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Addiction and ChoiceRethinking the relationship$
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Nick Heather and Gabriel Segal

Print publication date: 2016

Print ISBN-13: 9780198727224

Published to Oxford Scholarship Online: November 2016

DOI: 10.1093/acprof:oso/9780198727224.001.0001

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How an addict’s power of choice is lost and can be regained

How an addict’s power of choice is lost and can be regained

(p.365) Chapter 20 How an addict’s power of choice is lost and can be regained
Addiction and Choice

Gabriel Segal

Oxford University Press

“[M]‌ost alcoholics … have lost the power of choice in drink. Our so-called will power becomes practically non-existent” (Alcoholics Anonymous). In active addiction, when an addict who is trying to control or cease using attempts to choose to abstain, but fails, he chooses against his own will. He has lost the power to choose as he wants. Often, when an abstinent addict relapses, the relapse is preceded by a cognitive dysfunction that selectively disables his willpower in relation to his substance. These modes of disempowerment in choice making are correctly explained by a specific disease theory of addiction, articulated in the literature of Alcoholics Anonymous, and subsequently vindicated by contemporary cognitive/affective neuroscience. The cognitive dysfunction that precedes relapse is caused by stress. Twelve-step programs are effective at relapse prevention and are so because they are comprehensive stress-reduction and management programs.

Keywords:   addiction, Alcoholics Anonymous, twelve-step programs, stress, relapse, willpower, disease

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