To say that addiction is a type of illness need not be to say that addicts are not responsible for what they do, says Sean Walsh. The active alcoholic is constrained by their illness. But freedom and responsibility are consistent with constraint. And acceptance of responsibility is a necessary condition of recovery.

I know very little about the situation of Ant McPartlin, save that it seems to me that the right attitude towards that situation should be not one of judgement but of prayer. I do know something about what it is like to be an active alcoholic. There was a point in my life -and it was not that long ago- when I had drunk myself and my six-year-old child homeless. As a result, one evening my little boy was placed in the back seat of a strange car and driven 100 miles to be looked after by my family which (for good reason) found me too dangerous to have any contact with. As the car pulled away my first and overwhelming feeling was one of gratitude to that social worker for giving me some time away from my child so that I could carry on drinking. I was what is known in some circles as a “still suffering alcoholic”.

Suffering from what exactly?

I believe alcoholism (and addiction in general) to be an illness. The claim is not uncontentious. To claim that addiction is illness seems for some to let the addict off the hook. Surely the addict’s behaviour cannot be explained without some reference to responsibility? Surely even the active alcoholic is free to make choices, and it is those choices which have ultimately delivered her into ostracism, penury and (as in my case) homelessness? I agree with the critic to the extent that any analysis of the phenomenon of addiction must include reference to core notions of choice and responsibility. But this does not mean that addiction is not an illness. We can offer to the critic a model of addiction in which notions of illness and responsibility are included; and a model of recovery in which they are successfully combined.

Why should it be otherwise? The critic’s mistake, as it seems to me, is in assuming that an action being caused entails that it cannot be free. If my alcoholism is an illness then (the critic argues) when I drink my “choices” are consequences of the illness and in being so caused they cannot be free choices – since they are causally constrained. And freedom, if it is anything, is “absence of constraint”.

Or is it? Aristotle and his successors all the way to the Enlightenment worked with a richer conception of what is a “cause” than the mechanistic notion we are used to today. He argued that causes are not merely efficient (in the sense of bringing certain things about) but also final (in the sense of ordering the world in the direction of certain ends). Human persons and their choices share in this “final causality”. On the very first page of his Confessions, St Augustine addresses his God with the following remark: “You made us for Yourself, Lord, and our hearts are restless until they rest in Thee”. The thought here is not merely interesting theology but important moral psychology. Human persons have a need for happiness but such happiness cannot be found in filling our lives up with the ephemeral satisfaction of money, power or pleasure. Happiness involves a realisation that we are finally caused to be directed to ends that transcend those satisfactions.  Freedom is not, in this model, absence of constraint but involves a “movement of the will” away from the self in the direction of those ends to which we are ordered. We are meant to be a certain way. We are free to the extent that we strive to realize that end. Addiction, like all sin, is literally a form of disorder in that it traps the addict within the prison of the self, and runs up against that freedom. The addict does suffer therefore from a type of illness, albeit of a spiritual kind. And her freedom is not only consistent with her being ill, it is actually part of the structure of that illness.

The founders of Alcoholics Anonymous would rightly have baulked at the claim that they had constructed anything like a “metaphysics of addiction”. But I suggest that they did and that this is pretty much it. The AA Fellowship came about when one of its founders was away on an unsuccessful business trip and had a sudden understanding that in order to stay sober that night he needed to speak to and help another alcoholic. The very first Step of the AA 12 Step recovery program (the one we have to practise perfectly) asserts that we admit that we are powerless over alcohol. From this admission the program outlines that we alcoholics must live like this on a daily basis: that we must trust God (however we choose to understand that term), clean house (ethically speaking) and help others. This is an illness model of addiction built out of the core notion that to be sober we must be responsible and that responsibility involves a systematic looking away from the self in the direction of others, whether they are alcoholics or not.

This is a model not simply for sober living but for decent living. We are all of us “finally caused” to turn away from the self to the other, and freedom involves acceptance of constraint rather than the absence of constraint.  We alcoholics are lucky to have this model. And it gave my son his father back.

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