The decision to self-bind is made during calmer moments when addicts are not in withdrawal or experiencing strong desire to use. And addicts have many of these moments; as a rule, they do not spend all their time nodding out or in a frenzy to obtain more drugs.
No one would choose the misery that comes with excessive use. “I’ve never come across a single person that was addicted that wanted to be addicted,” says neuroscientist Nora Volkow, director of the National Institute on Drug Abuse and an enthusiastic booster of the brain-driven model of addiction. It is true, drug users don’t choose to become addicted any more than consumers of high calorie foods choose to become overweight. But addiction and poundage is not what they are choosing: what they seek is momentary gratification or relief—a decision that is rational in the short-term but irrational in the long-term.
A typical trajectory goes something like this. In the early phase of addiction, using drugs and alcohol can simply be fun; or it can be a form of self-medication that quells persistent self-loathing, anxiety, alienation, and loneliness. Meanwhile once-rewarding activities, such as relationships, work, or family, decline in value. The attraction of the drug starts to fade as the troubles accrue—but the drug retains its allure because it blunts mental pain, suppresses withdrawal symptoms, and douses craving.
Eventually, addicts find themselves torn between reasons to use and reasons not to. Sometimes a spasm of self-reproach (“this is not who I am;” “I’m hurting my family,” “my reputation is at risk”) tips the balance toward quitting. Novelist and junkie William S. Burroughs calls this the “naked lunch” experience, “a frozen moment when everyone sees what is on the end of every fork.”
In short, every addict has reasons to begin using, reasons to continue, and reasons to quit. To act on a reason is to choose. To make good choices requires the presence of meaningful alternatives. And making a series of good choices leads to achievements—jobs, relationships, reputations. These give a person something meaningful to lose, another reason in itself to steer away from bad choices.
In his book, Hart uses his own story to breathe life into what may sound like a sterile lesson in behavioral economics. He grew up in the 70’s in the benighted Carol City in south Florida, facing poverty, racism, domestic violence, bad schools, guns, and drugs. Hart himself stole and used drugs (though he was never addicted) and peddled marijuana. Yet he ended up thriving due to the many alternatives to drugs in his life. He calls these “competing reinforcers”—high school sports, educational opportunities, and mentors. Hart wants all young people raised in despairing circumstances to have those too.
Combating social ills on such a grand stage may be a pipe dream. But, in the realm of recovery from alcohol and drugs, the principle of competing reinforcers has been scaled down to size and is being replicated across the country. Take HOPE (Hawaii Opportunity for Probation Enforcement), a jail diversion program in which addict-offenders are subject to short periods of detention if they fail drug tests., but receive a clean corrections record if they complete the year-long program. One year after enrollment, HOPE participants were 55 percent less likely to be arrested for a new crime and 53 percent less likely to have had their probation revoked than those in a control group.