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November 12, 2012

Is Drug Addiction a Moral Issue?

http://www.jewishjournal.com/blog/item/is_drug_addiction_a_moral_issue/

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Absolutely not! Well, kind of. The Rabbi at Beit T’Shuvah and I have a decade-long argument, which for the purposes of this blog, I'll label the Cwon’t (can’t/won’t) argument.  He believes (in general) that people willingly won't change. I have always said that if they could they would (can't), and that they are stuck in behaviors that have a hold on them.  That makes him the tough Rabbi and me the empathy. It makes me the cynic and him hopeful, but frustrated. 

The medical community has adopted a disease model of addiction that centers on physiology, possible genetic components, and habituated behavior.  The story goes like this: addicts have a pre-disposition in their genes (or temperament) toward a particular sensation, engage in use of a substance, get stuck in a cycle of behavior against their own will, create strong neural pathways and get more and more entrenched in a destructive pattern of substance abuse.  They label this phenomenon a disease.  From this point of view the addict is a victim of a vicious disease that ravages the life of the addict and creates turmoil in their circle of friends and loved ones. From this point of view the addict CAN’T get sober without serious intervention and long-term care to arrest the disease. However, if an addict goes to see a psychiatrist for their condition, nine times out of ten, here’s how the story goes: psychiatrist assesses client; tries a little therapy, maybe some medications; client does not stop abusing; and after a few months (or years) the psychiatrist says, “I can't help you unless you get sober. Go to AA.” What are the things that happen in AA? Well, moral inventory and belief in a higher power are the fundamental building blocks of the program.

So we have a real conundrum, on the one hand the medical community will say addiction is not a moral problem it is a disease, on the other hand they are quick to prescribe a moral solution.  So here’s the deal: this controversy around addiction is tied to an age-old philosophical question around freedom, free will that is, and its limits.  Are people (addicts) choosing to destruct their lives, consciously making negative moral decisions? Or, is something choosing them?  Hence, we have the Cwon’t dilemma. Choice or no choice—that is the question.  The answer is...Yes!  Addiction is paradoxical, intrinsically.  It has two incompatible, polar opposite characteristics that define it: addiction is both a choice and not a choice.  Addiction is a malady of the body and the mind. It confuses emotions and weathers the spirit. Addiction is a condition that gives great insight into the paradoxical nature of human beings and points to a richness and complexity beneath the surface of reductionist views, and detached systematic thinking. 

If I reflect deeply on my life, it has these same contradicting polarities that shape it.  My life is both mine and not mine at the same time.  Think deeply about your existence, how much of it can you really take credit for?  I recognize that I play a part in my life, am responsible for it in ways, but much of my life is way out of my scope and is driven by an infinite amount of variables. My existence is immersed in mystery, internally and externally, my choices in life, at times, seem unconscious, automatic, driven by instinct and plucked from a random stream of thought that I myself have little to do with.  On the other hand some choices flash in from the depths of me with exacting certainty guiding the general course of my life.  In this mysterious cauldron of potential and happenings, where does our free will lie?  Who or what is directing the course of our lives?  Is it our genes? Our environment? Is it our minds? Our souls?  G-d?  Some admixture of all of those? That answer lies beyond the horizon of time and space and dwells in the land of the source of all.  In Jewish thinking every single thing in the universe does exactly what G-d commands, except for us, we (at times) have the freedom to do the opposite, but that freedom is not all encompassing, it has limits.  The fabric that weaves our existence together is this constant tension between our real human capacity to choose and create in the world and our powerlessness, even in our own lives.  We are both matter and spirit. Sometimes we make choices, sometimes choices make us.  It is this paradoxical admixture that causes our pain, allows us to triumph and most importantly creates our freedom.  We understand small bits of existence and will never understand all. 

Addiction plays a part in the daily life of every human being. Some addictions we label as destructive, some we label as constructive and those labels are contingent upon various social and cultural trends. Addiction is a necessary component of living, it is rote and automatic, and without that mechanical function we could never have the depth of living that we enjoy, in short, we could never build.  Addiction is instinctual and instinct is a necessary, but insufficient, condition for human living. To be human is to be able to override instinct or programing, it is to be able to do the right thing against everything, it is the infinite potential of the human spirit that one witnesses when someone transforms his or her life for the better.

A Chasidic master once instructed people to carry one piece of paper in each pocket, on one write, “for my sake the world was created,” on the other, “I am nothing but dust and ashes."   What does this mean?  We are the dust that bears witness to creation, and indeed have the capacity, the freedom to create, as well.  Our lives are both dust in the wind and whirling manifestations of the inexpressible. We are all fighting against the pull of our lower selves fighting to be more than dust, and we win some and we lose some. Therefore, in the final analysis we all must stand together, humbled by the eyes of eternity, for if you are not good enough, neither am I. Addiction is a moral issue, we have the moral obligation to see ourselves in the eyes of others.

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