Jumping From a Burning Building
Looking deeper yet, we can discern more subtle aspects of the functioning of free will and self/species-preserving systems. Under desperate conditions, humans do things they could not imagine under normal conditions. Members of the Donner party commited acts of cannibalism. People regularly jump out of high windows to escape fire. Under crisis conditions, we are able to make rapid calculations as to the most likely path for survival. My work with adults who were subjected to extreme abuse as children has indicated that this capacity for prioritizing between terrible choices is available at an early age.
Applying this observation to the phenomenology of alcoholism elucidates more about the process of "hitting bottom." In a study of 400 inner-city men, researchers found that alcoholics who become sober do so suddenly under the influence of some crisis situation (Vaillant and Milofsky, 1982). Employee assistance programs and professional assistance programs employ a strategy that frames a crisis such that the alcoholic must choose between loss of job and recovery. Faced with such a choice, alcoholics and addicts will choose the first steps toward recovery, even if it is in the hope of soon returning to "normal."
If alcoholics can see what is best for them, then why do they continue to drink in the face of obvious negative consequences? The defensive bulwark that their self-preservative systems erect against all influences for change is sufficient under most conditions to maintain the addiction, but it can be breached. Alcoholics sometimes experience a sudden spontaneous awakening. For instance, one patient found himself in a gutter outside a bar and was struck by the gap between his self-concept and the reality of his behavior. A mother hit rock bottom one day when she realized that she would be too drunk to get help for her child if her daughter became ill in the night.
The technique of planned intervention makes use of both force of numbers and surprise to maximize the chances of breaching defenses. The number of concerned people confronting the alcoholic seems to increase its effectiveness. The surprise of the intervention itself is further enhanced as the subject does not face the "attack" that they expect. Instead, those assembled express their personal experiences with, and feelings and concerns for, the alcoholic. The technique is aimed to create optimum conditions for habitual defenses to be breached.
The desired outcome of the intervention or hitting bottom experience can then be reached: The addict becomes at least outwardly willing to do whatever is necessary to achieve abstinence. To understand the whole phenomenon, we need to take into account both the element of choosing the lesser evil in a crisis, and the breaching of habitual defenses. Interestingly, the greater the element of crisis, the less of an impediment are the defenses, though the relative proportions vary widely between individuals.
Obsession and Insanity
A final observation about the behavioral control system that we call free will comes from anyone who has attempted a diet. After initial success in dieting, the strength and flexibility of the self-preservative system is revealed. When the brain is told it doesn't need more food, its reaction is more sophisticated than simply creating an increased desire for food. Soon, there is a tendency to obsess over food. The more the deprivation continues, the more obsessed we become.
Next, we find ourselves subject to alterations in our rational thinking. The jagged edge of a cake, which was not troublesome before, is now intolerable. We must recut the edge, but this time the cut is at the wrong angle and requires further correction. Soon comes the shameful realization that the cake has been completely finished. What happened? The self-preservative system was able to override good judgment and make some quite implausible thoughts seem rational.
Let us consider the possible species-preservative nature of these sophisticated mechanisms. The hunter-gatherer, who is weak from hunger and lacks the strength to venture out, must possess means of motivation to perform acts beyond endurance. While speculative, it seems quite reasonable to infer that the need for self-preservative systems is capable of creating obsessive goal-directed thinking and overriding reason when necessary. When these characteristics are applied to a system that is no longer serving the best interests of the individual, the result is, as described in The Big Book of Alcoholics Anonymous, "Cunning, baffling and powerful" (Alcoholics Anonymous, 1976).
Acknowledging that alcoholics have compromised their free will helps in working with them, both before and after initiation of recovery. Professionals working in the addiction field know that alcoholics do not need to come into treatment on a strictly voluntary basis in order to be successful. In fact, patients who present voluntarily for treatment are often more likely to leave treatment under the influence of their compromised free will.
Treatment offered in lieu of negative consequences may be a necessary counterbalance to the power of a compromised free will. Unnecessary coercion is usually destructive, but insufficient use of leverage is even less responsible, as it overestimates patients' ability to exercise free will in their own best interest. As the slogans of recovery so forcefully remind us, an alcoholic who tries to do it "on his own" is in serious danger.
The stress of realizing that one has lost control over one's own life (AA calls this unmanageability), along with the loss of the substance, creates an intense neediness that favors group bonding. The substitution of people for substances allows alcoholics to shore up their compromised free will with the power of the group. Over time, the result is a gradual healing of the free will as described above, until the influence of the addiction is at a minimum and the alcoholic's will is almost fully free.
Question of Complete Abstinence
Does this way of looking at alcoholism contribute to the debate about whether complete abstinence is necessary? For most people who have experienced the terrible loss of control over alcohol and their lives, the answer is rather simple. Within the powerful magnetic field of addiction, it is much harder to maintain clear thinking with shades of gray. If alcoholics give themselves permission to drink "a little," then the once-compromised behavioral control system will have a very hard time avoiding corruption by some seemingly rational idea that really represents the tug of the addiction. Similarly, the well-meaning physician's prescription of an addictive substance, especially members of the pharmacological class of sedative hypnotics (including ethanol, benzodiazepines, barbiturates and meprobamate, among others), is experienced by the alcoholic as a tease, opening the doors to uncontrolled use.
Not Guilty but Responsible
It is clear that after initial resistance, alcoholics do respond positively to being held responsible for their actions and, in contrast, get worse when they are relieved of responsibility. At the same time, the concept of guilt should not be applied to a condition characterized by compromised free will. Thus, returning to the issue of policy, clinical observation and the notion of compromised free will would suggest the need for a new category: Not guilty but responsible.
Inherent in this view is the idea that we are seeing self/species-preservative systems functioning normally, but with abnormal inputs. Viewing an alcoholic in trouble in this way puts the behavior in perspective and avoid the understandable but unhelpful reactions of anger, ridicule and well-meaning enabling.
Alcoholics Anonymous (1976), 3rd ed. New York: Alcoholics Anonymous World Services Inc., pp 58-59.
Vaillant GE, Milofsky ES (1982), Natural history of male alcoholism IV. Paths to recovery. Arch Gen Psychiatry 39(2):127-13