The role of choice in the onset of addiction is keenly debated. The question is whether addiction is involuntary or a matter of choice.
No one we have so far admitted to rehab ever harboured the childhood ambition to become an addict when they grew up. Why on earth would anyone consciously opt for a life of dependency-based misery? We will, however, always be sure of admitting people to rehab whose personal choices have played a part in the development of their addiction or addictions. Those choices will not always have been as free and clear as they may appear to have been at the time. A faulty dopamine system in the brain may play some part.
A person may choose to take a mood-altering substance or to engage in behaviours that have addictive potential. They may decide to accept an alcoholic drink, snort a line of cocaine, inject heroin, place a bet or click onto a pornography site. They may or may not know the degree of their attraction or risk to them when they begin to do this and they will almost certainly believe that they can and will manage any risk they might be aware of.
For many that might be the case. For others, powering the conscious action may be an unrecognised need whose fulfilment is a matter of subconscious urgency. Such underlying urgency might also apply to assuaging the pain of unmet or abused need or to escaping from discomforts being consciously experienced. Something impels them to want to change the way they feel. They are attracted to a substance or behaviour for its ability to serve this purpose. So they make a choice; the consequence of which may, sooner or later, be addiction. Addiction may not rob the addicted person of choice altogether but it greatly impairs their ability to exercise choice freely.
The choice to give up the consuming relationship of addiction and to enter recovery is always available to the addicted person. Of course, it becomes increasingly hard to remember that it is and still harder to make that choice, let alone act upon it; such is addiction’s enveloping grip.
The decision to enter recovery has to be a conscious one. It comes in the form of some variation on the theme: “I have to change my life.” Although what is called spontaneous or natural recovery does occur, it still requires the choice not to do one thing and to do something else instead.
A single choice may be the beginning of recovery but it must be continually reinforced. With the ever-present subversive potential of addiction ready to take advantage of any vulnerability, recovery requires healthy choices to be made moment by moment. Recovery is very much a matter of choice and choices in recovery matter.
