This morning, D and I were discussing addiction. We watched a few episodes of "Penn & Teller: Bullshit!" last night, and he said of the one about 12-step programs that he didn't really agree with their stance. Apparently, P & T believe that addiction is not really a disease, because it's a behavior, and therefore you can stop doing it as soon as you really want to. (We didn't watch that particular episode -- he just showed me a quick clip from it -- so that may not be their actual view.) My response was that I wasn't all that sure addiction is a "disease," either; at least, not the way cancer and the flu are diseases. It seemed to me that it's an analogical usage of the word. I argued that if addiction is a disease, then being in debt has to be considered a disease, too: it's a condition that can be caused by some initial poorly considered actions, but once it is brought about, it results in some painful obligations without any ability to directly control them.
In my view, two interesting questions emerged from the discussion:
1. Where is the line between things you can control and things you can't control?
Sometimes this is easy to determine. Arguably, I have control over whether I go running tomorrow, and I don't have control over whether it rains tomorrow. But sometimes there is a gray area, and the location of the line between control and lack of control depends on another factor. For example, you probably can't control a traffic jam making you late for work one morning, but if it happens every morning, then you would be expected to take some control, by either leaving home earlier or finding a new commute option.
If you're depressed, can you control this? People who've been depressed tell me no, but I've been depressed too, and it seems to me that there is some latitude for taking actions that are known to improve this condition, such as to get exercise, have meaningful social contact, and make an effort to smile. The trouble seems to be more a lack of motivation, or perhaps of belief that such tactics could actually work. (You can argue that such lack of motivation/belief is inherent to the condition, and thus uncontrollable, but I would argue that a gradual bootstrapping is still possible.)
"Constructive Living" is a pop philosophy that teaches that people have no control over their feelings, but full control over their actions, so people should learn to use their reason to overcome their emotions and take the actions they know are in their own best interest no matter what desires or inhibitions they might be feeling.
Sometimes I can be very forgetful. I have a few safety mechanisms that I've collected to deal with that tendency at this point in my life, but sometimes I don't implement them correctly or something still distracts me, and I forget something I really didn't want to forget. So do I have control over this? In a way, it's the ultimate example of something you don't have control over: if something is missing from your awareness, how can you be expected to act on it? But I have dealt with blame (from others) during much of my childhood and adolescence for failing to meet obligations. They believed I had control over whether or not I forgot things. Before long, I learned to believe this too, and blame myself for my failure to exercise control whenever I made mistakes. Was this right?
2. Does chemical use change you forever?
One of the founding principles of 12-step programs (as I understand them) is the belief that alcoholics (e.g.) are permanently alcoholics, and their only hope is to avoid drinking completely from the present onward. The implication is that they once had the ability to drink moderately, but now that they've messed up their systems by drinking too much for long enough, their ability to drink moderately is 'ruined' for life. Damien also described the condition of the "dry drunk," someone who has consumed so much alcohol in their lifetime that they retain some of the characteristics of drunkenness (slurred speech, for example) permanently.
So the question is, once you've been addicted to something, can you ever go back to the clean slate? If you've been a smoker, has your body chemistry changed in such a way that you will always crave cigarettes even if you never smoke another one? If you've had an eating disorder, can you ever really heal from that? I have always liked to think so, but maybe that's naive.
Around a week ago, I started consuming caffeine again. I quit caffeinated beverages last fall because I was convinced the caffeine was a major factor in depressive episodes I was having (it seemed to form a long-term pattern). But, since I'd broken down so many other abstinences lately -- I've been having meat and dairy when I've felt like it since starting to date Damien, and also drinking wine and fermented cider with some regularity -- it seemed like a natural thing to try caffeine again too. (Yesterday, we stopped at Espresso Vivace on Broadway for coffee on the way to work ... yum.) I said to Damien, "Let me know if I start to act crazy so I can quit again." I guess we'll see how that goes. But to the point: after the first day or so, the feeling of being caffeinated seemed perfectly normal. It's like I was resuming a prior adaptation, not getting used to something as if for the first time, even though it had been six months since I'd touched the stuff. Since I used caffeine for so many years, it may not be outlandish to think that maybe my body expects it now, and maybe it will never change back.
But still, it seems defeatist to think that just because you've had an addictive relationship with something that you are forever barred from having a healthy relationship with it again. Surely there are ways to control your usage (that do not depend solely on effort and willpower). One thing I do (I was explaining this to Damien, since he prevailed upon me during one shopping trip to buy a tub of ice cream, but I had to explain why I didn't want to) is, as a policy, I never buy things like ice cream or cookies to have in my household. I know that if I buy those things, I will eat them (perhaps even compulsively), and I won't get nearly enough enjoyment out of them to account for the calories. So instead, I make myself think of such things as treats that should only be gotten in single-serving quantities outside the home (like last Tuesday, when we tried to go to Ben & Jerry's Free Cone Day but the line was too long, so we went to Baskin Robbins instead). So, that's a way that I've developed a semi-healthy relationship with something even though I might have been inclined to exhibit compulsive/addictive behaviors toward it, without resorting to complete abstinence. Perhaps that kind of technique doesn't work in extreme cases, but then again, maybe it could work in most others? It seems like a question of framing to me. And perhaps again, motivation.
And what about addictions like gambling, shopping, and the Internet, which don't directly affect brain chemistry? Do these behaviors have the same potential to change our desires and personalities forever? If so, is there any behavior that doesn't have this potential?