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Friday, 7 February 2014

Heroin, addiction and free will

Mind Hacks

The death of Phillip Seymour Hoffman has sparked some strong and seemingly contradictory responses. What these reactions show is that many people find it hard to think of addiction as being anything except either a choice or a loss of free will.

The fact that addiction could involve an active choice to take drugs but still be utterly irresistible seems difficult for most people to fathom.

Let’s take some reactions from the media. Over at Time, David Sheff wrote that “it wasn’t Hoffman’s fault that he relapsed. It was the fault of a disease”. On the other hand, at Deadspin, Tim Grierson wrote that the drug taking was “thoughtless and irresponsible, leaving behind three children and a partner”.

So does addiction trap people within its claws or do drug users die from their own actions? It’s worth noting that this is a politicised debate. Those who favour a focus on social factors prefer prefer the ‘trap’ idea, those who prefer to emphasise individual responsibility like the ‘your own actions’ approach.

Those who want to tread the middle ground or aim to be diplomatic suggest it’s ‘half and half’ – but actually it’s both at the same time, and these are not, as most people believe, contradictory explanations.

To start, it’s worth thinking about how heroin has its effect at all. Heroin is metabolised to morphine which then binds to opioid receptors in the brain. It seems to be the effects in the nucleus accumbens and limbic system which are associated with the pleasure and reward associated with the drug.

But in terms of motivating actions, it is a remarkably non-specific drug and it doesn’t directly cause specific behaviours.

In fact, there is no drug that makes you hassle people in Soho for a score. There’s no drug that manipulates the neural pathways to make you take the last 40 quid out of your account to buy a bag of gear. No chemical exists that compels your hands to prepare a needle and shoot up.

You are not forced to inject heroin by your brain or by the drug. You do not become an H-zombie or a mindless smack-taking robot. You remain in control of your actions.

But that does not mean that it’s a simple ‘choice’ to do something different, as if it was like choosing one brand of soft drink over another, or like deciding between going to the cinema or staying at home.

Addiction has a massive effect on people’s choices but not so much by altering the control of actions but by changing the value and consequences of those actions.

If that’s not clear, try thinking of it like this. You probably have full mechanical control over your speech: you can talk when you want and you can stay silent when you want. Most people would say you have free will to speak or to not speak. 

But try not speaking for a month and see what the consequences are. Strained relationship? Lost job maybe? Friends who ditch you? You are free to choose your actions but you are not free to choose your outcomes.

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