If it wasn’t rational, cont’d

PET brain scans show chemical differences in t...
PET brain scans show chemical differences in the brain between addicts and non-addicts. The normal images in the bottom row come from non-addicts; the abnormal images in the top row come from patients with addiction disorders. These PET brain scans show that that addicts have fewer than average dopamine receptors in their brains, so that weaker dopamine signals are sent between cells. (Photo credit: Wikipedia)

Sam Wilkinson responds to the the coverage of Hart’s research (That crack and meth addicts in a lab will decline drugs for money.) and agrees that addiction is rational.

Hart has found the same thing. It isn’t the addicts are powerless; it’s that nothing on the other side of the scale weighs as much as does the benefit of the whatever-is-being-sought. Back on that Sunday in September 2006, nothing on that scale weighed as much as getting blind drunk. My perceived options in that moment were narrow. By artificially increasing the number of options, Hart shows that even the farthest gone can still make what we might be more willing to describe as the rational decision. Where we stumble is in misunderstanding that the desire the use is rational too.

He goes on to give a really wonderful description of addiction.

Addiction is so harrowing a foe because it literally becomes the solution for everything. The mind’s calculator shows the same answer no matter what the problem is. How do I solve an emotionally devastating day? Beer. How do I celebrate a beautiful day? Beer. How do I unwind after a long day? Beer. How do I endure an uncomfortable situation? Beer. How do I…? Beer. The answer is beer. It does not matter what comes after the ellipses. I wrote this several months ago after giving alcohol as a gift. I am more than six years sober and if I don’t pause long enough to think about the answer my brain is giving me, drinking suddenly starts to make an incredible amount of sense. But if I did stop short of that longer consideration, my conclusion wouldn’t be irrational, especially if I’d only thought to consider all of the good things there are about drinking. And there are good things.

I have a few thoughts.

First, I’m not sure Wilkinson and I are so far apart. During educational talks, I sometimes say, “If drugs did for you what they did for me, you’d be an addict too!” So, if he’s saying that a fundamental characteristic of addiction is that there’s something different about the way addicts/alcoholics experience drugs and that this dramatically changes the decisional balance about using, then I’d agree. I’m not sure I’d strenuously argue that this is rational. Sure, there’s an internal logic to it, but that’s only because the equation is rigged by brain dysfunction.

Second, I’m also not sure that I’d argue this means addicts have control. Hart’s experiments demonstrate that addicts have influence over their use, not that they have control–that they can delay their use, not that they can stop because of incentives. Does anyone really question what the addict is going to do with that $20 after the study is over? I mean, if I’m really hungry and you offer me $20 to skip a meal, I might take you up on that. But, eventually, no amount of money is going to be enough to get me to skip a meal. Sure, some people are super-human and have the force of will to starve themselves in the name of a cause, but that seems like a case where the exception proves the rule.

Third, Wilkinson uses his own experience to understand the matter. He’s 31, which means he was in his mid-twenties when he quit. We know that large numbers of people in their late teens and early 20s meet diagnostic criteria for alcohol dependence and that something like 60% of them will “mature out” and moderate or quit without any professional help or involvement in a mutual aid group. I believe strongly that those who mature out and those who have chronic problems have categorically different problems and we need to be very careful using the experience of one group to understand the other. I don’t know the writer and I don’t know which category he falls into, but he certainly fits the maturing out pattern.

Fourth, the degree to which we insist on free will and rationality is striking. Think for a moment about the argument that it’s rational for people to destroy their lives using drugs. We’re willing to twist ourselves in meaningless mental knots, ignore the obvious (like the fact that Hart’s subjects are very likely to use the money they get in these studies on drugs), and ignore the common sense ethical problems (experiments that put addicts up for a week, provide them with drugs and release them with a pocket full of money). All to make it fit into our monoculture.

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