November 1980 II/3
ADDICTION OR CHEMICAL DEPENDENCY
Though it is not often listed as a cause of death, chemical addiction is a serious cause of health disorders among people in the United States. More detrimental than its physiological effects, however, are the familial, social, and spiritual harms that result from chemical addiction. Almost everyone has a loved one whose addiction to alcohol or drugs is a cause of deep concern. Because chemical addiction disposes for, and causes, so much illness and suffering, a few thoughts from the ethical point of view concerning this phenomenon are in order.
While its development is not fully understood, one component of chemical dependency is physical pleasure. In the face of difficulty, tensions or frustration, the chemically dependent person runs away from the loss of normal satisfaction and achievement by indulgence in the physical pleasure and relaxation of the addicting experience. However, the search for pleasure alone does not constitute addiction. Rather the increasing sense of guilt and helplessness which accompany each overindulgence intervenes with the result that the incipient addict begins to indulge not for the sake of pleasure itself, but to blot out the guilt and remorse for the consequences of previous indulgences. Furthermore, this vicious circle is reinforced by the use of psychological coping mechanisms, such as rationalization and denial, which victims find necessary to assist in this suppression of guilt and pain. Thus, victims become increasingly unable to perceive the real consequences of their behavior. Extensive research shows that though chemical addiction causes are often physiological, the psychological component remains essential, so that persons who lack this component can sometimes use even so highly addictive a drug as heroin without exhibiting the typical features of addiction.
Is one personally responsible for addiction? On the one hand, therapists speak of addiction as a "disease" in order to reduce its moral opprobrium and to achieve a more sympathetic attitude on the part of nonaddicts. But, on the other hand, an important part of therapy is to get addicts to accept moral responsibility for the harm they have done themselves and others through addiction. This ambiguity can be cleared up if two points are kept in mind. First, chemical dependency is always a psychological disease since it involves an abnormal behavior pattern accompanied by the neurotic coping mechanisms already described. It is also a physiological disease because it sometimes produces physiological dependency and usually produces widespread organic changes which greatly aggravate the condition. Second, we need to distinguish between voluntary and free acts. Addictive behavior is voluntary in the sense that it proceeds from an inner desire, but it always involves a restriction of freedom since the desire is compulsive and the addict becomes less and less able to perceive alternatives of action or to choose among them. In times of addictive need the practical conscience of the addict is concerned totally with the need for a drink or a fix. He or she acts voluntarily and compulsively, but without free choice.
Hence, actual consumption of addictive substances by addicts is seldom in itself a morally culpable act because of diminished freedom, and the guilt felt afterwards is mainly unrealistic and neurotic. Though there may be some moral awareness of future difficulty when one starts using a potentially addictive substance, even the acquisition of addiction often proceeds so gradually and subtly that it is difficult to judge that the addict knowingly and deliberately chooses addiction. Nevertheless, it would be a mistake to think that all guilt experienced by addicts is illusory or neurotic. If it were, it would be hard to explain why admission of responsibility has proved so important a part of therapy. In sum, the most realistic and productive way to express responsibility for addiction is to say the addicted person has the obligation to ask and receive help from others, since therapy cannot be effective until the addict accepts help.
Responsibility of Health Care Professionals
The ethical responsibility of health care professionals in regard to addiction may be summarized as follows:
1. Realizing that addiction causes so much illness and sorrow, it is important for health care professionals to acquaint themselves thoroughly, not only with the nature and therapy of addiction, but also with the ways to persuade addicts to accept treatment, the treatment centers to which they can be referred, and the ways to support them in their efforts. Moreover, families and friends of addicts should be persuaded to treat addicts as victims of illness rather than morally responsible delinquents. Helping the family of the addict to be fair, but not overprotective, is an important goal for persons in health care.
2. Health care professionals should be aware that they themselves, as a class of people, have a chemical dependency rate higher than people in other occupations. Whatever the causes of this proclivity, individuals should develop a lifestyle with the proper psychological and spiritual means to overcome this tendency. Adequate and enriching relaxation and sensitive concern for others should be the bedrock of this lifestyle.
3. Perhaps an even more effective way for health care professional to combat chemical addiction is through preventive measures. They can play an important role in combating the drug culture mentality in the United States. According to this mentality, every pain, every sorrow or frustration, can be overcome with a pill, potion, or injection of some kind. Pharmaceutical firms constantly publicize drugs, such as tranquilizers, and health care professionals often are used by such firms to promote unnecessary drug use. Responsible professionals will not share in this promotion, because they realize that human pain, frustration, and sorrow cannot be simply suppressed. Human beings grow as persons by facing and working through the difficulties of life realistically as free people, not by running away from them and becoming slaves to a pleasure ethos. In this view, I am not proposing an exaggerated stoicism as the ideal of ethical behavior. Rather I am calling for a realistic effort to overcome the sorrow and suffering of life through relaxation and diversion, such as contemplation, music and companionship, which renew rather than destroy the human personality. Alcoholics Anonymous, which has led the way to the most successful methods of therapy for chemical dependency, has always emphasized that the addict cannot recover unless he or she reaches out to a Higher Power, is willing to repair damage done to loved ones, and serves one's neighbor. There is a message here as well, for those of us who are not yet wholly addicted.
Kevin O'Rourke, OP
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