On Addiction: The Medical Illusion

A generation or so ago the famous psychiatrist Karl Menninger asked, "Whatever became of sin?" Today we know the answer. Sin became an addiction. This phenomenon is part of what we might call the medicalization of all ills. This may appear to make our failings less sinful, but it does not necessarily lead to a cure. Some things that used to fall under the heading of conduct can indeed conveniently be redefined as sickness: abuse of alcohol is a prime example. No longer is the problem drinker to be shunned as a debauchee: he or she is an alcoholic, addicted to alcohol, and needs to be treated, not tried.

Webster's unabridged dictionary gives two relevant definitions of addiction: (1) compulsive use as of a drug; and (2) extreme devotion. There is a good deal of folklore that sees excessive drinkers as fitting into the second meaning, devoted to the bottle. However, it is, alas, sadly evident that for many the question is no longer one of devotion, which they might alter, but of compulsion, which they cannot.

Even so, seeing alcoholism as a medical problem has not made it completely amenable to a medical solution. There are drugs to administer, institutions to stay in, counselors to consult, but these medical approaches are not always effective. There can be no doubt that there are often physiological aspects to the compulsive abuse of alcohol; it is not merely a moral failing, and therefore requires something more than mere moral exhortation to control it. But short of depriving alcoholics of their freedom, it is impossible totally to bypass the moral dimension. Often it is the much more moralistic and quasi-religious approach of Alcoholics Anonymous that brings self-control back to the alcoholic.

Treating alcoholism as a disease has been helpful, at least to some extent, partly because it has removed some of the stigma of what used to be considered a sin and evidence of a weak character, a stigma that often created a defeatist attitude in the alcoholic and made recovery more difficult. It has also made it easier for family and friends to treat the compulsive drinker as one who needs help and who can be helped, rather than as one to shame and shun. Extreme devotion can be addressed rhetorically and morally, but compulsion requires stronger medicine.

The bottom line, however, is this: we should hold on to the knowledge that even when dealing with an addiction that has identifiable physiological aspects, such as alcoholism, there remains a moral dimension. This concept of addiction is also applicable to other forms of destructive behavior.

Can sex be addictive? Dare we still say that since Don Giovanni would not repent he was properly dragged off by the comandatore? If Giovanni was not expressing an extreme devotion to sexual self-indulgence, but was the victim of a compulsion, and could not help himself, it would seem unjust. One danger of applying the concept of addiction too promiscuously is the fact that while many newly defined addictions may be redefined as medical problems, for them there is no medicine or medical cure, or, if there is, it involves a loss of freedom that may be worse than the disease. An even more serious danger of labeling wrong behavior addictive is that it may free an individual of any consciousness of moral failing and consequently of the impulse to repent and seek forgiveness.

We do not normally suggest giving medicine for addiction to work. For those who want to be seen as "addicted to sex," or "to pornography," there might well be medicines or surgical procedures that would affect the problem, but only at the cost of freedom. The claim of addiction serves the addict, or his family and friends, as a kind of exoneration, a plea of diminished responsibility, as though he were not really free. But the only way to treat his behavior as addictive, the compulsive abuse of freedom, would be to use means that diminish or destroy that freedom. Sin may be dealt with by repentance, which can bring a recovery of freedom, but addiction, the plea that one is not free, will be dealt with by enforcing the destruction of that freedom.