Phillip Seymour Hoffman did not have choice or free will and neither do you.

Phillip Seymour Hoffman 1967-2014

Phillip Seymour Hoffman 1967-2014

In the wake of the tragic loss of Phillip Seymour Hoffman, a great artist, partner, father, brother, and son, I offer the following facts about the neurological disease of addiction.

The overwhelming majority of adults in the western world have passed through experimental stages in their lives where they have dabbled with some kind of brain altering addictive substance, i.e., cigarettes, alcohol, prescriptionpain killers, ADHD medication, anti-anxiety medication, and yes, even marijuana (save the ‘it’s not addictive” arguments for later, please).  And the overwhelming majority of these adults will emerge from their experiments unscathed, believing that their free will and good choices are what saved them from becoming addicted.

The problem with this thinking is that it is factually incorrect.  In other words, they are all wrong.

What saved them (you) from becoming addicted is that their brains did not respond in the same way that an addict’s brain does. They were born with a resistance to addiction. Their free will and good choices had nothing to do with it.

It is time for all of us who got through unscathed to stop patting ourselves on the back for our genetic good luck, and it is time to stop judging those who were not born with the same good genes as defective.

About Phillip Seymour Hoffman, a relapsing drug addict, you may have had the thoughts, “He knew better.” or “Shame on him for throwing his life away.”

Let’s look at these ideas through the lens of how the brain actually works. Yes, he “knew better.” He ‘knew better’ in the frontal lobes of his brain, where we all execute our better judgment and can make calculations of our behaviors and circumstances based on risk and reward.

Here’s the problem, the activity of our frontal lobes can be shut down by the other parts of our brain when there is significant stress in our body. This comes from what is called the “fight, flight, freeze, or faint” mechanism.

This mechanism in the brain is hard-wired into each of us for survival purposes. It is the part of the brain that puts someone into shock when they have been injured and/or traumatized. It is also the part of the brain that can allow a person to lift a car by themselves if their loved one or someone they care about is in danger.

The brain does not analyze the type of stress it is experiencing, that is, this ‘fight or flight mechanism’ is binary. It functions on a “yes” or “no” basis.  “Yes,” there is enough stress to activate the mechanism or “no,” there is not enough stress to activate the mechanism. Human beings have no control over when this mechanism is activated.

This is how PTSD works. Seemingly innocuous sights, sounds, smells or sensations trigger this brain mechanism even when there is no actual threat to the person. The stress in the body is not even consciously recognizable to the person with PTSD. The brain reacts to the trigger and the person is put into the experience of being threatened without choice or control because the frontal lobes cannot get their signals through. When this mechanism is activated free will and choice become impossible. This is true for each and every human being on the planet, whether we like it or not.

The brain of an addict, Phillip Seymour Hoffman in this case, experiences withdrawal symptoms as stress. And since it operates on a binary system, it does not sort out “good” stress (I’m so sick because I’m kicking heroin-good for me!) from “bad” stress (I’m so sick because I’m kicking heroin I’d better call a doctor). The brain only knows if the stress is present or not and how much stress is present.

When withdrawal symptoms, i.e., physical distress, anxiety caused by emotional stress, etc. reach a certain point in the brain, the brain automatically cuts off the access to the frontal lobes (in a manner of speaking) and begins to direct the body rebalance the stress, to find equilibrium, so that the brain can return to “normal” functioning.

“Normal” functioning to the brain of an addict is defined as having the addictive substance in the body. So while any relapsing addict “knows better,” the addict literally cannot access the part of his brain where his/her better judgment is stored. The addict loses his choice and free will and is at the mercy of his brain which is in extreme stress and working to regain it’s equilibrium, at any cost, i.e., get more of the addictive substance.

The idea of losing choice, of relinquishing free will, is unthinkable to most of us, especially those of us fortunate enough to live in the U.S. where we have so many choices in so many areas of our lives. Also, human consciousness defends heavily against the possibility of ‘no choice’ which is paradoxical considering we each carry a brain mechanism that removes choice, but I digress.

Suffice it to say that according to our brain physiology, choice and no choice are equally important to the survival of the species. The problem is that we humans are only conscious of the importance of choice (and the free will to make those choices).

Over the centuries, mankind has had tremendous difficulty acknowledging and treating brain disorders of all kinds.  And we haven’t made much progress in our supposed “enlightened” age of civil rights either.  Consider this, it was less than 50 years ago that 90+% of those born with Down’s syndrome were institutionalized for life.  Also, in spite of (or maybe because of?) a tremendous increase in the diagnoses of brain disorders in the last 40 years, all but a small percentage of treatment centers and publicly funded programs for treatment have been permanently shut down.

What we have on our hands in the U.S. is a mental health, i.e., brain health, crisis. This is abundantly clear to us every time someone with a serious brain disorder buys an assault rifle. Actually, those instances are but the tip of a gigantic iceberg. And even though we have had great breakthroughs in neuroscience, we are woefully lagging behind in treating people who suffer and offering support to their families.

How did this happen? There are more than a few ways to answer that question. One of the important answers is that we are naturally defensive against the idea that brain disorders which disconnect us from our free will exist. It’s too frightening an idea to consider, so we come up with stories.

A century or more ago our stories revolved around the idea that the person suffering was possessed by demons, and that these demons ran in the family. Perhaps the person’s mother was possessed? May she was a witch? Someone in that family must have sinned and now they are being punished, etc.

It was stories like these that ran so strongly through our cultures that families up until, well now, actually hid loved ones away in mental institutions and even disavowed knowledge or connection to them in order to avoid the stigma that would be placed on the healthy family members also.

We have made some progress, but as Mr. Hoffman’s death painfully points out, not nearly enough. We seem to have compassion and some amount of treatment and support available for those who have schizophrenia, psychosis, delusional disorder, autism, and Downs syndrome.  (It’s not nearly enough treatment and support and the families and loved ones of those with these disorders suffer an enormous amount financially, emotionally, and physically with the burden of lifetime care of those who live with these challenges.)

Outside of these few of the many neurological disorders that exist we lose all compassion and concern for people and their families who are suffering, and we tell a modern day version of the demon possession story about them.

We continue to isolate and reject people suffering from a physiological disorder of the brain and force their families and loved ones to bear the lifetime burden of their care in shame and silence, in 2014, in the wealthiest nation the planet has ever known.

Our stories about these people who look so normal, so successful, on the outside but whose lives come crumbling down upon them or are cut ridiculously short no longer revolve around possession by evil spirits but by a defect in their character (selfish, lazy, greedy, arrogant, gluttonous, apathetic, hedonistic, etc.), a defect in their temperament (evil, violent, narcissistic, vain, eccentric, etc.) or a defect in their judgement or intelligence (immature, moron, idiot, being an a**hole).

In the absence of knowledge about how the brain functions these stories created theories about the causes of these behaviors (moral corruption, low character) and consequences which mirrored our cultural value system (it’s their own fault, they got what they deserved).  Out of our stories came ideas on how to avoid these behaviors (work hard, believe in God, be kind to others), consequences of these behaviors (why goes around comes around, God helps those who help themselves) and systems of support to uphold the implementation of these ideas (church, 12 step, therapy). Sometimes the theories, ideas for correction and the support systems even work, but sadly, not most of the time.

All of the above stories/theories are normal individual and cultural adaptations to the unexplainable. This is how we humans learn and grow. Gratefully, these days few if any people think a person with a phobia has had a spell cast upon him by a witch and now needs an exorcism while the family and neighbors have to find and lynch the witch.

Neither is a person with an addiction suffering from poor character, temperament, or judgment from which he can be cured with hard work, belief in God, attendance at church, 12 step and therapy. (Hang in there, recovered and recovering 12 steppers. I’m on your side. See ** below.)

What we fail to see is  a) how self-serving these old stories are, and b) how ineffective our current treatment modalities are (see #a). Our theories about addiction don’t really exist to explain the illogical behavior of someone who is suffering, but mostly to separate ourselves from that behavior with the assurance that what has happened to that “loser” won’t happen to us. And when the need to distance ourselves from that “loser” is satisfied we don’t bother to fact check our theories. Nor to we bother to notice if the treatment schemas we’ve created even work (they don’t).  Rather good proof that our theories are self-serving, don’t you think?

We also fail to notice the fear and sadness that comes up for us when we hear of the tragedies that befall those with high-functioning neurological disorders, especially now. It’s 2014 and tragedies like the death of Phillip Seymour Hoffman have been happening steadily for 40+ years, with no end and no answer in sight. In light of this kind of repetitive hopelessness we are left with little choice but to blame the victims in order to soothe ourselves. And it is difficult, if not impossible to create solutions in the presence of hopelessness.

The mental health/brain disorder crisis we are facing right now, this decades-long epidemic, is with the so-called high-functioning neurological disorders, i.e., depression, anxiety, bi-polar, ocd, anorexia, bulimia, and addiction (I have left out more than a few of the disorders, but these are the most familiar of the lot).

However, neuroscience is offering us the best reason to hope for good treatment outcomes in decades. The more we learn about how the brain works (like when the fight/flight mechanism is activated) and how it works when it is “broken” (fight/flight mechanism too easily triggered in addicts) the easier it will be for people who have these brain glitches to be identified and treated without shame and blame.

The first, most effective way to face our cultural crises of too many people with brain disorders being undiagnosed and untreated is to educate ourselves about these disorders and learn to spot the people who are suffering so that we can help them understand what is wrong with them and help them to agree to receive treatment.  We have to change our cultural view of addiction and the like before we can create more effective treatments for it and the other high-functioning neural disorders.

The change has to come from those of us who either do not have the disorders or have been successfully treated for the disorders because those with the disorders are not able to help themselves.

I like to say it this way, the last person to know that his brain is broken is the person with the broken brain.

This is just the way human consciousness works.  The only organ in the body that seems to make self-diagnosis impossible is the brain. I mean there is no mistaking a kidney stone trying to pass. When someone is in that kind of pain they don’t blame it on their lack of character. But the brain is expert at being able to reframe and explain away its own glitches.

Whatever isn’t working in a person’s brain is that person’s “normal.”  Over time people with high-functioning neurological disorders develop plausible explanations for their symptoms and adapt to them as best as they can.

And when life problems that are obviously (to those around them) connected to their neurological disorders become apparent on the outside of their lives (car accidents, drained bank accounts, lost jobs, broken marriages, etc.) they usually blame their own character defects or someone or something else. Therefore, the person with the problem is the least likely to be able to get themselves the help they need.

The way to begin to help people like Phillip Seymour Hoffman (deceased-drug addiction), actor Cory Monteith (deceased-drug addiction), singer Amy Winehouse (deceased-alcoholism), author David Foster Wallace (deceased-depression),actor Jon Hamm (depression), TV personality Nicole Richie (anorexia), actress Karla Alvarez (deceased-anorexia/bulimia), actress Amanda Byne (bi-polar disorder), actor Howie Mandel (ocd) , reality TV star Vinnie Guadagnino (anxiety disorder),  actress Brooke Shields (postpartum depression) is to become educated about the physiological causes of these disorders so that when you see the behaviors in friends and loved ones you can begin to educate and support them.

Here is where the education begins, when otherwise high functioning people think and act in ways that defy facts and logic and threaten their well-being and the well-being of their loved ones, then we need to understand that they have a brain disorder, not a moral or character disorder; and they need medical treatment, not shaming, blaming, therapy or a sentence to a 12 step program.

This means that alcoholism, drug addiction, eating disorders, suicide attempts, phobias, adhd, anxiety and depression, et al are all disorders of the brain and as such need the treatment of a medical doctor first.

(Read that again. It’s a truth, not a theory. But since the truth is not widely known it will seem counter intuitive. You will want to say, “Yeah, but…..” Read it again. Alcoholism is a brain disorder. Drug addiction is a brain disorder. Let it sink in.)

Here’s why this is true–otherwise high functioning people could not be high functioning without good judgment, good enough character, and at least average intelligence.  If they can hold down a job, go about the activities of daily living, have friendships and loved ones, and display empathy towards others before and during their lapses, melt downs, relapses, et al.,  then their frontal lobes are fully functioning.

The only explanation, for their behaviors then, is that their frontal lobes (where their high-functioning skills are located) have been hijacked by a different part of their brain.  When someone’s brain is highjacking their frontal lobes, they need medical treatment.

Blessedly, neuroscience is catching up with us and giving us facts about how our brains actually work.  So it is time NOW to drop those stories we have made up and begin to apply the facts of neuroscience as we understand them to the untimely deaths of addicts of all kinds and to the public meltdowns of otherwise functioning adults.

And it is way past time that we spread the word about what is really going on with these people who struggle mightily and their families who bear the burden of loving them and having to care for them.

Remember, these people don’t know that their brains are broken.  They are high-functioning and so they blame themselves. And they come to hate themselves for their problems more than you can imagine.  They live in a dark and self-loathing world where they come to believe that they don’t deserve any help which is why they don’t surrender themselves for treatment. They need the help of their friends and families and the world around them in order to get around the obstacles of their broken brains to get help.

When our entire culture understands as common sense that addiction is an individual neurological disorder that requires immediate medical attention then a person like Phillip Seymour Hoffman has a chance to understand that he has “one of those brains” that will shut down his frontal lobes and take away his ability to exercise good judgement and control of his behaviors.  And until he knows this fact about his brain in same the way that he knows a bone sticking out of his leg means he needs to go to the ER, then him and those like him will not be able to ask for help.

And a guy like Phillip Seymour Hoffman isn’t going to know these things until we all know them.  And that time is NOW.

Phillip Seymour Hoffman died from having a combination of sensitivities in his neural wiring that caused his brain to override his better judgement, take away his free will and caused him to take the actions that ultimately killed him. It appears that these sensitivities were unknowingly activated by a prescription of pain killers that were necessary at the time to treat a different medical condition.  Because of his previous 23 years of being clean and sober he was presumed  safe to take the pain medication. And it looks like what he and maybe even his doctors didn’t know about how his brain worked kept him from staying in treatment long enough to allow his brain to rewire itself around those sensitivities and render him clean and sober again. For this, like all addicts in this situation, he deserves our kindness and compassion.

If this post has helped you to understand addiction please do share it.  My passion is to help educate us all so that more people with neurological disorders will get the treatment they need.

Debbie Bayer, MA, MFTI

**A note to my 12-step friends:  There are two caveats to the success of 12-step work 1) It works when you work it. and 2) You have to be honest, and some people are constitutionally incapable of being honest with themselves.  There is no doubt that over the last 70+ years the 12-step community has the highest success rate among alcoholics of any other treatment modality. This community is also incredibly successful in the support of sobriety among drug addicts of all kinds.
The problem lies in the millions of people who cannot meet the two criteria for success in a 12-step program due to other types of brain disorders.  Their suffering demands that health professionals continue to seek out effective treatment strategies for them.  I am certain that you have compassion for their plight and support these more unfortunate folks in their recovery.
DB
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1,498 thoughts on “Phillip Seymour Hoffman did not have choice or free will and neither do you.

  1. Excellent blog; I also strongly agree with you in regard to your clearly written, thoughtful, educated opinion regarding the nueroscientific model of brain ‘dis’-orders & I can certainly tell you have done significant research on the complexities of addiction & other mental illness. I am glad you did not bombard us with stats & empirical data, as it was refreshing to simply read your ‘thoughts & opinions’, not clouded with reference to facts & figures, etc. especially as it seems you have written this blog from your heart and mind, not meant to be evaluated as a dissertation, as some of your readers seem to imply!!
    Thank you for sharing & I will be most honored to also share with others in the MH Community as I think you are ‘spot on’!!
    : )

    • I disagree..the article is all moot..because the addict makes a choice to acquire the decease when he tries heroin for the first time. If he then becomes addicted, it was his/her choice in the first place..Also, the danger is there to die the first time you try this drug and everyone knows this..Phil Hoffman loved heroin more than he loved himself, his partner, his children and his career. He made his own choice to become addicted..sad..but true.

      • Nice of you to pass judgement; it is really a shame that you didn’t read the article and just paid “eye-service” to it. Perhaps you have children-perhaps you do not. I hope, should you do, that your children do not become addicted to any substance(s) because no matter the addiction, according to you, they will love it more than they love themselves. That there tells me you learned nothing from this article and live in the world of public opinion. Too bad–you really could have learned something worthwhile.

      • I feel like I’m repeating myself because there’s so many silly comments like yours on this thread. Anyways, addiction is not something you “catch” by taking a drug for the first time. It’s there before the drug is taken. The brain of an addict is vulnerable even BEFORE the first drug is taken. Look at it this way, if there were no drugs or alcohol on this earth the disease would still be there, it would just manifest in different ways. Using drugs and/or alcohol is only a SYMPTOM of the disease, and symptoms come in all shapes and sizes. Addiction is much deeper than the mere ingestion of a drug or alcohol.

      • With all due respect, but being someone to whom English is a foreign language I am not sure how your confusion of ‘disease’ and ‘decease’ and apparent struggle with interpunction should be weighed in on the solidity of the argument you’re trying to make.

      • This has nothing to do with my having children or not..if I did have children, I would believe the same thing..if they tried heroin and got addicted, THEY did this to themselves…I do have compassion for drug addicted people..it’s almost because the joke’s on them..”just wanted to try it once”..and that’s the end…very, very sad..but no one is responsible except for the person who made the bad choice to begin with. Period.

  2. This is not entirely true either,like alcoolism,physiological brain Traits are aquired by long term consumption and are not passed down the child. this is biased generalisation that avoids one the biggest denominators in long term
    addiction, and thats is the Abuse and traumatic experiences of young people
    mental disorders that tend to mystify logical brain functions (culting processes)
    and lower than average intelligence.The biggest aid towards Addiction is Psyco -pathological, it litteraly lies in how we lay the founded use of our brains,and not realy its physiological disposition!

  3. A disease is something you get, an addiction is something you choose…You choose which drug you want to take, then a percentage will get the disease…
    Let those who have never taken a drug to relieve anything
    (prescription or street) be the first to cast a stone….

    • Lmao! The disease of addiction is already there BEFORE the drug is taken. The drug doesn’t CAUSE it. If drugs and alcohol didn’t exist in this world the addiction would manifest in other ways. I’m sorry man, I’m not trying to embarrass you, but you should really think about what you’re saying before you say it.

      • why are you laughing? Your assertion is a fallacy. Addiction is a pyschological disorder, not a physical one. Addicts are made, not born. There is no hard evidence to suggest otherwise, there is only theory.

      • Please clarify your position. Are you really saying that people aren’t born with psychological disorders? What about autism, child-onset schizophrenia, Asperger’s, obsessive-compulsive disorder. The list goes on and on. The brain is no different than the body in terms of susceptibility to congenital disorders. I’m not sure if you’re confused or you just misspoke.

  4. Just seen this posted on Facebook and thought it would be appropriate for this thread :

    “When you repeat a mistake, it is not a mistake any more…. It is a decision.” ~ ~ ~ Paolo Coelho

    As an addict in recovery (3 years) I can honestly say that choosing to seek recovery has been the best decision that I have ever made. It had to get pretty bad for me before I made the decision, but having done so the results have been amazing. For anyone interested, I have recently published a book called ‘Far More Than We Think’ which sets out my understanding of how recovery worked for me. I am not saying that I am right but I can say that it makes sense to me.

    Best wishes to all addicts out there, both still active and those in recovery. We can all beat this thing once we choose to accept the problem and take the action needed to recover.

    • Interesting standpoint indeed.

      First of all, congratulations on 3 years clean/sober/abstinent. 🙂

      So do tell, all these years when you unexplainably found yourself stuffing food in your mouth again even though you were full / having yet another beer even though you were still hungover from the night before / sleeping with yet another woman even though you knew how terrible it would make you feel afterwards… or whatever it is you’re recovering from … it was just wrong choices? Like choosing to wear a red sweater versus a blue sweater? Or going left at the intersection raither than right? That’s quite a puzzling idea to me: If it was just wrong choices even though you were present to the repercussions, where didn’t you chose to stop earlier?

      • Good question ! It was alcohol for me. Looking back I was clearly in denial. I knew that it was a problem but didn’t want to face the fear of stopping, because it was a crutch and my way of coping with life. My experience of addiction is that it got worse over time until the point where I was desperate enough to do something about it. In reality I had the choice to seek recovery all along but chose to ignore the fact that I had such a choice. It may be different for others, but for me the fear and misery of continuing to drink eventually outweighed the fear of stopping and hence recovery became the more attractive option.

  5. My dad’s father was a raging alcoholic. My dad inherited his addictive tendencies, but fear of turning out like his father kept him from trying anything heavy. Instead, he has been addicted to coffee, soda, food, sleeping. He had free will even with his “addict gene.” My brother has struggled with drugs and alcohol since he was a teen. He used to say that he couldn’t help it because of his genes, and so he was never willing to take personal responsibility. Guess what? He is now clean and sober. He got to a place where he CHOSE a different path for himself. Is it harder for him to stay clean than someone who doesn’t have the addiction gene? Absolutely! Does that mean it’s not possible and he has no choice? Nope! That’s just a cop-out.

    • Oh, I am also a psych nurse at a rehab facility. Many patients repeat treatment. I KNOW that it is harder for people with certain genetic material and brain wiring to get and stay clean. I also know, though, that it is possible if you set yourself up to succeed (which required a good support system). Just as an over eater may require food to be restricted because they don’t have the willpower to refrain from those bad habits, a drug addict can facilitate success, too. It just can’t be dependent on willpower- or free will- to always make the good choice. For many, the choice just needs to be taken away by making it inaccessible.

  6. Thank you, thank you, thank you for your words. I am 62 and have lived with panic disorder since I was 18. During my marriage I was shamed because I wasn’t behaving! My daughter is 27 and has it too, along with postpartum depression, she was shamed by her husband, who of course I wanted to smack! For years I thought I was the only one with panic, I thought I was crazy. In the 70’s the Dr’s thought I was crazy! We are good people, just wired a bit haywire!! I will share your words over & over!!!!

  7. Thank you for this. I’m a 20 year old, physically healthy student and have been diagnosed with PTSD. I have been a swimmer and runner my whole life, but for the past year I haven’t been able to exercise because of a cigarette addiction. Although this article can’t fix my disorder, it reminds me that I can’t feel guilty if I ever want to be more than my disorder. I hope this helps other people with PTSD also.

    • This is the most ridiculous statement I have ever heard..you can’t exersice because you smoke! STOP smoking sister..buck up and go for a run!

  8. As a counselor, I find this article very interesting. Many valuable points and interesting new perspectives on addiction, the brain and the human condition. What I am wondering is, how will the medical model, or medicine actually TREAT this condition? You mention neuroscience, but how will this help and in what way? I suppose your article is a step in a certain direction, but I am left wondering, now what?

    • There are many ways to treat the brain based on neuroscience. Dr Daniel Amen is a great source for beginning to research. As far as I can tell, any approach grounded in study and knowledge of the brain will lead to better outcomes for recovery than any other treatment options.

  9. Thank you for this piece which concisely brings all the elements into play. It’s a public service. I stopped reading most of the comments because so many choose to misunderstand what you’ve so sublimely said. Thanks again.

    • I continue to try to read the comments to remind myself what I’m up against as I go forth working to find treatment options that are based on and include neuroscience. In so many ways, this article and all the comments have been so valuable! Bless everyone of us~

  10. I think the whole idea of determinism is you always do feel like you are actively making a choice. I believe choice is much more passive than we think. Instead of free will perhaps we have what Sam Harris calls it “firm will”. People often use the example of picking coffee over tea or Pepsi over Coke as an example of free will and choice. This is flawed logic in the sense that yes, you can choose to have coffee over tea in the morning but which one do you like better? Why do you like it better? In the end, you don’t choose your choice. If you like Coke better than Pepsi, maybe its because you don’t like things with too much sugar in them, perhaps you like more carbonation in your soda but again, you didn’t actively choose to like or dislike those things, you just do. When an addict seeks recovery and it might be a much more complicated decisions of hormones and enzymes and chemicals in your brain and body creating an environment that finally makes recovery possible.

  11. here is the one thing the article did NOT mention,,, he DID have a choice as to whether or not to use to the FIRST time,, he DID know the dangers of heroin, he DID know the consequences and he DID so of his own volition…

    this isnt some guy who got into a horrible accident, and got hooked on painkillers… he KNOWINGLY took a drug that he KNEW was going to become an addiction. Heroin affects everyone the same.. once you take it,., you;re hooked… there is no such thing as a ” recreational” heroin user….

    sorry if it’s harsh… great actor.. great guy… but, there is something called PERSONAL RESPONSIBILITY. Addictions do not manifest, unless you actually take the substance in question….

    • You are another one who didn’t read the article and are just paying it “eye-service.” If you’re just here to be a dumb sheep, then go. The rest of us are genuinely interested in trying to learn how to help those who are addicted break the chains of any type of addiction. People like you coming in and bleating “CHOICE CHOICE CHOICE” don’t help whatsoever and are the ones who know absolutely zero about the neuroscience of addiction yet think you know everything. You think you sound so knowledgable, yet you really know nothing about addicts or their choice of substances or addiction in families. If that statement you made was all you had to contribute, you were better off keeping it to yourself than sharing it here, where a lot of us are trying to stay current with neuroscience and the way it affects addicts.

    • Dave, have you ever made any bad choices in your life? You write as if you have a monopoly on personal responsibility. Look, the brain of an addict is different chemically, anatomically, and histologically speaking from a “normal” brain. The addict’s brain experiences stimuli (triggers) that puts the mind in a state of craving. Sometimes the addict can overcome said craving and sometimes they can’t. There are so many variations that go into the equation, but for whatever reason the craving can be so strong that it’s not an exaggeration to say the addict is left helpless. It has everything to do with brain physiology, and NOTHING to do with personal responsibility. I wouldn’t expect you to understand or agree with this because you’re (probably) not a neuroscientist or an addict and you’re left with the impression that we all have the same willpower when it comes to making (or not making) bad choices (as if all humans have the exact same life experiences and genetic make-up). Addiction is a complex issue and it’s easy to reduce it to a matter of personal responsibility but that’s simply not the case. I recommend you read some academic journals on addiction and brain physiology, and try to do so with an objective mind.

  12. Yes he had a choice! I am an addictions professional . Telling people they do not have a coice, imho, fuels their addiction and makes them not take responsibility for their actions

    • Before the choice to get better comes the awareness that something isn’t right. As an addictions professional you are well aware that the awareness that something isn’t right comes long after thousands of wrong choices have been made under the wrong assumption that self-destructive behavior is perfectly normal.

  13. I don’t have to read any of this. The reason being, he had free will before he was addicted and he chose to place himself in the circumstance to be addicted to drugs. Hence his free will still caused the core problem of being addicted in the first place. Also , to assume he only bought drugs when he was in withdrawals and his frontal lobe was shut down by his stress response is outrageous. This dude wasn’t a homeless guy that had to wait a day of withdrawals to make 20$ dollars to pick up his drugs; he is a millionaire that can most likely make sure he always has enough and rarely experiences withdrawals. Therefore he would not experience this negative augmentation of the frontal lobe that you say is caused by withdrawals. I say this is blatantly invalid based off the FACT that you do not know Philip’s habits and brain inside and out.

    • Well said Jake! Adiction is the end result of a bad choice not the tragedy of society. I have no sympathy for someone who dies as a result of a choice. It’s a shame that an actor of his caliper had to kill himself and cause the rest of the world to live without his talent. If you are one who blames the addiction on this then you are someone who doesn’t take responsibility for your own actions.

      • Perhaps your assertion that addiction is the result of bad choice would be more credible if you could differentiate between caliper and caliber. If you are not an addict, you have little idea of addiction’s fatal attraction.

      • You are basing this on what? Show me the science that proves addiction is a matter of personal responsibility. Until you can show me something of this nature I’m just gonna laugh at your silly anecdotal comments. There’s evidence galore that addiction has nothing to do with personal responsibility and everything to do with brain physiology. Just because you wish it were a matter of personal responsibility doesn’t make it true. If the evidence showed that, I would be arguing your point with you…but it doesn’t. Now, stop believing what you want to believe and do some research.

      • I too have no sympathy! No sympathy for someone who renders himself a fool as a result of chosing to make a bold statement but choses to do so using absurd spelling. Bad spelling is the end result of a bad choice and not the tragedy of society!

  14. Dear Blogger, Please indicate that this is your opinion and not based on science of any kind. I appreciate your thoughts, but as an adult child of an alcoholic/addict who has relapsed more times than I can count, your article sounds a bit like my parent when she is physically but not emotionally sober. Some of the things you ask loved ones to do sound more like enabling to me. In my circumstance the safety of myself and my children has been at risk and sometimes the only thing you can do for a loved one is let go and hope they find the strength and courage to seek sobriety on their own. I do believe there is sort of chemical imbalance that leaves some people with the inability to cope with things in their lives. Regardless of who, what, why, when, where or how, a person is still required to take responsibility for themselves and their actions.

    • JC, it’s your opinion that it’s not based on science because you haven’t researched it yet. Go do the research and find out for yourself that this blogger has written on a valid, science-based subject. Basing opinions on your own experience is not science.

      • Actually, reaching a conclusion based on experience (which are observations) is, by definition, science. I appreciate the point you’re making in your article, and agree to certain aspects of your position, but if you’re going to use the word “science” as a blanket defense against rebuttal, you’re not being very scientific.

        I think the counterclaim you’re fighting to dismiss isn’t that addiction is a choice, it’s more that addiction isn’t a boolean condition. One hit on a crack pipe doesn’t instantly turn someone into an addict any more than going one day without feeding the addiction means they’re cured of it.

        Addiction, like most things in life, is a process, and at some point along the road, there was an opportunity to be fully cognizant of the repercussions of continuing theaddictive behavior AND have enough control over their faculties to make a decision in their own best interest.

      • Bah… I got my people mixed up. I saw some other comments of yours and my brain decided you were the blog author. Sorry about that gaffe.

    • I am sorry about your struggle with your addicted mother. What you learn in ACA is centered around the problems of the – well guess – child of the addict, nothing much is said about coping with addiction itself. Even the AA book is archaic when it comes to explanatory models about addictive behavior. And while this blog post may be written quick and dirty, it covers the science of addiction quite well.

  15. Did Phillip Seymour Hoffman Really Have a Choice? | Paul Andersen

  16. Addicts Have No Free Will? | the Grace Apparatus

  17. Its been in the last 20 yrs with the advent of spect exams where we can actually see where blood goes in the brain, that our understanding of the neurological underpinnings of most mental disorders are understood. The only issue I would like to address to a brilliant article is the damage addiction does to blood flow to the pre-frontal cortex of the brain. In other words, if blood is not flowing to the pre-frontal cortex that person does not even have access to that part of the brain responsible for impulse control, executive functions like judgment ,attention span and decision capability. The brain of a person with an addiction as seen through a spect exam shows multiple holes in the brain where blood is not going. We can also show this same person what their brain will look like after a year of abstinence. All the holes are filled in, not all the way back to the original picture of the brain prior to the addiction but clearly impressive enough for anyone without too much brain damage to recognize the benefits of abstinence. We can also show the beneficial effects on the brain of various therapeutic treatments including medication. The unfortunate aspect of spect is most insurance or government programs will not pay for treatment involving this technology. But if you would like more information of how you can still benefit from this technology, I would encourage you to read any book by Daniel G. Amen, M.D. Having worked in numerous Community Mental Center as an outpatient therapist for 18 yrs, he provided for me a quantum leap forward in our understanding of addiction and mental illness.

  18. This looks like very pieced together information, but taken out of context of what previous authors have intended. There are no references given to back up these claims and, being in the research community, this is leading people to the wrong conclusions. People are not born addicted unless their mother is drug addicted when carrying them. This is not to say some cannot be genetically prone to it, but it does not mean they are automatically addicted, or alcoholic for that matter. Please, readers, take heed when reading, and consider that empirical research is available and several studies should be considered before making decisions on these topics.

    • It’s very unsettling to know that we have researchers out there like yourself who suffer from subjectivism and clearly lack an understanding in addiction. First of all, this is a BLOG. The author writes for friends–and friends of friends–and generally doesn’t get more than a hundred views. It’s annoyingly pedantic to expect her to cite references in this context. Sure, maybe you didn’t know this and maybe you don’t know what a blog is. Well, if that’s the case then shouldn’t you leave silly comments about references out? Now, about addiction. Did you honestly think she was trying to sell the claim that addicts are born actively addicted to a particular substance? I can’t believe you insinuated this. No, what we say is that people are born with an addictive brain which leads to addiction. I don’t even like the word addiction because it makes people like yourself focus too much on the actual ingestion of drugs and alcohol. Even if an “addict” lived in a reality where drugs and alcohol didn’t exist, their disease would manifest in other ways. The actual ingestion of the drug is only a SYMPTOM of the disease. And we all know there can be a variety of symptoms for any disease. Stop focusing on the symptom and look at the underlying problem. I can’t help but think you were lying about being a researcher because your comment just seems to simple and reductionist for someone with a researcher’s mind. But who knows…

  19. A master’s level intern with a lofty treatise? Slam 12 steps then vindicate them with am asterisked comment? Shame on you. LH, Psy.M.

      • Who the hell leaves their credentials after a such an immature and pompous comment. Better yet, who leaves their credentials at all in the comment section of a blog? Aren’t you embarrassed? Leads me to believe you are completely full of sh*t.

      • Dammit, my previous comment wasn’t intended for you. Sorry. It was intended for the credential wielding impostor.

    • You don’t even have to read a single book to will realize that your statement is wrong: If your born without legs, you won’t go anywhere. If your born blind you will not see colors. If your born with a brain that doesn’t work according to specifications, you will not be able to make proper decisions. If you’ve only experienced a certain subset of reality, you will only be able to make descisions within that subset of reality known to you.
      Does that make sense?

  20. This is a very good article/blog. Thank you for explaining this so well…and I cringed when I read the posts from people who, after reading your very clear explanation, still do not get it and judge others harshly. Of course people shouldn’t be addicts, out-of-control, etc. So let’s get to why they are, and then work on it. Punishing and judging aren’t working so well, and the sooner the shame is taken out of this, the sooner more people will get well.

  21. Very good article and informational. Although, I still see a lot of comments from people that refuse to believe the advances of science we have learned. I would imagine these people have never had anyone in their lives with mental illness. Addiction is a symptom of mental illness in which they self medicate. I do agree that people put a stigma on those with the disease to elevate themselves which keeps progress of this disease from moving forward faster then other diseases.

    • Thank you Amy! Addiction is a symptom, yes indeed. I’m amazed at all the people on here willing to use name-calling and hate language to try to force their point. Really, addiction is also a hijacking by a terrorist and the terrorist is not nice, you can hear that in some of these comments! So here’s a hint — if you’re angry and cussing and calling people stupid, you’ve been hijacked and you’re not out of the woods like you think you are.

  22. While it was absolutely his choice to use, as a treatment provider , we dont deal with drugs in treatment. No one should deal with drugs in treatment or using…all addicts whether current or former know all about drugs and using. (after 23 years and a relapse of heroin, 10 days “in a rehab” is a joke! I would also suggest that there was alcohol/tobacco/overeating etc. use over those 23 years).We go under all that crap to “Why” they use! There is always a “why”. Once you find that and teach someone new coping skills, including medication assisted (why wasn’t he on suboxone, or an anti-depressant or even methadone?)…then they can choose or not to use again but they now have other ways to deal with life. As far as 12 Steps: if it is pure, if it is not the 70’s inspirational poster slogan rehab crap and therapy without a therapist that masquerades as 12 Steps now a days the Steps absolutely do work. For one main reason: In the Big Book and in NA’s book all thru the books it talks about we do recover! Not that we will always “be in recovery” implying no one ever gets better they just keep trying, but we DO recover. I get so tired of the “Recovery Movement”…does no one EVER get over it?? IThe 12 Steps gives hope…I am a former heroin addict, not a recovering addict, not an addict. I am no longer using addictive substances and I have other ways of dealing with life. The cure for addiction is not using addictive substances. ANY addictive substances…addicts switch their drugs of choice constantly and I have seen pics of Hoffman drinking at events). So yes abstinence first. (It’s way hard to help someone discover themselves when they are spracked out). The way to not use again is to find out why you did in the first place! What did drugs replace in your life…it’s not rocket science! As for the disease model: which came first the chicken or the egg? Which came first: using drugs changes the brain or the brain was damaged and demanded drugs…who knows and really, who cares! Unless they develop a brain implant that keeps everyone super happy (WAY SCARY) it really does boil down to choices…ESPECIALLY after 23 years theoretically “clean”. PS: There is nothing wrong with my brain now…I dont put substances in my body to change my mood or brain chemistry and weird…no addiction! I absolutely have control over what I choose to do and whether I choose to be an addict or to not be an addict. “Powerless over the disease” is when we are in active addiction, not when we are recovered! Then it becomes a choice!

    • You position on addiction is mind-bogglingly self-righteous if not dangerous. You are very fortunate if you feel that you are recovered, but addiction does not work that way and you cannot speak to how others will react/cope with their own addiction. Preaching ‘choice’ prevents progress in destigmatizing mental health disorders and those who suffer from them. Your addiction experience is specific to you and to suggest that you are recovered (if you truly were an addict) is terribly irresponsible. Please do more research before ascending your soap-box next-time.

      • Yes, actually addiction does work that way. After years of being a hard core, needle using heroin addict and criminal, I absolutely had a choice on whether to use again or not when I was released from prison the last time! I chose not to use and I chose to live my life using no substances! And, addicts do in fact recover! The word addict means to be currently addicted to something that significantly interferes with life and functioning…could be exercise, shopping, eating or heroin. If you are no longer indulging in that activity or substance, then by definition you are not an addict but a former addict becasue you are no longer addicted! 12 Steps is HUGE on personal responsibility! Read the literature! We dont have any control when we CHOOSE to use something but ultimate control over whether we DO use something…no soapbox..just the facts! If we as a society keep sugar coating and giving excuses for every bad choice, at what point would anyone WANT to be recovered? By saying you are always in recovery, by saying you have no choice over being an addict, you are romanticizing addiction…its not a freaking movie, its not all dark and seductive and romantic…people really die! No stigma allowed in my world…addiction is what it is and I know tons who have moved on and are recovered and are very open about the fact that they did and others CAN recover. I am very open about my former addiction to anyone anytime, my criminal history too. BUT I DO NOT sit back and play the victim and wait for society to pat me on a the head and say “Poor little drug addict” has a brain disease..cant hold her responsible or expect her to be a responsible adult..The truth: I am a responsible adult and I hold others responsible for their behaviors as I was held to mine…I HAD a disease but even cancer patients are cured if they go past five years with no flare ups! When you hold others in a space of “sickness”, you are treating them worse than the addiction ever did…maybe you should take a look at how having others or yourself viewed as constantly “sick” serves you as opposed to seeing others potential to be well and healthy and recovered. Some people NEED others to be sick to feel well themselves…

      • Good for you. I hope your perspective keeps you from using ever again. Disability is a tangible condition-doesn’t make you a victim, it can create more responsibility. Representing yourself as cured from addiction is simply untrue both psychologically and physiologically-you are forever changed-you should know that since you were on Heroin.
        YOU ARE NEVER CURED. Read the science-some of the words are long…sound em out.

    • So since you’re recovered from addiction am I right in assuming you returned to casual use of alcohol? Just as the cultural standard suggests and the vast majority of the society does, yes?

  23. Phillip Seymour Hoffman did not have choice or free will and neither do you. | silverapplequeen

  24. What you say may have merit, however your comments are not backed up with scientific literature or research studies. A small bibliography would be appreciated.

  25. I do believe that drug addiction, like alcoholism, is a disease. However, I also believe we all have a choice of whether or not to open the door to those diseases. Yes, I did have a choice, as did Seymour. Heroin is illegal. That is enough to keep me from trying it. I choose to obey that law. Did I drink when I was underage? No. Do I drive if I have had a drink? No. I choose to obey the law. We all have that initial choice. It’s the fork in the road. I am not judging him or anyone else. I have family members with similar problems-but they had a choice. To say they did not, completely takes all responsibility from them. Oh wait…of course because that is the world today. Nobody should be held responsible for the consequences of their actions….

  26. I found your post to be very enlightening. I became disabled several years ago and after finishing up with several surgeries, wanted to return to work, and couldn’t because I had no formal education. IN 2013 I began seeking a degree in Neuropsychology. I come from a long line of addicts, as well as those who have suffered from depression and PTSD. Being someone who suffers from addiction, PTSD, and depression myself, I would like to speak the naysayers of your column here. Addiction is not always something that you can recognize. You see anyone who is using drugs or alcohol as weak. What about those who use other things to escape the reality of their lives, such as shopping, eating, video games, a hobby,exercise, etc. Aren’t those things an addiction as well when they take over a life? Yes they are. In my early 20’s I was drinking at least a fifth of scotch a day. By the grace of God, I was able to quit cold turkey. While I would not recommend this method to anyone who drank as much as I did, without medical intervention, I managed to whiteknuckle though the dt’s of this and did the same when I quit smoking years later. I now find myself at a interesting juncture where I have begun using shopping to deal with the stress in my life (disability, divorce, surgery, 2 teenagers…), to the point that my home looks like something from a reality TV show on hoarders. I can not say why I did not recognize it, (I am usually a very clean and orderly person (type A)), since it caused more stress for me by the clutter around me. While I suffered buyer’s remorse several times over, while in the moment I could not stop myself. Now I am taking steps to correct my behavior and getting my life back on track. By my telling you all this I am trying to point out that addiction and mental illness such as depression, are not something you can “strong will” your way through. Believe me when I say this because I have a will of tempered steel. Science backs me up on this. We are now finding out that people who suffer from these things change their genetic code and then pass it to their offspring. If the offspring suffer with addiction or depression as well they add to that genetic code and pass it along as well. While I do not entirely believe that I am not without responsibility to react to my issues in a positive way, I would like to point out as well, that my condition is in response to a genetic code that I was pass through both sides of my family. Neuroscience is just beginning to discover how and why the brain works. Keep in mind that years ago people thought that those suffering from epilepsy were possessed. Do not become like them taking a hard fast stance on something we really don’t understand 100%. One more thing to remember, those of us who live in the dark have a much harder time finding our way with only pinpricks of light that shine through the fabric of our existence, than those of you who walk in the constant light. Please keep this in mind when passing judgement on an individual

    • Great share. Thanks for sharing your struggle with us. I hope it sheds light on what it means to be an addict to those who don’t understand.

  27. I’m not sure what to think of your excellently written article. I learned quite a bit. I think, however, that if I were an addict, your information would make me feel helpless. And there never has to be a first time for any drug or alcohol. You may be pressured, enticed, or immature, but your first try is still a choice.

  28. Debbie, thank you so much for saying what so many of us who live with the disease know. The idea of having no choice is something we have to work on consciously, daily. Mr. Hoffman’s death has certainly upped my vigilance a couple of notches. I hope you will stop by my blog, where I write about recovery (and life!) from the perspective of, well, the living. The only thing I could say about PSH’s death that hadn’t been said was this very personal poem about losing someone you love:
    http://phylliscapanna.com/2014/02/08/poem/

  29. Thank you for the thoughtful critique of the way we think of and treat addiction in our often too-judgmental society. We need all the ‘lobbying for compassion’ we can get. Maybe you will help sway some opinions with the points you’ve made and the evidence presented.

  30. Choosing to do drugs is a choice, choosing to quit drugs is a choice. Education and therapy helps but if you don’t have the desire to quit all the therapy and education in the world will not help.

    • And then what about those who have lost the mental capacity to know that they need help? Shall we just sit and wait for them to die or shoot themselves or shoot up schools or jump off buildings? Wake up people! There are hundreds of thousands of mentally ill people out there who appear to be just fine until they hurt themselves or others! If they are one drugs and we can prove it, let’s get them helped whether they want it or not. “All living things want their lives. Only those mentally impaired and/or on drugs do not know this.”

      • You can only help people that need help, want help, ask for help, and then you can only help them to help themselves. You can not help addicted brains if they don’t want help. Until they hit some type of bottom, they will keep doing what they are doing.

  31. Addiction and the Devil card | James Ricklef's Tarot Blog

  32. He had a CHOICE as to whether he wanted to use or not. That is the same for everyone. When we take our very first drink or drug it is not because of a neurological disfunction it is because we CHOSE to have it. If we want another we will make that choice to have it. And sure after long term abuse the chemical becomes an addictive substance to the brain. Drugs/Alcohol abuse changes chemicals in the brain hence the disfunction. Prior to that later stage of abuse each and every one of us had that choice to use. We also know the dangers of abuse and that addiction is a possibility but we still choose to flirt with that and take that chance. The old saying “It will never happen to me” but for some it does happen and it was their informed choice. And to say also that suicide is also a neurological disfunction that takes away choice is a bit out there. That is also a choice that people make. A choice they make because they are unhappy in their lives. They cannot handle what ever the trauma they have had to deal with. That is how it is for some people. I know. I am a recovering addict. I chose to use. I knew when the drugs was getting to be a problem so I made the choice to stop. I tried to commit suicide. That was a choice I made. I wasn’t mentally balanced at the time, my soul was crushed but I was still capable of making the decision. Obviously it didn’t work. We are all given the free will to make choices. Whether our choices in life are good or bad is a determination of the environment we are brought up in. Regardless of the type of environment we still have personal choice. I understand what was said in the blog but it is a fine line between having a choice to becoming automic without thought at all. We are all born with the ability the choose. That is a part of the brains function and individualises us…. But I do agree that sometimes part of the brain can become compromised and doesn’t work as well as it should which could make people do things they wouldn’t ordinarily do or do things that is not accepted by society. But to class all addicts and suicides in that one bracket is wrong. Choice only gets taken away when the damage done to the brain renders a person incapable. Prior to that we made the choice.

  33. Fantastic piece, very well written and spot on points. I myself went through about a 10 year period of addiction, and many of my friends who were in this with me became true addicts. I’ve lost at least 2 of them from their addictions, and happily seen others able to battle their demons and come out strong. I have to say that while I do feel more on the side of those who do not have a mental or physical addiction problem there are certainly days when I think of my past and how easy it was to just disappear into my own head from time to time, but I can control it. I feel that knowing very bright and loving individuals who have struggled with true addiction I have come to see it in a different light, to understand that there is a true need for these substances due to the change in the chemical constitution of their brain. It’s a hell of a road back and I never really think such a thing is “cured” but rather a profound realization of the damage one has suffered and the need to make a change…which is not something that anyone else can tell a person – it has to be their decision. Much like my bipolar disorder when I am in a deep depression. One cannot just snap out of true depression just as one cannot just stop using because others tell them it’s not ok. In both cases we well know a change should be made but it’s just not possible in most cases.
    I feel terrible for PSH he was truly an amazing actor with a broad portfolio. The world lost one very talented individual that day.

  34. I believe humanity will one day look back on us and realize that our understanding of human behavior generally and brain science specifically was as primitive as blood-letting and leeches. It is clear that the belief that we have a free and unfettered will is an erroneous assumption. What we now struggle to determine is the degree to which that will can be effectively exercised. It is not a level playing field for every person. “Just do it” sounds good but simply does not work for everyone. That is not an excuse or enabling; it is a statement of fact. As a Christian, I see the necessity of a discussion about faith, brain science, and mental illness. We Christians desperately need to realize that human behavior is a very complex interaction of several dynamic processes.

  35. Yes, our brain’s healthy and wiring do effect whether we will become addicted or exhibit behaviors and have feelings and make decisions that make it difficult to make healthy choices as we cope with life’s stressors. And the value of the latest neuro-scientific understanding does have immense value for current treatments and potential for future treatments as the author asserts. And she makes good points about how we tend to “blame the victim” rather than understand the dynamics of the struggles of those who are mentally ill..

    But I would like to make two points. First, to simply relegate all our addictions and problematic cognitive processes and emotional entanglements to solely brain wiring and structural and chemical predispositions negates how the whole physiology of the body interacts with the brain. . And further as other respondents have outlined, the environmental components effect persons in both positive and negative ways as many have gone the addiction route or recovered because of those very factors.

    Secondly, while it may be true that at certain points a person’s capacity to make a rational choice is diminished or may even be impossible. i.e. the drunk who is so very confident he can drive flawlessly or the diminished rational capacity of one long addicted to drugs, ultimately regardless of the situation, the person with support from others must choose to find ways to mitigate against their tendencies toward addictive behaviors and learned patterns of addiction. Regardless of the understanding that scientific research might give us, ultimately the power of choice and responsibility of choice at some point must rest with the person. Otherwise we are simply victims of our genetics, brain physiology, and previous life journey without hope. The power of choice is what makes us human and gives us the possibility of making life better for ourselves and those around us. .

  36. Relapsing with significant sobriety is part of my story and while I have sympathy, I also recognize that it never, and I mean never, has to be that way. What was my experience and what I see repeatedly in our treatment community is not a failure to go to AA. It’s a failure to work a program, a failure to have what the writers of the Big Book called a spiritual experience. Quoting Jung, the Big Book says “Here and there, once in a while, alcoholics have had what are called vital spiritual experiences.” Sadly, I think that not much has changed since Jung spoke those words. It is still only “here and there, once in a while.” Complete psychic changes are very rare. But they all begin with an opportunity, in my case with the grace of the Holy One. So we get an opportunity that meets us at the point of our surrender, but what happens next depends on so many variables, it’s difficult to explain. Do we have people in our lives who love us enough to tell us the bitter truth? Even enough to withdraw from us? If we go to a treatment center, do we go one that continues to coddle and infantalize us, to pander to our worst instincts — or do we go to one that emphasizes understanding our powerlessness and finding the Power? Then, if we go to a 12-step program, do we go to one that tells us to use our broken brains to address the problem with our broken brains? “Just don’t use no matter what! Play the tape through!” Um, I use no matter what. I use when they’re taking my kid away, when I’ve behaved in such a despicable way that I’ve alienated everyone. And play the tape through? When my spiritual malady has driven me to the point of mental obsession, I don’t even get the tape in the freaking player. But I have to believe that choices, my choice, comes into play at some point. I have a choice between “blotting out the consciousness of [my] intolerable situation or accepting spiritual help.” I believe that I have the choice to “maintain a certain simple attitude.” I retain the ability to make those choices as long as I maintain good recovery habits, the most important of which is to work with other alcoholics. I am disturbed whenever I hear any assertion that seems to let us off the hook for personal responsibility.

    • I agree Completely. What you say is exactly right. Anyone that does not agree, does not understand addition. I am a alcoholic. I have been involved with AA for over 19 years. I have experienced alcohol
      addition and got to the point of drinking 1/2 gallon of vodka a day plus beer chasers. I would get drunk and pass out, wake up and do the same thing over and over again. I was lucky and grateful that when I got to the point of suicide thoughts, I went for help. This was my choice when I hit “my bottom”. A “bottom” is when a person gets to lowest point, that they want to change. Some people never get to this bottom and end up DEAD. I saw all this happen, good or bad over the last 19+ years. If you don’t understand all of this, you don’t understand addition.

  37. It is very kind of you to view addictive personalities in such a (patronisingly) benevolent light. Either you come out as one of or you stop pretending to understand the chemistry, psychology, physiology or anything else about this curse. I’ve done it all – I mean all of it including 15 fabulous years in a 12 step programme. I agree with a lot of what you say and reading between the lines, think you are probably one of us. Without personal honesty, there is no clearing of the conscience hence no recovery. If I’ve got you wrong and you are trying to write an ‘academic’ article on the nature of addiction then please do some serious research and provide the relevant references.

    • Please explain: How does the autor being an addict or not lend credence to the ideas presented here? How would that even be of relevance for the argument, rather it being of relevance for you personally?
      And further, how do you know that “personal honesty” matters to recover from substance abuse? Your twelve step community may have told you so, but that doesn’t make it any more right, does it? There is zero evidence that replacing a life of addiction by a life of 12 step work is the most effective way to to treat addiction.

  38. I just can’t leave this alone. The Big Book, specifically The Doctor’s Opinion, identifies two levels or times at which “choice” might be a factor. The first is the bodily addiction (which research now indicates may be a problem in the brain, specifically in the mesolimbic dopamine system (the ventral tegmental area and nucleus accumbens). The Big Book makes clear, and I agree, that once a drink or drug is introduced, no choice exists on whether to continue or stop. This is where we are bodily different from our fellows. The second is the mental problem. Here is where the the Big Book and I part company from the scientists and those who insist we have no choice. Much scientific research seems to suggest that we never have a choice, not even after 23 years of sobriety. Malarkey! Baloney! Horse poop! If you follow the precise plan of recovery in the Big Book and if you have a sponsor who will help you see the truth about your selfishness, self-seeking, fear, and dishonesty by helping you analyze your resentments, and if you make DIRECT amends to those you have harmed (rather than the easier softer way advocated all over AA and NA: “Just don’t steal/lie/cheat anymore”), and if you make it your overriding concern to help the man who is still sick, you absolutely have a choice. You are recovered. Those who relapse do so because they either never did, did halfway, or stopped doing the program of recovery. A lot of people who “never did” are only doing what others in their AA communities do: treat AA as a clean and sober club and fellow members as the Power. The people who “do halfway (or some other fraction)” are those who believe they are strong-minded enough to cut corners (that is, not powerless). Those who “stop doing” build up arrogance and complacency over years of sobriety and become spiritually unfit, then restless, irritable, and discontented. Finally they drink, which is a relief at first, but rapidly becomes a nightmare. I can’t speak for PSH. I don’t know if he never did, did partway, or stopped doing. His death is tragic, but it could have been prevented. However, not by any shallow, ridiculous consideration of what he had to lose. The Big Book tells us on page 24 that “we are unable, at certain times, to recall with sufficient force . . .” Those certain times may happen after a few weeks or after 23 years. But no human power can help. And no relapse comes out of the blue. It begins long before you take your first drug or drink.

    • Wow, it continues to amaze me how people hold on to the twelve steps like it’s the only thing that works. Having attended at least a thousand twelve step meetings myself I am a little creeped out today when people weave big book lingo into their sentences as if it was their own talk. Like the pastor who leaves no space for other opinions and preaches incessantly and loudly. It’s an excellent way to turn off “the most important people in the room.” It’s unappealing.

      See, the big book was written in the 1930s. It has worked then, it was revolutionary even, because AA was the only thing that worked with alcoholics. Not only was it the only the thing that worked… at the time mankind knew very little about psychology, and almost nothing about neuroscience. There was no effective medication to stabilize people’s mental anguish, and talk therapy was in its infancy.
      However, since then an awful lot of brain science has been done, medications have been invented, and effective psychotherapies have been developed. Buddhism too offers great new ways to deal with the roots of addiction, without having to believe in some form of deity or power that would rectify things for us.

      In these modern times it is really against all reason to hold on to the assumption that attending meetings for the rest of our lives is the only way to regain a life worth living. Great if it works for you, but please don’t impose onto others that what you’ve read in a book from almost a hundred years ago is the only means to recover from addiction.

  39. Phillip Seymour Hoffman did not have choice or free will and neither do you - Broken No More

  40. “What saved them (you) from becoming addicted is that their brains did not respond in the same way that an addict’s brain does. They were born with a resistance to addiction. Their free will and good choices had nothing to do with it.”

    You’re 100% sure of this?
    A persons environment, and upbringing has nothing to do with it?
    Why are people who are badly abused so often addicts?
    It’s just a coincidence, that they were abused, and their addictions are in fact caused by biology?
    Seriously?

    • It’s a combination of genetics and environment. And, according to research, the genetic aspect is much stronger. They haven’t quantified it exactly cause there are so many variables involved, but it’s somewhere in the range of 60% genetic and 40% environment. It’s not at all inaccurate to say people are born with an addictive brain. Its just some individuals are born into an environment that doesn’t facilitate the addiction, and they are spared. But even those individuals will exhibit certain behavioral characteristics throughout their lives that suggests atypical brain physiology. I hate the word addict/addiction because it’s so much deeper than that. Using drugs or alcohol is only a symptom of the disease, and I think you’re focusing too much on this particular symptom. Symptoms have different manifestations–using drugs/alcohol is only one. Also, statistics show there’s more addicts that come from homes without abuse than with. This may be due to the fact that there’s simply more homes in America without abusive parents than with abusive parents, but either way you look at it, your environment theory is untenable.

  41. It seems as though a lot of you are very focused on the mental disorder “addiction” and people’s choice to consume drugs the FIRST time. What you need to consider, is why on earth would someone subject themselves to something that could [as many of you have pointed out] kill them the first time they use it? The answer is quite often other underlying mental disorders.

    Anxiety and depression stem from a combination of genetics (as does addiction, there is an actual “addiction” gene- DRD2) and environment, also known as Nature AND Nurture. We now know that there is no one or the other, we are products of our own genetic material and those genes being switched on or off depending on the circumstances that we encounter in our lives.

    Young, talented people are often asked to develop and grow in their craft before they have fully developed and grown as mature individuals. Regulation (emotional, attention, behavioural) skills are lacking, meaning the ability to cope has not been learned. This is a frustrating way to live, but fortunately one of the brain’s natural abilities is to problem solve.

    I was 17 and extremely depressed and suicidal the first time I tried cocaine (I had been off and on for 3 years). I had been drinking and smoking since I was 12, and cocaine seemed like a solution to the sadness that I was beginning to realize was not going to go away on it’s own. In researching cocaine (because I am an incredibly over-analytic individual and I seek out answers and facts obsessively), I read that some of the side effects of cocaine were increased energy, elevated mood, and a feeling of supremacy. As someone who would regularly look in the mirror and burst into tears, constantly worry about what other people thought of her, and never have enough time in the day to complete all that was expected, cocaine seemed like a godsend. Sadly, when the high ended, I returned to feeling how I had felt before. This is where addiction comes into play. You aren’t addicted to the drug- you’re addicted to what the drug does to your brain. I was addicted to feeling good. For some people, exercise gives them that feeling. As someone who was dancing 8 hours a day throughout high school, that wasn’t the problem. For some people it’s food. Well, guess what? Food wasn’t exactly a comfort as a teenager who had strict body expectations either.

    My point is, it never starts with a “choice”. It is so much more complicated than that. As Debbie discussed, it is a neurological impairment. Something in my- and so many others’- brain is imbalanced. It doesn’t function in a way that I can make proper “choices”, at least, not without the help of some kind of a drug to regulate the way the neurotransmitters in my brain work (thanks, Zoloft!). The sooner people out there realize medically treating mental disorders, rather than assuming they are all happening as a choice of the individuals living with them, the sooner people will start to get better. I find it so very frustrating that people out there still think that people CHOOSE to be unhappy. Treating these disorders is no different than treating someone with diabetes or cancer, and they are just as deadly.

    • Wow, you are spot on. This is exactly what the “First Timers” need to hear. Although I’m sure they’ll come up with more silly retorts. I really couldn’t believe I was hearing so many people use the ‘first time” argument. Hopefully your comment at least changed a few minds. I really enjoyed reading it.

  42. I struggle with the tone of this article, which is that it is not their fault, that the only problem is that they were unlucky when it came to gene roulette. I believe that it is likely I have the same gene as PSH. IF I drank alcohol, IF I smoked, IF I did drugs, I would struggle with addiction. (Key word is “struggle.”) Recognizing my parent’s addiction to cigarettes, at a young age I decided to steer clear of addictive substances. But addiction has many guises and my experience with addiction has shown me that, though harder, choice is still available. Absolving addicts of responsibility by saying we do not have choice or free will, is itself counter-productive and irresponsible.

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