Addiction: A Disorder of Choice [Hardcover]

Gene M. Heyman (Author)

Book Description

Publication Date: June 15, 2009 | ISBN-10: 0674032985 | ISBN-13: 978-0674032989 | Edition: 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.

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 20090526)

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 20090612)

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 20090620)

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 20090623)

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 20090725)

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 20090815)

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 20091119)

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 20100315)

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: 6.1 x 0.8 x 9.2 inches
• Shipping Weight: 15.2 ounces
• Average Customer Review: 3.9 out of 5 stars  See all reviews (14 customer reviews)
• Amazon Best Sellers Rank: #991,477 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

46 of 52 people found the following review helpful

5.0 out of 5 stars A must read on addiction and choice July 22, 2009

By Thomas W. Clark

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. Heyman, a psychologist with appointments at Harvard and Boston College, presents an eye-opening and empirically grounded theory of voluntary behavior that goes a long way toward explaining addiction, not as a disease, but as choice-making gone bad. His analysis adds substantially to the growing literature in behavioral economics that shows we are not optimally rational maximizers of our own self-interest. Addiction, it turns out, is simply one rather vivid manifestation of a basic feature of voluntary action: judged from the standpoint of an ideal consumer taking a long-term view of her choices, we tend to overconsume our immediate preferences, and in so doing undermine our net self-interest over the long haul. Drugs, including alcohol, are very good subverters of ideal, globally informed choice-making, so addiction properly understood is a paradigm disorder of choice, of voluntary behavior. Since diseases as commonly defined don't primarily hinge on choices, addiction doesn't qualify as a disease.

Because it presents choice-making as a function of controlling contingencies, not free will (p. 114), Heyman's theory does at least as much to destigmatize addiction as the disease model, while staying true to its actual behavioral dynamics. Those advocating for addicts need not deny the obvious: that addiction is unlike illnesses by virtue of the role voluntary behavior plays in becoming addicted, in obtaining drugs, and in ceasing to use them. As Heyman points out, even though people choose to use drugs and alcohol, no one chooses to become an addict. Moreover, he emphasizes that addicts can't simply choose to quit without a change in the circumstances, biological and environmental, that control their choices. He is not, therefore, a stern moralizer bent on punishment, but a clear-thinking, humane psychologist wanting to apply our best behavioral science to the treatment and prevention of addiction. No one should pre-judge this book based on preconceptions about what questioning the disease model might entail.

8 of 8 people found the following review helpful

5.0 out of 5 stars Facts triumph July 7, 2011

By W. Cheung

Format:Paperback|Amazon 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.

29 of 39 people found the following review helpful

5.0 out of 5 stars Changed My Understanding of People June 1, 2009

By Alexandra Hopkins

Format:Hardcover

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.

The first couple of chapters, which include first person accounts by addicts, are page-turners. I stayed up too late reading them! I'm not a professional, but I followed the research in the later chapters and simply skipped some of the more technical stuff.

I think that addicts and even people like me who just eat too much dessert for their waistlines will find the scientific results revelatory. For researchers, this book could be a game-changer.

Dr. Heyman shows that, according to the research, "Once an addict, always an addict," doesn't hold water. It's not just a matter of a few addicts who beat the odds. Most addicts go clean on their own by their 30s. Unfortunately, by that time, they may have wreaked all around havoc.

Dr. Heyman reveals a key that addicts who go clean appear to tap into. This key can open the door to prevention and effective treatments. Despite years of failure within many treatment programs, it turns out that there are programs that are scientifically proven and a few that are proven to work amazingly well.

These research results also suggest changes needed in our childrearing and educational systems to help kids stay off drugs and to make better decisions in general.

Every once in a while I read a book that changes my understanding of people and life. This book has changed not only my understanding of addiction but also a key aspect of how people make decisions in many areas of their lives.