- 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: 19 customer reviews
- Amazon Best Sellers Rank: #1,382,767 in Books (See Top 100 in Books)
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Addiction: A Disorder of Choice 1st Edition
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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.
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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.
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. It's the second book I've read on addiction (the other being The End of My Addiction) where the author's attitude hurt the impact of what should have otherwise been a landmark book. That being said, it's important to read books that are critical of the status quo in a given field. It's an easy way to play devil's advocate in conversation and sound more educated on a topic than you might actually be.
Rather than take one viewpoint the author skillfully dissects the notion that addiction is a disease.
This is one of, if not THE, best I've read on the subject all season.
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