Why is stigmatization in the case of drug addicts so wrong, according to Dr. Volkow? Because addiction is a disease, and nothing else. According to Dr. Volkow people resist this idea, and falsely believe “that willpower should be sufficient to stop drug abuse”. After all, if you give drugs to rats until they are addicted, they will pursue them to the exclusion of all else, to their own detriment and even to the point of death. Moreover, you can show that there are changes in their brains by comparison with non-addicted rats.
Thus an addict has roughly the same metaphysical status as an addicted rat. He does what he does because, like Luther, he cannot do otherwise. He is a slave of his biochemistry, he is a Zombie whose master is his habit. To blame him for his behaviour is like blaming a leper for his leprosy.
This is all the most lamentable bilge, of course. When you consider what heroin addicts actually have to do to become heroin addicts it is clear that, at least to begin with, they want to be heroin addicts, it is not something that just happens to them or creeps up on them unawares. For example, they have to learn where to get their heroin, how to prepare it, and how to inject it (most people have an aversion to sticking needles into themselves and have to overcome it). They have to learn to disregard or overcome such side-effects as nausea, which is normally extremely aversive. Most of us would go a long way to avoid nausea. As a matter of fact, most addicts take heroin intermittently for some time before taking it regularly. The expression “hooked” is implicitly a lie; the addict has hooked heroin, not the other way round.
Still, it might be argued that, having become addicted, the addict loses all powers of control, but this too is not so. The experience (among many others) of American soldiers returning from Vietnam, who addicted themselves to heroin while there, proves it. They swiftly ceased to be addicts on their return to the US, notwithstanding all of Dr. Volkow’s neurocircuitous and neurochemical blather.
Theodore Dalrymple, “Stigma and Sympathy”, The Iconoclast, 2020-09-23.
June 23, 2026
QotD: Addiction
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