Addiction and Personal Responsibility: A Fundamental Conflict
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.
Previously we explained we lack certainty as to the precise cause of addiction. It follows there is a lack of consensus about the most effective approach to treatment as well. However, our discussion about the causes of addiction would not be complete without a discussion of personal responsibility. This issue of personal responsibility leads to a great deal of controversy about addictions. This issue of personal responsibility is not unique to addictive disorders. People who develop hypertension and heart disease because of obesity face similar difficulties. So do cancer patients who smoke cigarettes. What each of these have in common is some part of the illness is due to life-style choices; things we have control over. Other parts of these illnesses have to with genetics; things we don't have control over. This creates a problem with respect to personality responsibility. Who caused the problem? Who should fix it?
Brickman and colleagues (1982) have presented a useful analysis of personal responsibility. Their analysis reveals there are two fundamental questions:
Who is responsible for creating a problem?
Moreover, who is responsible for solving it?
These two questions yield four possibilities with respect to responsibility for personal problems:
The Moral Model: People are responsible for creating and solving their own problems.
The Medical Model: People are not responsible for creating or solving their own problems.
The Enlightenment Model: People are responsible for creating, but not solving, their own problems.
The Compensatory Model: People are responsible for solving, but not creating, their own problems.
The table below summarizes these four possibilities:
"I'm responsible for creating the problem, and I'm responsible for solving it."
What do I need to solve this problem? Proper motivation
Someone else might say: "It's your own fault, so I'm not going to help you. You need to solve this problem on your own."
Extreme, exaggerated version of this model: Faulty and distorted thinking such as "Everything that happens to me is my own fault." OR "I can solve all my own problems, I don't need anyone."
Healthy recovery application: "I decided to start drinking, and now I'm deciding to stop."
"I'm not responsible for creating the problem, but I'm not responsible for solving it."
What do I need to solve the problem?- Treatment, experts
Someone else might say: "You are ill. You need help."
Extreme, exaggerated versions of model: Becoming helpless and completely dependent upon others
Healthy recovery application: "I didn't plan on having these problems, and I have no idea how to get rid of them. I should follow the advice and suggestions of the experts who are trying to help me."
"I'm responsible for creating the problem, but I'm not responsible for solving it."
What do I need to solve the problem?- Self-discipline
Someone else might say: "It's clear you don't understand the true nature of your problems, so let me explain it to you."
Extreme, exaggerated versions of model: Becoming crippled and ineffective because of extreme guilt and self-loathing; complete submission to authority; blindly following others.
Healthy recovery application: "Looking back, I see what I did to cause my addiction and I've learned from my mistakes. Now I'm going to follow the guidance and direction of a greater authority that can show me how to change my life (completely if necessary)."
"I'm not responsible for creating the problem, but I am responsible for solving it"
What do I need to solve the problem? Knowledge, skills
Someone else might say: "I respect you for your efforts. Let me know if you need any help."
Extreme, exaggerated versions of model: Failing to recognize one's own limitations, grandiosity, stubbornly refusing help of any sort.
Healthy recovery application: "I sure wish I didn't have these problems. However, since I do, I'm going to figure out how to resolve them. I'll get some help if I need it."