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What aspects of alcoholism are voluntary or involuntary?

The assessment of whether any human behavior is voluntary or involuntary has both ethical and scientific implications. Historically, the study of psychology was originally regarded as a moral science, whereas the behavior of all other nonhuman organisms and inanimate objects was regarded as part of the natural sciences. This division seemed logical because humans act based on conscious voluntary deliberation, whereas all other things appear to act in a more mechanical involuntary manner. To some degree, that general belief and separation remain true today, illustrating science and society's continuing struggle to separate human behaviors that are a result of natural causes (involuntary) from those that are a result of choice (voluntary). As science continues to advance, the line separating these two alternatives is becoming increasingly blurry; however, every society's ability to function effectively and with a sense of fairness requires such distinctions be made. This is important because if a socially undesirable behavior is regarded as voluntary, then the person behaving in that manner should be held responsible for his or her actions and punished appropriately. If, however, his or her undesirable behavior is involuntary, it should be excused and prompt society to treat the person humanely in a manner that provides care and relief.

The distinction is easy to make when behavior occurs as a result of a specific pathological process, such as a brain tumor or a seizure, or when someone commits fraud, as the recent Enron trial demonstrated. What if the behavior, such as alcoholism, blurs the boundaries, however? Convincing someone that alcoholism is a disease appears to be, on the surface, a bit of rhetorical spin, especially when voluntary abstinence is the treatment of choice for a problem that argues that the choice to drink is not voluntary in the first place. The transition of an individual from a social drinker to an alcoholic, when there is no overt pathophysiological evidence of a disease, continues to invite a great deal of societal anger. This transition can be complicated and difficult to define because it is based on a pattern of behavior that many people can identify with because they too have had a drink in their lives, and it appeared to be a matter of choice when to stop, hence the notion of moral failing.

The courts generally rely on psychological theories of behavior to help them distinguish between behaviors that are voluntary from those that are involuntary. As noted in Question 9, psychological theories of behavior rely on learning theory The courts define voluntary behavior as behavior that responds to rewards and punishments, whereas involuntary behavior is defined as the result of a response to eliciting stimuli. This makes sense for the simple fact that the courts enforce the law by prescribing punishments to those who break it and thereby (hopefully) providing an incentive to not break the law in the future. This is essentially the difference between operant and classical conditioning in that operant conditioning is thought to be voluntary and classical conditioning involuntary.

Convincing someone that alcoholism is a disease appears to be, on the surface, a bit of rhetorical spin, especially when voluntary abstinence is the treatment of choice for a problem that argues that the choice to drink is not voluntary in the first place.

Eliciting stimuli plural for eliciting a stlmulus. It is a trigger that elicits an involuntary or automatic response.

Alcoholics also have very strong reactions to eliciting stimuli, such as evoking overwhelming cravings when passing a favorite bar, meeting up with a drinking buddy, or having the smell and taste of a particular drink.

Alcohol dependence is highly rewarding as well as acting strongly in a manner that generates various eliciting stimuli ultimately prompting automatic responses. Both operant and classical conditioning effects act in concert so that the degree of influence on the behavior as voluntary verses automatic is difficult to determine. Studies repeatedly demonstrate that people with severe addiction problems do respond to rewards and punishments just as people without addiction problems do, but to a significantly lesser degree, especially when those rewards/punishments are competing with the highly rewarding addictive substance. Alcoholics also have very strong reactions to eliciting stimuli, such as evoking overwhelming cravings when passing a favorite bar, meeting up with a drinking buddy, or having the smell and taste of a particular drink. In fact, eliciting stimuli can even provoke such negative reactions as withdrawal symptoms even after someone has been successfully detoxed on an inpatient setting and they enter a place where those withdrawal symptoms began. For example, to understand these feelings better, imagine going without water for a day or food for a week. The thirst and appetite centers would become so strong as to focus centrally and to prompt you to act in any way that can satisfy your thirst or hunger. This has great survival value, but alcohol has essentially highjacked that part of the brain so that it responds more intensely to alcohol than any other reward or punishment.

If we are to answer the question more thoroughly, other factors need to be considered when determining whether any particular alcoholic's drinking is voluntary. These include a number of issues: (1) The more impaired someone is intellectually, the less voluntary his or her behavior can be. This is why society and the courts generally do not regard the mentally retarded or minors as responsible as normal adults. (2) The more reactive someone's emotions are to trivial incidents, the less voluntary their actions can be in response to their emotional states. (3) The more the need to relieve pain drives the craving for alcohol, the less voluntary the behavior can be. (4) The more restricted the choices one feels that he or she has, the less freedom he or she has to act otherwise. (5) The more universal the patterns of responses are, the more apt they are part of a process that transcends individual choice. (6) The more detrimental the behavior is to one's health and survival, the less voluntary it is. (7) Finally, how ingrained and unchanging the behavior is despite attempts to modify the behavior with various consequences, the less voluntary it is. All of these factors play a role in how voluntary one's alcoholic behavior is. People undoubtedly choose to drink, but no one chooses to be an alcoholic.

Delirium tremens (DTs) an acute withdrawal syndrome from alcohol that frequently occurs In alcoholics who have a 10-year (or more) history of heavy drinking.

Susan's comment:

The notion of "eliciting stimuli" is hard to imagine, but I have watched it happen. For example, being in a hospital setting seems to exacerbate Bens withdrawal symptoms. After pouring a toxic substance into his body with little to eat for days and subsequently stopping, Bens body is completely depleted — like a car running out of gas. Interestingly enough, Bens surroundings directly impact the severity of his symptoms. The progressive nature of the disease, along with "kindling (Question 66), has resulted in his suffering from serious delirium tremens (DTs) (see Questions 63 and 64). This condition, however, has only manifested itself in the hospital setting. During the times that he takes Ativan and withdraws at home, I watch very carefully for signs that he may be headed "off the reservation," but it doesn't seem to happen. There may be a lot of reasons for that, but I believe that the hospital setting elicits his anxiety much worse than the home environment.

 
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