Drug or Alcohol Addiction a Disease or a Character Fault?

The question of the day concerns whether alcohol or drug addiction is entirely involuntary (unconscious) or entirely voluntary (conscious).

In the “Big Book” of Alcoholics Anonymous, the word “consciousness” appears at least twelve times (according to an AA Big Book concordance):

Sometimes the word is used in the context of understanding the need for an intentional, strived for connection with the addicted person’s higher power, as in the God-consciousness religious twelve-step members refer to (found in the Spiritual Awareness appendix), or as in the eleventh of twelve steps we follow, wherein we seek [through prayer/meditation] to gain, maintain, and improve a conscious contact with our higher power (found in the wording of Step 11).

Sometimes the word is used in the context of the acknowledgement of the human’s awareness of the possibilities of addiction rehabilitation, as in (despite the archaic gender-specific wording), “[AA intends to] “Burn the idea into the consciousness of every man that he can get well regardless of anyone” (found in the “Working with Others” chapter).

But sometimes the word is used in pointing to our options as addicts/alcoholics who do nothing or who instead seek recovery, as in the alternatives to “go on to the bitter end, blotting out the consciousness of our intolerable situation as best we could…” or to “accept spiritual help” and get treatment (from the chapter, “There is a Solution”), used to imply that we have an addiction that is beyond our control but we also have control over how we act on or toward that which is beyond our control, as in that “consciousness within” (in the “Bill’s Story” chapter) that we all possess.

In other words, the prevailing belief is that we do have conscious ability to overcome our addiction to drugs or alcohol. This is one side of the debate, persisting against the other side, which holds, conversely, that addiction to alcohol, drugs, or any other gripping substance/tendency is innate, genetically predisposed, and impossible to conquer with mere self-control.  But science has contributed to helping solve the question of addiction, and addiction treatment centers tap into such studies as the following in an effort to provide support using a combined strategy of twelve-step, behaviour-modification approaches that satisfy both sides or theories in the addiction debate.

The Science of Willpower

On one side of the camp are those like renowned social scientist Roy F. Baumeister and New York Times science columnist John Tierney who champion and advise on increasing willpower in their book by the same name.  In Willpower (Penguin Press, 2011), they outline the 1998 experiments by Baumeister that point to the way willpower can be worn down, or, tired out: Given the premise that humans spend about four hours a day resisting some or another temptation, the studies used student “egos”—with the ego being accepted as the seat of control of desires, impulses, passions—and found a phenomenon Baumeister terms “ego depletion”.  The students were tasked with resisting/controlling impulses toward several appeals: they were asked to engage in resisting eating cookies (even while they were hungry); to track a display they found boring (and avoid watching/ignore a comedy playing on the VCR); to write down what they were thinking (while also avoiding thinking about a polar bear); and to suppress emotional responses to the clip of Terms of Endearment (1983) (the scene wherein Emma Horton, played by Debra Winger, is in a hospital bed dying of cancer and one-by-one says goodbye to her kids in a candid, “I think we did a pretty job discussing this, don’t you?” way, as the kids themselves either leave the hospital room sobbing or angry and stifling their pain. 

Immediately after warding off numerous instances of temptation, the students were then given further willpower tasks to which they responded with much more difficulty—showing delays, lapses, and weaknesses when it then came to solving tough puzzles, squeezing a grip, repressing salacious thoughts, etc. 

Thus, as the person with an addiction can relate, it is tough constantly, consciously fighting the urge to drink or use, especially when resistance is down at the end of a stressful day (of fighting off numerous temptations, besides).  But is addiction all that voluntary? Can recovery it be as easy as just saying “no” or just stopping?

The Science of Uncontrolled, Uncontrollable Impulse

Now, while Baumeister and Tierney also prove it possible to build up the willpower “muscle”, on the other side of the camp is the research that points to addiction as impulse alone, as an involuntary sort of blinking response to appealing stimuli. Scientists using fMRI equipment have taken a group of subjects into what they tell them is a study of how colour impacts the human brain.  There, they instead measure subliminal responses to the “smelling” of alcohol.  Introducing a trace amount of alcohol not obviously perceptible, the researchers assessed the part of the brain showing activity upon the nose registering the smell. They detected activity in the amygdala—the organ in the brain that, about the size of an almond (for which the amygdala is named), is seated in the center of the brain in the hypothalamic region of the temporal lobe, where desire, impulse, pleasure, etc. are activated/experienced.  That is, when the participants unwittingly received a smell of the alcohol, the amygdala showed increased activity.

In other words, this tiny part of the brain is located at the site considered responsible for the sympathetic system, what we know as the fight-or-flight system: in the face of fear/threat (or, in the case of drugs/alcohol, in the face of craving), it is this part of the brain which unconsciously responds…, by running away, staying to “fight”, grabbing without thinking, etc.. That is, the research suggests that in such cases, the brain responds without the person voluntarily choosing to respond: or, the brain of the recovering alcoholic in the study was reflexively, not intentionally, responding to alcohol.

The Science of Self-Control

But back on the willpower side of camp, the research stacks up again:

In the same set of studies, researchers, again using the fMRI tool, surveyed for presence or absence of activity in another part of the brain—in the prefrontal cortex, the part of the brain located at the backside of the frontal lobe which is responsible for higher-order thinking.  In the same recovering alcoholics, when the alcohol essence was unconsciously perceived by the amygdala, the prefrontal cortex would become more active—to minimize amygdala activity. 

Conversely, the same experiments were done on individuals not in recovery, and while similar amygdala activity was recorded, there was no increased activity in the prefrontal cortex area of the brains of these subjects.  In other words, in the recovering/recovered alcoholic, the cognitive centers were actively influencing the response to alcohol; in the non-recovering/non-recovered alcoholic, the frontal lobe section was not stepping in to consciously influence the response section. 

In alcohol rehabilitation, it may not matter at the start whether a person can control his/her urges and impulses. It may be accepted that he/she turns over the powerlessness to a power greater than the self (an entity that does have such power, that is) and therefore follows the “Thy will be done” approach.  Or it may be that the person ascribes to the use of conscious control to get and stay clean and/or sober.  Regardless, as they say in the “We Agnostics” section of the Big Book of Alcoholics Anonymous, “The consciousness [emphasis added] of your belief is sure to come to you.”