Addiction and environment

Substance abuse has always seemed to me like the chemical version of Robert Nozick's Experience Machine, which is not something that I would personally choose to get plugged into. Perhaps those drug awareness campaigns of yore did hit their mark. But what are your options if you're trying to get out of addiction's remorseless grip? Xi Chen's write up on Kirsten Smith might have an answer.

Smith went from being a heroin addicted bank robber, to a scholar, who's trying to change how we see addiction. Smith thinks that it's more empowering for addicts to see addiction as a series of life choices, than to approach it as a disease.

Smith is now an assistant professor of psychiatry and behavioural sciences at Johns Hopkins University in Baltimore, Maryland. But in the noughties, Smith and her then boyfriend were arrested for robbing a bank to fund their drug habit. Before her sentencing hearing, Smith wrote a statement to the Judge, taking responsibililty for her actions, "I wasn’t abused or molested as a child, I didn’t grow up on the ‘wrong’ side of town. I wasn’t raised by wolves but by a mother and stepfather who love me and gave me countless opportunities to succeed." Chen says:

Smith was steadfast in her belief that her actions were volitional from the start. Her drug use and crimes were not the products of an immoral character or a faulty brain incapable of change, but rather of an environment where heroin was accessible and desirable.

This reminded me of Will Self talking about how he started taking heroin aged 17. "Sometimes, when I hear people without experience of addiction blame addicts for their behaviour I feel like saying to them: "You simply don't understand – how can a child be held responsible for doing such a dreadful thing to himself?" But then again, at other times I have to acknowledge: it was done wilfully. No matter how obscured they were by the fogs of adolescent self-deception, I was fully acquainted with the facts."

For Smith, being in an environment where an addict no longer has access to drugs matters a lot. In her case, psychiatric diagnoses and personal reflection didn't help her quit heroin. Only imprisonment, forced abstinence and a return to education did. Chen:

For Smith, free will is a spectrum, and yet many volitional behaviours get jumbled together under the label “addiction”, as if people with substance-use disorders have permanently lost control over their actions. She believes that although her desires, intentions and choices were constrained by factors that developed from continued drug taking – such as a lack of access to medical care, running out of money, being locked out of the university system – she maintains her behaviour was always the result of conscious decisions. For the same reason, she emphasises that lifelong cravings and relapses are not inevitable. Like everyone else, people who use drugs are “complex systems that can change”, and she believes that they should be held responsible for enacting that change.

Chen explains that "Smith belongs to a new generation of addiction scientists who are using their personal experiences to inform their research. Their focus is on helping people with substance-use disorders to identify the environmental factors that lead them to use drugs, and encouraging them to take action to change those factors."

It's been said that addiction support programmes like the faith-based Alcoholics Anonymous don't work for everyone. I don't know whether addiction is a disease, a series of choices, both or something else entirely. But I can't help thinking that for those attempting to recover from substance misuse, the more science-based approaches there are to choose from, the better for them and for all of us.