Recently I listened to the author of Addiction: A Disorder of Choice, Gene M. Heyman, interviewed on the Tom Ashbrook show. A lot of the discussion revolved around the term “disease”, which I can’t really comment on, but a great deal of Heyman’s thesis is grounded in rather conventional behavior genetic insights. In short, a behavioral trait can have a host of inputs, and is often a combination of environment & genes developing over a lifetime. Alcoholism is not much of an issue among observant Mormons because of their environment, not their genes. Heyman points out that whereas some behavioral phenotypes, such as schizophrenia or autism, are extremely difficult or impossible to cure through one’s own personal choice (i.e., for schizophrenia you may need medication, while many autistics are what they are no matter the drug or environment), addiction therapy can work and so change the expression of the trait. Additionally he makes some important criticisms of the methodologies of clinical studies of addiction which seem important to me, primarily that there is a strong selection bias in these samples which overstates the inability to control impulse in individuals prone to addiction (similar problems probably resulted in an overestimate of the concordance for homosexuality among twins).
But the bigger issue is the same as the one that crops up with obesity, what role does personal responsibility and public policy play? Many of the critics of Heyman seem to be suggesting that he is reverting to blaming someone with an illness. The fat acceptance movement makes similar arguments. These issues, and the fact that policy and culture revolve around them, mean that we have to begin to rethink our conceptions of free will, choice and decision making. It isn’t about people being good, bad, irresponsible or moral, it is people being who they are, and confronting the cards they’re dealt.