Addiction: A Choice Or A Disease?

Addiction: A Choice Or A Disease?

Many have exclaimed, “Addiction is NOT a disease — it’s a choice!” A disease, they’ll say, is something that you have no control over; it suddenly afflicts you when you least expect it and wreaks havoc on your life. People don’t do anything to bring about disease in their lives. Addiction, on the other hand, is something that people choose to engage in. No one makes anyone drink their first drink — or any drink thereafter. No one is forced to do drugs at any point in their life, yet drug addicts, they’ll point out, choose to participate in drug-seeking behavior, hang out with other drug addicts, and repeatedly make irrational, counterproductive decisions that invariably result in self-destruction. How can this possibly be tantamount to someone who has a disease that they didn’t ask for?

As I noted in my previous blog entitled Understanding Addiction, addiction takes root in the midbrain — otherwise known as the limbic system. The limbic system is home to what is known as the pleasure pathway — receptor sites that release chemicals that make us feel good when we engage in pleasurable behaviors like eating, sex, playing, etc. What differentiates an alcoholic/addict from a non-addict is the way in which this neural pathway is activated and affected by drugs and alcohol. What causes this is extremely complex, but what is consistently found lies in genetics.

Studies show that between 40 – 60% (DSM V) of the variability in alcoholics comes from parents where at least one has also suffered from alcoholism. When it comes to drug addicts, this variability hovers around 50% (DSM V). These findings were substantiated by countless identical twin studies that showed, despite being adopted into different homes where the environments were nurturing, wholesome, and drug/alcohol free, twins whose biological parents were addicted to alcohol were still more likely to develop alcoholism than others reared in those environments who were not born to such parents. The variances in studies are endless, but the result was the same: genetics play a profound role in addiction. But what does this have to do with it being considered a disease and not a choice?

Let’s look at diabetes, for instance, when we consider the affliction of disease. Diabetes results as a malfunctioning of the pancreas, which produces insulin. Either the body stops producing it altogether or in such low amounts that it is rendered ineffective to take in the nutrients from the food we eat. But what underlies diabetes? Why do people develop it? Well, a scant amount of unfortunate people are born with it or develop it as a child — this is known as Type One diabetes. But the vast majority of people develop Type Two diabetes as adults, which is attributable, in large part, to poor diet and lack of exercise. In other words, unhealthy lifestyle habits are predominately to blame for their disease. As a result, they go to a doctor who tells them to lay off certain fatty foods, start exercising, take a pill or insulin shots, etc. If they comply, they can go on to live good quality lives; if not, their condition will likely worsen, and death may ensue. Are choices involved in their prognosis? Did their lifestyle choices have anything to do with their disease onset? Yet, we don’t demonize and vilify them like we do an alcoholic or drug addict — why?

What I failed to mention in speaking about people who have diabetes is it’s not solely their poor lifestyle habits that doomed them to acquire a deadly disease. Think about it, some of the worst eaters and laziest people we know have never gained weight and will likely never get diabetes, congestive heart failure, high blood pressure, or any other dreadful health affliction — but why? Again, we find ourselves back at the genetics argument. People who are born to parents who have had a history of certain diseases are inherently susceptible to developing those diseases during their lifetime, but the key determinant is one’s lifestyle. The lifestyle choices they make will either stave off the genetic predisposition or allow it to take root and fully manifest.

To compare, in the same way one’s pancreas has changed when diabetes sets in, an addict’s brain chemistry has been permanently altered. In the same way one goes to a doctor and is prescribed insulin and instructed to change lifestyle habits to live more healthily, an addict is prescribed Methadone, Antabuse, Suboxone, etc., and ordered to enter treatment to develop healthier lifestyle habits. In the same way, there is an onset and progression that can lead to death if diabetes not managed well — and so there is with drug and alcohol addiction. With so many similarities and congruency between the two, why do we criminalize one and sympathize with the other? Why do we hold firm that one is a choice that deserves punishment and the other a disease that deserves sympathy?

Understanding Addiction

Understanding Addiction

It’s no secret that most of us in prison (about 80% in fact) have been involved with and/or addicted to drugs and/or alcohol for many years, eventually leading us to where we are today. Many— if not virtually all of us — neglected our familial responsibilities, job obligations, parole or probation requirements, and essentially any expectations one would have for someone who desires to live a quality life in the free world.

For the myriad loved ones who have suffered unspeakable pain as we have continually let them down — most notably our children — while chasing and abusing our drugs of choice, it is often thought that we “chose” drugs and/or alcohol over our loved ones; after all, they’ll say “Why would you do it when you know it’s going to cost you everything?” They’ll reason that anyone can quit anything “if they really want to.” On its surface, this makes perfect sense, but underneath — in the realm of addiction — it’s much more complex.

Without getting too scientific, allow me to make a basic distinction: our rational thoughts (i.e. considering consequences, planning, goal-setting, restraining from instant gratification for delayed gratification, etc.), occur in the prefrontal cortex part of our brain. Addiction, however, manifests in the lower, most primitive part of our brain known as the limbic system. This is where our fight-or-flight system is, where our sexual appetite derives, and where our “pleasure pathway” is located. A hamburger is enjoyable because when we eat it, chemicals in this part of the brain are released, and the connection is made that hamburgers taste good. The next time we see or smell a hamburger, this part of the brain is ignited, and we feel drawn to eat the hamburger. We are inclined to engage in behavior that yields pleasure, thus we have a chemical/neural circuit known as the pleasure pathway.

This primitive part of the brain is where addiction becomes deeply rooted. The chemicals released from drugs and alcohol flood our pleasure pathway and have a very strong impact on the limbic system, but for the person who is more likely to become addicted due to a genetic predisposition, for instance, this reinforcement is much stronger. The reasons we use (i.e. to be more sociable, numb negative feelings, etc.) also factor into our likelihood of becoming addicted. What this reinforcement looks like in the brain of a non-alcoholic person who drinks an alcoholic beverage is, say, only four parts of the limbic system will be affected, whereas the alcoholic who drinks will experience a much stronger effect because nine areas of the brain are affected. Moreover, once the disease (it is a medical disease because 1) it has an onset, 2) it’s progressive, and 3) it can kill) sets in, the addict is triggered in the craving part of the limbic system when they see, smell, or are reminded in some way of their drug of choice. This is tantamount to someone who is very hungry being intensely stimulated when they walk down the street and smell barbecue smoke. Again, the pleasure pathway in the brain is more sensitized to drug and alcohol cues than someone who is not an alcoholic or drug addict.

Back to the rational part of the brain. When our “addicted brain” (limbic system) has been triggered by stimuli, our rational brain is chemically suppressed, severely reducing our capability of making logical decisions. Studies have shown the more emotional we are (taking place in our fight-or-flight system), the less we are able to use our rational brain. Therefore, when we’re angry we often do and say things we later regret. In the same way, when our addiction is ignited, we don’t have full access to our rational brain. Bypassing that liquor store in order to be home to eat dinner with the wife and kids makes all the sense in the world, but the brain chemistry that has been aroused by passing that liquor store makes that decision much more complex. Getting high to avoid stress spurs our brain in a way that makes us ignore any possible consequences that may come tomorrow or next week. Make no mistake, this is not to skirt responsibility or accountability for the damage and harm we’ve caused countless people who love us, but merely a brief explanation into what is underway in the brain that makes decision-making processes for the addict much more complex than the non-addict.

Finding My Purpose In Prison

We’re pleased to introduce a new contributor to our blog, Eric Burnham.

My name is Eric Shawn Burnham. I was born April 21, 1979 in Las Vegas, Nevada, but I grew up in grad-speech-picOregon and California mostly. I came to prison in 2001, and I’ve been at EOCI ever since. 

When I was 21-years-old, I took another man’s life while intoxicated, and I was given a 25-to-life sentence in prison. I deeply regret the actions of my youth, and I’m ashamed of the lifestyle I was living that led to the death of another human being at my hand. But as much as I want to, I cannot change the past. I can use it to shape my future, however.

In 2003 I earned my G.E.D., and in September 2015 I earned a Bachelor of Arts in Counseling, graduating Summa Cum Laude (3.98 GPA). By mid-2017 I will have earned my Master’s degree in Counseling. In addition, I’m accumulating CEUs (Continued Education Units) in order to meet the requirements for state certification as an alcohol & drug counselor. (I’ll still need 4000 hrs. of clinically-supervised counseling after I’m released.) My education is important to me because I’m dedicated to helping young people avoid making the same mistakes I made.

I work as a tutor in the G.E.D. program here at the prison, and I love my job. It doesn’t pay well, but it gives me the opportunity to help young people and practice my skills.

Personal growth, to me, means becoming the person I was designed to be. I’m not too sure where the balance is found between nature and nurture in the formation of my spirit as a unique human being. I do know, however, that I’m just one incarcerated man trying to overcome my past mistakes and make a positive impact on this crazy world. I kind of think that’s what life is all about: taking the bad and using it for good.

Finding My Purpose in Prison by Eric Burnham

Can the prison experience be good? Inmates are crammed into small cells or overcrowded dorms like sardines, surrounded by some of the most difficult personalities on the planet, and ordered around by self-righteous, often power hungry and abusive authority figures. The cramped living quarters are physically uncomfortable. The lack of privacy is emotionally exhausting, and the empty nature of prison friendships is socially unfulfilling. The boredom is mind-numbing. The loneliness can be crushing, and the inflexible power structure imbeds anger into one’s personality. The incarcerated person is completely isolated from loved ones — few things hurt more than knowing your friends and family have moved on without you. Perhaps the hardest pill to swallow, however, is knowing this is all self-inflicted. After all, if you admit it’s your own fault, you are then responsible.

There is no escaping the fact that I’m responsible for an incredible amount of devastation. I’ve brought suffering to my victim, my family, and myself; and I cannot move forward with my life until I acknowledge that. But when I finally realize I am the problem, something miraculous happens: I also realize I can do something about the problem. I find purpose. The time I’m serving in prison becomes an opportunity to change how I view the world, how I treat others, and how I meet my needs. However, I cannot accomplish that on my own. I need God’s help. But if I’m committed to learning how to become a better man, God has promised to help. “And we know that for those who love God, all things work together for good, for those who are called according to his purpose,” (Rom. 8:28).

God is interested in transforming me into an instrument of light, and He will use the difficult experiences of incarceration to bring about changes in me that I cannot completely understand. But I’ve got to do my part. I’ve got to live like I believe it. How I view my situation will determine how I live while I’m here. I am not the victim. The selfishness of my past put me here. But if the selfish deeds of my past led to my present incarceration, what might my present positive actions lead to in the future… if I give my present to Him… on purpose?

Letters From Prison: Frequent Unexplained Deaths

From a prisoner in the Sing Sing facility in New York.

inmate survey

Q: Please indicate issues you would like to see addressed in your facility.

A:  Actually, everything, because management could not run a hot dog cart for a week without going out of business. Clearly they want recidivism. Keep the cells full – just like a hotel needs its rooms full. Sing Sing may be best prison in NYS, but very badly run.

Main problems are health care with ZERO education, prevention, healthy diet, age appropriate care or exercise for older men. We have frequent unexplained deaths of fairly young men. Our pharmacy is very prone to errors. After our Nurse Administrator was “fired” and arrested, they gave her another job in mental health which is technically a different agency. She kept her parking spot! Does it sound like a certain church? Educational opportunities are here only for those who fit profile of 20-25 years, above average IQ, interested in college, and no mental illness. That is about 150 out of 1600. My GED classroom has 20 seats. About 1000+ men need a GED. Obviously, this “does not compute.”

Roughly half the population has substantial mental health problems (on psych meds, zero impulse control, talking to themselves, self-medication / drug abuse, very low intelligence, illiterate in any language). Treatment of mentally ill is overmedication, zero exercise, poor diet and isolation.

For those of us who came to prison with skills and education, the problem is no opportunity to use or maintain skills. Our library is okay for fiction, otherwise zilch. Very old, e.g., vacuum tube electronics and a book on Fortran IV (might be valuable to a collector?). Car books have carburetors and crank windows.

Drug problems are major. Head in the sand about problem because “they” don’t want to explain how drugs can get through a forty-foot-high concrete wall. (Staff, of course.) Only control point is poverty of most prisoners.