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Then what role does choice play?

In my mind it plays at least two critical roles: one in prevention and one in recovery. Prevention is particularly important in the younger than 25 yo brain developing years when the brain is more susceptible to entrenched damage from SUD. This time is even harder due to the natural and healthy adolescent urge for adventure, wing stretching, and independence pursuit. Greater risk-taking accompanies this stage pairing a greater vulnerability physically with reduced resources mentally. Guidance and open discussion are fundamental to helping young people make healthy long-term choices in this arena. On reflection, I think that we did not discuss the dangers of substances sufficiently because we never imagined they would be appealing to our kids given their upbringing and family environment. We thought sub-consciously that we were immune to this problem. Perhaps if we had regular conversations Joel would have been more protected from his innate vulnerability. (See Jessica Lahey’s book Addiction Innoculation if you have young kids.)

The second critical role of choice is choosing recovery. The cruelty of this disease can be seen in that it breaks the decision-making apparatus of of brains disabling the volition needed to gain the desired freedom from the substance. There is a bitter irony in that while 60% of the vulnerability to SUD is genetic and totally out of an individual’s control, treatment success is dependent on their ability to behave as if they have 100% control through using their damaged reasoning and choice making. We, our individual attitudes forming the societal attitudes underlying our institutions and protocols, can help dramatically, easing the path to earlier and thus more long-term successful treatment.

Having worked in this community for more than I decade I can state confidently that every person suffering from SUD wants to break free from the substance once they realize it controls them rather than they control it, that it is destroying their lives. The substance’s effect on the brain hides this realization though. There is one tragic exception that I have seen, that is the long-time addicted persons who have struggled mightily to become free of their addiction but have repeatedly failed, often because they cannot access the help they need, that give up and are just waiting for death to end their hell. My question to us all that are free from SUD, are we not here in the US a better society than to allow that? Is that who you want to be? Will you see a drowning person and walk on by with the suggestion they learn how to swim, or they should not have made the choice to get so close to the water? When you fall in the water over your head in some other area of your life, is that how you want to be treated? How about your child? Stigma kills; let’s stigmatize the agents of the disease, not the person who has it. We will all benefit.


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