremely difficult, painful, uncomfortable, and in some cases (as this commenter pointed out) life threatening. But just because doing something (i.e., quitting alcohol) is painful, difficult, uncomfortable, and/or dangerous does not mean it can’t be done. It does not mean one is powerless to make the choice to do what’s necessary to quit, including tolerating pain and discomfort. The most obvious proof of this is that people quit drinking all the time. Everyone knows someone or multiple people who have done it. People that have been drinking heavily for decades suddenly decide to quit drinking and do (the same goes for cigarette smoking and other drugs). Many people do it completely on their own, some seek out support, but ultimately, it is up to the individual to make the choice to stop. And ALL of this takes power. The decision to quit and the mental and physical effort required to quit take power—the power to think and the power to act. If the person is dependent and is concerned about the dangers of quitting, then he can choose to seek out professional or medical help to do it safely. Again, people do this all the time.
Unfortunately, many people in the mental health field fail to make the distinction (with patients and within their own minds) between the biological effects of ingesting a substance and the choice to ingest it (or continue to ingest it) or not. The failure to make this distinction (by error, default, or evasion) causes some health professionals to hold the premise that patients are powerless over their choice to use substances or not. This incorrect premise then gets communicated to their patients (and the public), and it extinguishes their belief that they have control over their choice to drink or not. After all, they’re an “alcoholic,” they have a “disease,” they can’t help it. This sets patients up for failure. It also gives patients the excuse to relapse. I can’t think of a more damaging and unethical message to communicate to patients.
Comment 2: “…And he mentioned cigarettes, nicotine is the ultimate synthetic neurotransmitter, it is a nerve agent used to kill insects and in a high dose cause a sea anomie to ejaculate to death literally…[I]n animal studies an animal will use a substance or direct stimulation of the pleasure center of the brain until death ensues. They will do this neglecting all other biological and sociological needs and/or obligations. This is physical powerlessness. I believe empowerment is very important but there is a difference between having consequences with rational control and a physiological need/desire for a substance…the [animal] studies have been replicated in many different animals, rhesus monkeys, rats, dogs, other rodents such as mice, guinea pigs etc. It really is fascinating. Having said all of the previous, I do believe that humans are capable of higher level thinking and are different from animals; however we do have a snake brain!”
My Response: Although there is a lot of value in animal studies (particularly in medicine), in the field of psychology, we are dealing with the human mind/consciousness, and have to keep in mind that we are not, rats, snakes, insects or sea anemones. We are human beings. What separates human beings from the lower animals is that we have a rational faculty; that is, we can think conceptually while animals only have a perceptual faculty—they do NOT think. Animals act automatically because they are hard-wired to act in a particular way. Human beings are not hard-wired—they have to learn everything through the process of gaining knowledge over time through their perceptual and conceptual faculties (i.e., through the use of their senses and their ability to reason and integrate knowledge).
But, thinking is a CHOICE—It is not automatic. We have to CHOOSE to think using our free will. Animals don’t have that choice—they don’t have free will or the ability to think conceptually. A monkey, rat, or sea anemone does not have the knowledge (or means of acquiring the knowledge) that excessive use of alcohol (or drugs) is damaging to their bodies; and therefore, they will only behave in reaction to the pleasure or pain the substance gives them once they ingest it or it’s been administered to them. If the substance gives them pleasure, they will consume more, even to the point of causing death. The sea anemone (or rat, or monkey) does not think, “That alcohol (or drug) makes me feel good. But, I know if I ingest it in an excessive amount, it could make me feel very sick or cause death. Thus, I will refrain from ingesting it.” Animals do not have this capacity. However, human beings do have the capacity (if we choose to use it) to recognize that even though it feels good to drink alcohol or do drugs (or it provides temporary relief or escape), if we continue to use it excessively, it will cause damage to our bodies and lives, and potentially cause death. So, the only value these animal studies could potentially have is to inform us of the potential biological effects alcohol (and other drugs) could have on our bodies. They can’t tell us how human beings will choose to act when faced with that knowledge.
(Originally appeared on Examiner.com)
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Dr. Steve Orma is a San Francisco-based licensed CBT clinical psychologist, recognized mental health expert, and specialist in the treatment of anxiety, stress, and insomnia.
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