The battle rages on.

Addiction is a disease.

Addiction is a choice.

Dr. Jason Powers, a board certified addictionologist and family physician, champions the disease model.

"The suffering is miserable," Powers told a crowd of about 60 alcohol and drug abuse counselors at NAU's du Bois Center back in August. "Addiction, living in addiction, is a living hell."

There is no "choice" in addiction, any more than there is choice in diabetes, he added. Powers' talk focused on the disease of addiction, based in part on his book, "When the Servant Becomes the Master."

On the other hand, Gene Heyman, a psychologist who teaches at Harvard and Boston College, asserts in his latest book, "Addiction: A Disorder of Choice," that addiction is indeed just that -- a choice. A very complex choice with a number of psychological, social and maybe even biological variables.

"Some say addiction is a choice," Powers said, adding that the classification as disease absolves people of responsibility in the matter, according to critics. Yet, that same sentiment does not appear to cross to diseases like diabetes, or colon cancer, which can be brought about by choosing a poor diet.

When suffering from diarrhea, make the choice not to have it and see how far it gets you, Powers said.

It is the stigma associated with addiction and the often antisocial behaviors of the addicted that serve to undermine the idea of disease. People appear to choose to take that next drink, or line of coke, or next shot of heroin.

CHOOSING LONG-TERM GOALS

Heyman's detailed study of addiction focuses more on choices people make that go wrong, or bad. Short-term choices, made day in and day out, undermine long-term goals of life and lead to an ever increasing severity of consequences that hinder those goals.

Heyman notes that only a small portion of drug users become addicts, and that less than 20 percent of alcohol users become alcoholics.

And with choice comes the ability to change from choices of short-term satisfaction that hurt long-term goals to choices that enhance long-term goals. In essence, to quit being addicted -- something the disease model says is incurable.

Heyman also cites data that says addicts, about three quarters of them, end up quitting on their own without benefit of treatment -- something which flies in the face of the addiction-as-disease model.

SURVIVAL MODE KICKS IN

Drugs and alcohol, first and foremost, are tools, Powers said. They change feelings in the brain more than anything that happens naturally in the body. Drugs and alcohol can alleviate anxiety and depression, and they can deliver pleasure and happiness.

"They are very good, effective tools," Powers said.

But when they stop working and begin to go bad, the tools begin to gain control. He recited an old fable: "First, the man takes a drink. Next, the drink takes a drink. Then, the drink takes the man."

What happens in the process is that the self-aware frontal lobe of a person, the place where a person can make a choice, is overridden by the much older and very primitive part of the brain's limbic system.

The limbic system is concerned with survival, defense, procreation. It is the part of the brain that activates in search of food when hungry, of flight when confronted with danger, of perpetuation of the species.

The limbic system always wins, Powers added. He challenged the audience to consider holding their breath for six minutes, and if they do so, they will win a large sum of money. The frontal lobe makes the choice to do so, but the limbic system, in charge of survival, makes a person breathe well before six minutes are up, no matter how much the frontal lobe wants the money, Powers said.

And when the limbic system is satisfied with food for survival, or sex for procreation, the brain releases a chemical called dopamine to indicate all is well with the world. Alcohol and drugs also cause the release of dopamine, but at much higher levels, indicating to the limbic system, eventually, that the alcohol and drugs are essential to survival.

And the power of choice is no longer possible.

NO GOING BACK

And once that change has happened in the brain, there is no going back, so the sufferer must manage the disease, much the same way a person with diabetes manages sugar levels in the blood once the body's ability to produce insulin has been compromised beyond repair.

Powers used another analogy: A cucumber, once turned into a pickle, can never go back to being a cucumber.

A variety of tools are helpful to manage the disease of addiction, including 12-step groups that allow people with common experience to identify with one another. Also important is the treating of underlying problems and symptoms that alcohol and drugs were being used to deal with.

Larry Hendricks can be reached at 556-2262 or lhendricks@azdailysun.com.

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