“”Drug addiction: is it a disease or is it based on choice:”””
A disorder of choice, Gene Heyman surveys a broad array of evidence—historical, anthropological, survey, clinical, and laboratory-based to build an argument about the role of basic choice processes in the phenomena that comprise drug addiction. He makes a compelling, multifaceted argument that conceptualizing drug addiction as a chronic disease (like schizophrenia or diabetes) is both misleading and erroneous. In developing his argument, he points out that the best survey data available indicate that most drug addicts quit their addiction, a fact inconsistent with a chronic-disease model. He illustrates how basic, normal choice processes can lead to addiction, arguing that people do not choose to be addicts, but that normal choice dynamics can lead them to that condition. He points to a variety of factors that keep most from becoming addicted, with a focus on the role of choice governed by choice-by-choice contingencies versus choice governed by the outcome of sequences of choices, a difference in an under-described activity called framing. His view is consistent with the most effective treatments currently available, and provides a basis for continued basic research on choice as well as research on treatment and prevention.
A disorder of choice Gene Heyman makes a case for drug addiction to be a result of natural processes involving voluntary (i.e., operant) behavior, specifically choice. This approach stands in stark contrast to the current received view, at least as promulgated by the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), that drug abuse is a disease, specifically, “Addiction is a chronic, often relapsing brain disease…similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease….” . Over the course of seven chapters Heyman makes his case by describing the history of drug abuse and addiction, societal responses to it, case histories from addicts, the epidemiology of drug addiction, “rational” and “irrational” choice, brain–behavior relationships, and approaches to treatment of drug addiction. These descriptions provide the bases for the focal points made, which are that normal, apparently rational choice processes can lead to poor long-term outcomes (e.g., addiction), and that an understanding of such processes offers a viable approach to the prevention and treatment of drug addiction. Of particular interest to readers of this journal is that the behavioral processes involved have been studied and characterized to a considerable degree by those who investigate operant choice. In addition, scattered throughout the exposition is a litany of evidence making the view that drug addiction is a disease, at least in the normal sense of that word, difficult to defend. In this review I endeavor to describe briefly and evaluate some of the key points made by Heyman about how normal choice processes play a role in drug addiction and to highlight his arguments countering the “addiction is a brain disease”.