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Addiction: A Disorder of Choice [Hardcover]

by Gene M. Heyman
4.3 out of 5 stars  See all reviews (15 customer reviews)


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Book Description

June 15, 2009 0674032985 978-0674032989 1

In a book sure to inspire controversy, Gene Heyman argues that conventional wisdom about addiction—that it is a disease, a compulsion beyond conscious control—is wrong.

Drawing on psychiatric epidemiology, addicts’ autobiographies, treatment studies, and advances in behavioral economics, Heyman makes a powerful case that addiction is voluntary. He shows that drug use, like all choices, is influenced by preferences and goals. But just as there are successful dieters, there are successful ex-addicts. In fact, addiction is the psychiatric disorder with the highest rate of recovery. But what ends an addiction?

At the heart of Heyman’s analysis is a startling view of choice and motivation that applies to all choices, not just the choice to use drugs. The conditions that promote quitting a drug addiction include new information, cultural values, and, of course, the costs and benefits of further drug use. Most of us avoid becoming drug dependent, not because we are especially rational, but because we loathe the idea of being an addict.

Heyman’s analysis of well-established but frequently ignored research leads to unexpected insights into how we make choices—from obesity to McMansionization—all rooted in our deep-seated tendency to consume too much of whatever we like best. As wealth increases and technology advances, the dilemma posed by addictive drugs spreads to new products. However, this remarkable and radical book points to a solution. If drug addicts typically beat addiction, then non-addicts can learn to control their natural tendency to take too much.


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Editorial Reviews

Review

This is an important book. In clear and compelling prose Heyman lays out evidence from real-world observation and psychological and pharmacological laboratories that addiction is a choice not a disease. He shows that the causes of addiction, its control, and its potential reduction are the same as the causes, control, and reduction of all voluntary behavior. The book has the potential to revolutionize the behavior of anyone involved in the control of addiction including, most importantly, addicts themselves.
--Howard Rachlin, author of The Science of Self-Control

Most medical practitioners believe that addiction is a disease. By showing that self-destructive drug consumption actually responds to information and incentives, Gene Heyman's path breaking book should make us rethink our conventional, and inadequate, drug policies.
--David Laibson, Harvard University

The idea that addiction is a disease is an article of faith in the study of drug and alcohol dependence, providing the foundation for much of the treatment and public policy related to addiction since the early 1900s. In [Addiction], psychologist Gene Heyman dismantles this time-honored assumption, arguing that addiction is first and foremost governed by personal choice, and does not therefore fit clinical conceptions of behavioral illness.
--Charlie Gillis (Maclean's 2009-05-26)

We have a justice system that treats drug use as a malevolent act of will (to be punished) and a medical profession that treats it as an unfortunate disease (to be cured). Who is right? In a magnificent new book, Addiction: A Disorder of Choice, Gene M. Heyman, a lecturer in psychology at Harvard Medical School, argues that it is not his fellow medical professionals...Heyman shows that the ordinary dynamics of human decision-making are sufficient to bring addiction into line with what we know about other, non-addictive behaviors..."No one chooses to be an addict," as the saying goes. Mr Heyman shows that this is wrong--or at least that this is the wrong way of getting at the problem...Maybe nobody would choose to be an addict. But being an addict is not what substance abusers are choosing. They are choosing a momentary action, not a lifetime identity. This is a rich book that reverberates far beyond the field of addiction studies. Attentive readers will find in it lessons about debt-financed consumerism, environmental spoliation and the whole, vast range of self-destructive behavior that we engage in out of self-interest.
--Christopher Caldwell (Financial Times 2009-06-12)

Psychologist Heyman argues that addiction involves no "involuntariness" or "compulsiveness," but that addicts tend to use "local book-keeping" instead of aiming at a "global equilibrium." So for them, the (rationally) anticipated pleasure of the next dose weighs more than the (rationally) anticipated pleasure of a drug-free week, or month, or life. (Compare a dieter who scoffs a chocolate cake.) This generalizes to the slightly terrifying proposition: "It is possible to continue to make the best choice from a local perspective and end up at the worst possible outcome." Luckily, Heyman concludes, what is voluntary can be changed--but only if it is recognized as voluntary.
--Steven Poole (The Guardian 2009-06-20)

Heyman's main target is the conception of addiction as a form of compulsion which leaves people with no choice: he points out that people not only have a choice, but that they regularly exercise that choice in response to their circumstances. He spends a good deal of time explaining how it is possible that people can make bad self-destructive choices voluntarily...In addition to its helpful but brief survey of the history, experience, and science of addiction and its treatment, the main value of Heyman's book lies in its setting out of evidence for his view using relapse rates from large scientific surveys that include those who are not in treatment. The book will be of interest to most researchers in addiction, those who work in mental health treatment and policy, people with addictions and their families and friends.
--Christian Perring (Metapsychology 2009-06-23)

Drawing from behavioral economics, Heyman shows how the failure to sacrifice short-term gains (getting high) for long-term gains (sobriety-aided productivity) is endemic to a consumer culture, and how important a person's social context is to reining in the penchant for pleasure...His approach is refreshing, avoiding false dilemmas about free will and biological determinism.
--Gary Greenberg (New Scientist 2009-07-25)

Provocative and engaging...What Heyman is offering, in effect, is a global theory of addiction, with elegant and seemingly irrefutable answers for all the great imponderables in the field: why people start abusing substances, why most of them stop by the age of 30 and why a smaller percentage end up relapsing...How you will react to this book depends very much on what you think about free will and personal responsibility. There is, however, one point on which all readers will agree: Heyman's challenge to the disease concept of addiction is both coherent and provocative. The result is a readable book that will have you thinking about the choices people make and the choices societies make for them.
--Jessica Warner (Globe and Mail 2009-08-15)

Heyman's book is interesting and controversial...There's lots of good sense about drug addiction in Heyman's book, and it can be read with profit by general readers and specialists.
--Bruce Alexander (Times Higher Education 2009-11-19)

An important and provocative book...Heyman mounts a devastating assault on the brain-based model of addiction. Not that he views addiction as independent of the brain--no serious person could even entertain such a claim. What he rejects, however, is the notion that excessive drug or alcohol consumption is an irresistible act wholly beyond the user's control, as the term "addiction," commonly understood, implies...Addiction: A Disorder of Choice is an invaluable tutorial in how to think about drug addiction...Addiction should be required reading for anyone who treats patients, researches addiction, or devises policy surrounding drug-related crime.
--Sally Satel (New Republic online 2010-03-15)

About the Author

Gene M. Heyman is a research psychologist at McLean Hospital and a Lecturer in Psychology at Harvard Medical School.

Product Details

  • Hardcover: 216 pages
  • Publisher: Harvard University Press; 1 edition (June 15, 2009)
  • Language: English
  • ISBN-10: 0674032985
  • ISBN-13: 978-0674032989
  • Product Dimensions: 8.9 x 7.1 x 0.8 inches
  • Shipping Weight: 15.2 ounces
  • Average Customer Review: 4.3 out of 5 stars  See all reviews (15 customer reviews)
  • Amazon Best Sellers Rank: #1,241,423 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews
48 of 55 people found the following review helpful
5.0 out of 5 stars A must read on addiction and choice July 22, 2009
Format:Hardcover
This is an important, well-written and eye-opening book on the nature of addiction and voluntary choices. Don't let the title fool you. In attacking the disease model of addiction, Heyman is in no sense out to punish or stigmatize addicts. I've written a full length positive review at [...] here are the first few paragraphs:

Controversy about addiction over the last few decades has centered on the virtues and drawbacks of the disease model: Is addiction justly portrayed as akin to other mental illnesses such as depression, obsessive compulsive disorder and schizophrenia, and perhaps even physical illness? Or does the disease model conceal important dissimilarities to these conditions, and therefore compromise our efforts to treat and prevent addiction? The current consensus in the addictions establishment, for instance at the National Institute on Drug Abuse (NIDA), strongly favors the disease model. NIDA, other agencies, and addiction specialists have worked hard to promote the idea that "Addiction is a chronic disease similar to other chronic diseases such as type II diabetes, cancer, and cardiovascular disease." Since it's often seen as a moral failing, declaring addiction a disease has helped to destigmatize addicts and encourage parity for addictions treatment under medical insurance. This is all to the good, even if the conception of addiction driving these trends is contested.

Gene Heyman's well-written and persuasive book takes dead aim at the disease model, so will likely not be welcomed by its supporters. But whatever side of the debate they're on, anyone interested in the nature of addiction and choice should read it.
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9 of 10 people found the following review helpful
5.0 out of 5 stars Facts triumph July 7, 2011
Format:Paperback|Verified Purchase
This book is short in absolute terms (well short of 200 pages) but at times it takes a sufficiently slow pace in order to present data and facts as tightly as possible, so as to convince the reader that: drug addiction is a matter of the individual making ultimately irrational and harmful deicisions based on a mode of thinking that does not take into account the importance of the harmful but delayed effects of drugs, and the inability to delay one's gratification.

Very convincing data are presented showing that the majority of drug users either never develope addiction or remit from addiction without any medical treatment. These facts suggest very strongly that voluntary decisions at least play a role in drug addiction.

The author explains (Chapter 6 - pages 115-141) very thoroughly why a decision that appears reasonable superficially can nevertheless be suboptimal and detrimental simply because the individual does not think about the bigger "global" picture of the situation, and does not consider the long term impact of the action. These are much more difficult when compared with merely considering the prospect of instant pleasure. Simple mathematical models are also presented for illustration.

Studies (page 164-166) have shown that social values do have an impact on the incidence of drug addiction. This should be of no surprise because values expectedly have an impact on how individual think, evaluate and make decisions.

The author does admit (page 152) that it is still not entirely certain whether drug usuage may reduce a person's ability to consider one's actions rationally. So it is not possible to exclude the possibility that there may exist a tiny number of addicts who indeed have a disease rather than a "disorder of choice".

In summary: a most rewarding and important book - particularly for health professionals who have to look after drug addicts, and to health policy makers as well.
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19 of 25 people found the following review helpful
3.0 out of 5 stars Fascinating, but unnecessarily academic August 15, 2009
Format:Hardcover|Verified Purchase
The study of addiction is complicated by a number of problems. Like sociology, it tends to be dominated by people with strong personal or political positions that ultimately prevent it from being as objective as it should be. For instance, it is not uncommon for addicts to go straight from recovery to working in rehab clinics or doing social work. While this is great for them, it inherently alters the lens with which they look at the subject, making many reluctant to accept findings from outside their own experience.

This book is important to read because it goes an entirely different route. Starting with census data, Heyman looked at people who fit the diagnosis of addiction and tracked what happened to each addiction as the person aged. What he found was shocking. Without treatment, the majority of all "addicts" quit by the time they turn 40. As part of these findings, he noticed that drug abuse responds to economic and personal incentives. Having responsibilities, getting pregnant, the threat of being fired: these were extremely effective motivators in driving people to immediately cease drug use. The author's point is obvious: How can addiction be a chronic brain disease if most people kick it without the help of medicine or programs? More importantly, we know nothing about these people because no one studies them. Instead, our knowledge of addiction is limited to people who are in treatment, likely a heavily distorted representation of the population.

Tyler Cowen's criticism of this book is that Heyman often overstates his claims, and he's right. The book is written in the style of a self-justifying academic paper and this is probably the reason you haven't heard of it.
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Most Recent Customer Reviews
5.0 out of 5 stars Best popular book on this topic
A book to recommend to anyone having family or loved ones dealing with one form of addiction or another. Read more
Published 1 month ago by Paul D. McNelis
5.0 out of 5 stars My Harvard Professor: Gene Heyman.
YES. drug and alcohol addiction is a BEHAVIOR of choice.

Remember: NO ONE forced a needle in your arm, or made you open the door to the liquor store. Read more
Published 2 months ago by drswifey
5.0 out of 5 stars Fantastic !
This is an absolutely fascinating empirical statement about the complex etiology of addiction. I've had family members who were challenged with addiction & the "dogma"... Read more
Published 11 months ago by Jim H.
5.0 out of 5 stars Careful take on the other side
Heyman's book carefully considers the claim that addiction is a disease, which is somehow supposed to preclude that addicts choose their behavior, from historical, cultural,... Read more
Published 15 months ago by Candice Shelby
5.0 out of 5 stars Excellent.
Excellent book. Well written, scholarly but interesting. Demonstrates understanding of the most current research on neuronal functioning, and gives exciting perspective on... Read more
Published 19 months ago by D. Kukal
4.0 out of 5 stars A Disorder of Choice
Having read the only the reviews and the authors summary, I think he truly does have something to say about addiction as a disorder of choice in the addiction model. Read more
Published on September 11, 2011 by Jennifer
5.0 out of 5 stars A Couragous Book
A book such as this one will generate two types of reviews: those who will evaluate it based on what it presents and those who simply dislike its thesis irrespective of the... Read more
Published on September 27, 2009 by Sammie
1.0 out of 5 stars Please Rewind
One should really stand back and consider the worth of the thesis of this book from a practical standpoint, even if proved. Read more
Published on September 3, 2009 by Don B
5.0 out of 5 stars Strong, Intelligent, and Useful
This book was great. I must say it was one of the first I've read that was completely able to swing me away from the "addiction as a disease" concept. Read more
Published on July 5, 2009 by N. Sperry
5.0 out of 5 stars Changed My Understanding of People
This is a landmark book. It gives a clear, research-based understanding of a basic cause of addiction, one that we can actually do something about. Read more
Published on June 1, 2009 by Alexandra Hopkins
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