Compulsive choices in addiction?

Is addiction an issue of bad choices or is it a case of biological, compulsive, necessity?

If you know anything about me and my views, you know that I think little of anyone who tries to separate these. I see and talk to people all the time who are stuck in compulsive behavioral patterns but with some education and good helping of supportive tools they can begin to change these patterns and return to normal life.

But then there are those who just don’t seem to ever get better.

The frustration and shame that come along with compulsive, addictive, behavior can be greatBe it lack of motivation, readiness, mental health issues, or a simple case of not having found a good enough reason to stop, these addiction clients can be the most frustrating and the most rewarding to work with. Any victory, no matter how small, with a difficult patient can put a big smile on my face. I love nothing more than to have someone tell me that they’re sending me a very “tough” or “resistant” client only to discover that when they’re with me, neither of these traits is really representative of their personality.

Or maybe it’s just a matter of perception, right?

Life is about choices, and compulsive or addictive behavior is certainly included in that equation. But that doesn’t mean that all choices were created equal. Indeed, all the evidence points towards the conclusion that choices are differently easy or difficult depending on a person’s experience, biology, and environment. In so many animal studies (called conditioned place preference experiments) researchers have shown that exposure to an environment in which drugs are given makes an animal much more likely to spend time there. We’re talking about 3 to 4 exposures at most and animals find it hard to leave – imagine what 3 to 4 years of that kind of exposure can. Self-administration studies (the kind where animals press levers and buttons for drugs) have revealed that animals can go through some pretty lengthy, complicated procedures to get their drugs and that their experience makes them continue pressing for a long time after the drugs have been removed from the equation. If a rat can learn to press one button, wait some time before pressing another, and finally poke his nose in a whole to get a hit, you can bet that people can do the same without needing to resort to explanations about unhealthy family environments. Family environments matter, as do friends, neighborhoods, and cultures – along with neuroscience they all create the picture we end up calling addiction.

As far as I’m concerned, there is no doubt that experience with drugs can lead to reduced self-control over activity that has been linked with drugs. Add triggers and cravings to the mix and the question of some compulsivity in addiction seems moot to me. Still, there is no doubt that compulsive or impulsive behavior can be helped when you’re not approaching the client as if they are somehow flawed but that doesn’t mean they weren’t compulsive in the first place.

Trying to make the picture simpler is like trying to draw a Picasso without being able to sketch a simple bowl of fruit – it might fool those who don’t know much but it’s far from true cubism.

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