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  • Common Sense, Science, and ‘Spirituality’
  • Gabriel M. A. Segal (bio)

Disease, stress, Alcoholics Anonymous, serenity

I would like to take this opportunity to thank Heather (2013) and Graham (2013), my friends, for their generous help while I was writing the paper and for their commentaries.

On close examination, alcoholism looks like a mental disorder. Severe alcoholism certainly does. The alcoholic’s desire- and belief-forming systems are functioning in a most abnormal and disorderly way. From a computational perspective, a desire-forming system has a software bug. The severe alcoholic is psychologically very ill indeed. The reason he acts like a lunatic is that he is one.

This may matter because sick people deserve benefits and time off work. It also matters because the alcoholic can often be forgiven for behaving as he does. He is ill. He really does not wish to be as he is, or to act as he does. He often drinks very much against his will. He really does not want to make the choices he makes. He wants to choose not to drink, but fails. ‘Wanting’ a drink is rather like itching: imagine itching badly all the time and trying not to scratch. Sometimes the persistence and power of the urge simply overcomes all resistance. And other times it is because of a major cognitive breakdown, a failure of memory or some genuinely crazed thinking. The alcoholic’s decision-making system is wrecked by the disease.

The social learning paradigm does not work. Alcoholics are not taught to drink in school. And humans do not acquire behavioral dispositions by processes of Pavlovian or Skinnerian conditioning. Incentive-sensitization is much more than a permanent S-S or S-R link. How much a cue will make an alcoholic ‘want’ to drink depends on his general state of mind at the time. Pavlovian conditioning or connection strength is an important factor, but not the only one.

There are no strict or precise laws or even interesting ceteris-paribus generalizations governing human behavior or governing the acquisition of the link between stimulus and ‘wanting’ through any so-called reward-learning process.

Very similar profound methodological problems best Heyman’s behavioral-economics framework. The amusing graphs he produces to model choice-making behavior do not correspond with anything in the minds or brains of human beings. Hence, the models have little chance of predicting behavior accurately. And they do not. To understand human behavior, it is necessary to look at the psychological and neurological mechanisms controlling it. That is hardly surprising and has been a lesson in psychology since Chomsky (1967) so successfully applied the idea in his critique of [End Page 325] B. F. Skinner’s behaviorist approach to human linguistic behavior. To understand both language acquisition and language use, one needs to understand what is in the minds and brains of speakers. Exactly the same goes for the acquisition of habits of excessive drink or drug use, and drinking and using behavior itself. Common sense tells us that, and science agrees completely.

Alcoholic drinking in general results from a spectacular failure to learn from previous mistakes and from what one has been told (compare Hyman 2005). Alf, in fact, had 6 months of cognitive-behavioral therapy and motivational interviewing, with the aim of learning to control his drinking. He spent the 6 months trying to unlearn his drinking behaviors and learn to make the sensible non-drinking choices instead. This strategy failed and a few months after that, he was drinking as much as ever. He later joined Alcoholics Anonymous (AA). The twelve-step program works by teaching the member to deal with the real triggers for drinking: distressing emotions. He learned to deal with these by healthy, natural methods, and lost his desire to drink completely.

Stress caused by turbulent emotions is the main cause of the problem. The alcoholic begins to experience problems in work and relationships, and his physical and mental health deteriorate. This causes stress, which causes more drinking, which causes more stress, and the alcoholic is in a vicious spiral of decline.

Stress is what causes relapse. It sets off ‘wantings’ that adversely affect the subject’s memory and their...


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pp. 325-328
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