Is drug addiction a ‘disease’ – a medical condition that leaves you with no more choice in the matter than, say, a bout of pneumonia? Apparently not, according to research described by Sally Satel in a piece for the Atlantic. The research is that of Carl Hart, a neuroscientist at Columbia University:

“The basic experiment goes like this. Hart recruits addicts who have no interest in quitting but who are willing to stay in a hospital research ward for two weeks for testing. Each day, Hart offers them a sample dose of either crack cocaine or methamphetamine, depending upon the drug they use regularly. Later in the day, they are given a choice between the same amount of drugs, a voucher for $5 of store merchandise, or $5 cash. They collect their reward when they’re discharged two weeks later.

“More often than not, subjects choose the $5 voucher or cash over the drug, except that, when offered a higher dose, they go for the drug. But when Hart ups the value of the reward to $20, addicts chose the money every time.”

This was not what Hart expected:

“Wasn’t addiction a dopamine-driven compulsion ‘that hijacked the brain and took control of the will?’ he asks. As a graduate student Hart was taught that… Indeed, this has been conventional wisdom in research circles for at least the past two decades.”

Of course, no drug user wants to be a junkie anymore than an over-eater wants to be fat, but these things aren’t what the choice is actually about:

“…addiction and poundage is not what they are choosing: what they seek is momentary gratification or relief—a decision that is rational in the short-term but irrational in the long-term.”

As Carl Hart’s research shows, this desire for momentary gratification or relief is not an overwhelming compulsion. Given a better choice – or at least a more desirable one – it can be resisted:

“…every addict has reasons to begin using, reasons to continue, and reasons to quit. To act on a reason is to choose. To make good choices requires the presence of meaningful alternatives. And making a series of good choices leads to achievements—jobs, relationships, reputations. These give a person something meaningful to lose, another reason in itself to steer away from bad choices.”

Ideally, everyone in the grip of addiction would be provided with the prospect of such achievements. But, sadly, this won’t always be possible – not immediately, anyway.

Yet there is another kind of choice that addicts can be presented with:

“Consequences, rather than rewards, or sticks, rather than carrots, can work too. When at risk of losing their licenses, addicted physicians show impressive rates of recovery. When they come under the surveillance of their state medical boards and are subject to random urine testing, unannounced workplace visits, and frequent employer evaluations, 70 to 90 percent are employed with their licenses intact five years later.”

It may be a cliché, but, if all else fails, tough love really can give addicts the dignity of choice.