Compare these two quotes from Dr. Leshner.
The first is from an article he published in the JAMA, Oct. 13,
1999 (an equivalent statement is in his Science article, Addiction
is a Brain Disease, and it Matters, Science, vol. 278, pages 45-70,
10/3/97), and the second from his current web page at NIDA
These are from his discussion of his Hijacked Brain Hypothesis
of addictions, his theory of addictions.
"Although the onset of addiction
begins with the voluntary act of taking drugs,
the continued repetition of voluntary drug taking begins to change
into involuntary drug taking, ultimately to the point that the
behavior is driven by a compulsive craving for the drug,"
"We now know that while initial
experimentation with drugs may be voluntary, continuing
drug abuse changes the brain in fundamental and long-lasting ways.
These brain changes trigger the compulsive drug-seeking and drug-taking
behaviors that are the hallmarks of drug addiction."
You'll notice the change from "begins
with the voluntary act," to "may
be voluntary." This change seems small but is actually
galactic. It is the first recognition that even the first use
of a drug, leading to addiction, is (may be) involuntary. On the other hand, the change to "may be voluntary" may just be a figure of speech and not signify any change in his concept of the volitional nature of the first drug use. Being an optimist, that there is intelligent life in the universe, I will assume the former explanation and move on while waiting for a response from my e-mail to him (below).
What does this differentiation mean?
It means that there are people whose drug use is inexorable and
involuntary from the start. The implication of this is staggering
and is actually one of the tenets of the Hypoism paradigm, although
Leshner doesn't know about Hypoism because he has ignored all
my attempts to inform him about it. The distinction between is
and may be voluntary is a recognition that choice
and control are impossible, just as Hypoism states. The whole
issue of free will, for that matter, is up in the air when it
comes to addictions and use of addictors for hypoics. I think
there is no free will in addiction etiology. Hypoics are born,
not made. The new take on the involuntary nature of the first
use makes it clear that the drug war, prevention efforts, and
criminalization and punishment of addicts is not only useless
but inappropriate. It changes the emphasis onto the addict's brain
before the first use rather than on his brain after the first
use, an enormous change of emphasis. It also de-emphasizes the
importance of the drugs and other addictors (prohibition and drug
war) as is demanded in the Hypoism paradigm and places the emphasis
correctly on early diagnosis of Hypoism followed by early recovery,
as in any genetic and involuntary disease, the only effective
means of prevention of a disease's symptoms, in this case, addictions.
Moreover, and equally as important,
this distinction means there is something behind addictions, even
the first use of the addictor: a mechanism in the brain that makes
certain people, use addictors against their will and get addicted.
This idea, of course, changes responsibility for having the disease
of addiction and getting addicted from personal to neurobiological.
Not only is this change important for relief of guilt and remorse
from the victim, but also is helpful to destigmatize, remove denial,
and to allow the person to get into recovery at the earliest possible
Something behind addictions? Yes, a
neurobiological mechanism that drives people with the correct
pathophysiology to seek out addictors unconsciously, use them
to change how they feel, and get addicted per force.
This discussion continues in the article
on this web site called The Third Millennium N4A Conference Keynote
Address on Hypoism. A similar discussion of the Hijacked Brain
Hypothesis is in the Hypoism Magazine section of this page called
#8 Critique of Alan Leshner's (NIH) Hijacked Brain Hypothesis.
Please read them if you haven't yet. Both were written before
he made the above change in his statement on the voluntary nature
of the first use of the drug. I have e-mailed him today about
my congratulations on his change of orientation:
I was heartened and excited to see that
you changed the statement of initial drug use by addicts from
"is" to "may be" voluntary in your home page
discussion of addiction. Could you please tell me how and why
you made that change? It may be the beginning of the most important
realization about the role of free will (or lack thereof) and
volition in the field of addictions. As you will learn, if you
choose to read about my Hypoism addiction paradigm, inexorability
from the getgo is a key and essential element in the genesis of
addiction in those who are the real addicts. My neurobiological
paradigm categorically clarifies the essentially unconscious nature
and brain location of the mechanism that is etiologically responsible
for all addictions: to substances, behaviors, and beliefs. One
of the basic reasons why addiction is so confusing is due to this
unconscious as opposed to conscious mechanism. The implications
of this differentiation are clearly discussed in my book, Hypoic's
Handbook, that discusses all aspects of the Hypoism paradigm from
the neurobiology, physiology, genetics, animal addictions, etiology,
natural history, course, recovery, to policy for addictions. I
have attempted to inform the addictionology community for many
years about Hypoism, but have been ignored. My paradigm is, I
believe, as close to the neurobiological reality of addictions
as is possible today. Until the paradigm is changed to one that
comprehends the "involuntary" nature of addictions based
on the physical location of the brain mechanism responsible for
both the initiation and maintenance of addiction, we will make
no headway into improving recovery and policy, and even more so
for prevention. I would ask you to read three articles on my web
page whose url's I include. If these interest you, maybe you'll
read the book. I hope so. I'd be happy to discuss all this with
you at any time. I believe there really is a solution to addictions,
but one that is not based on the current paradigm. In fact, it's
diametrically opposite to the current paradigm. Much of its difference
is the realization of the difference between "is voluntary,"
and "may be voluntary." My paradigm, when accepted and
taught to the country, will do for addictions what the discovery
of microorganisms did for infectious diseases. I hope you have
an open mind.
Well---You can ignore this article as evidence for Leshner changing his concept of the word VOLUNTARY. I just today heard him speak at the DEA conference on club drugs and he clearly and explicitly stated, "Initial drug use is voluntary." So, this article will stay on the web site just to clarify anyone's query concerning the above quote by him at the beginning of the article.