Addiction a Choice, Says Psychologist
Those of us who keep up with the field of adolescent substance abuse, as well as substance abuse treatment in general, are well-versed in the idea that addiction is a chronic, relapsing disease, and that it is not a choice.
Psychologist Gene M. Heyman says in a new book from Harvard University Press that addiction is not a disease, and it's not involuntary. Instead, he says, it's a choice. He doesn't mean that individuals choose addiction, but that every time they use, they're making a cost-benefit analysis -- i.e., a choice. And furthermore, he argues, most addicts quit without treatment once the costs outweigh the benefits.
This is certainly a provocative thesis. I'm curious what someone like Thomas McLellan, Ph.D., would say. McLellan was lead author on the seminal article in the Journal of the American Medical Association (JAMA) that made the case that addiction is a chronic disease.
McLellan might also be intrigued by a review of Heyman's book in New Scientist, which implies that the disease-model is the result of a cynical attempt by doctors to get alcoholics to come to them with their problems. However, now that Mr. McLellan is deputy director at the Office of National Drug Control Policy (ONDCP), he's probably other things on his mind at the moment.
So what do you think? I'd be particularly interested in how you think Heyman's argument might apply to research on adolescent substance abuse. Leave a comment.
I have 2 comments, and I hope others will have comments/responses as well:
1. Has Dr. Heyman not reviewed the brain research on addiction? Clearly there is a physiological impact of substance abuse and addiction.
2. I am not a "one size fits all" substance abuse professional. Not everyone fits the disease model who is in need of or can benefit from tretment services. My own soapbox is this: I feel the "addictions field" is hung up on addiction, and doesn't pay attention to the nuances of those who are misusing and/or abusing mind altering chemicals. I prefer the term "substance abuse provider" to account for the varying degrees of problematic use. I will step off my soapbox now and look forward to an intense discussion (I hope).
I think the doctor is right on that it is a choice however I would have to agree with Angie on what the substance is that is being abused. Heroin for instance would affect ones physiological dependency more so then marijuana.I think more research needs to be done.Still I believe it starts as a choice.Then you feed the addiction by using creating a dependancy.
We make choices every day,this is not the issue. It is hard for me to believe that if someone truly understood their value would continue to destroy their body, mind, and soul. I honestly do not believe anyone with a healthy state of being would choose death rather then life. No one will convince me living on the streets due to addiction proves the idea of "cost" or their stubbornness to change. Some, regardless of how much they have lost never stop using drugs. There are several factors that play into addiction and how fast one gets out of it. Some addicts come from a wealthy support system while others none. Some grew up in a toxic environment while others end up in one. I was lucky to get off the drugs and streets of Portland and now am a Junior with a 3.4 gpa at Portland State University. I have an amazing support system. Does it get easier to stay off of drugs? I would say that it is. Only because of the wealthy emotional,mental,and spiritual support I receive every day.My brain is slowly healing however it has been a challenge.Leaning to communicate with my body why and how I am feeling the way I am helps me to understand why I am prone to making wrong choices. I have much more to say if someone would like to hear me. Thank you for you time and patience.
While the initial use of any mood altering substance could be argued that it was driven by choice the ensuing progression of the addiction is most definetly not by choice. What drives an individual to continue to use inspite of the progressive negative consequences other than an alteration to the individual's cognitive process. The adolescent addict has long posed a challenge to those of use working with them and their family due to the fact that htere is a great deal of, in most cases, familial support/enabling which could slow down the progression. The best indicator of the possible progression of the adolescent's addiction can best be determined by the family history. This is simular to other Chronic illnesses such as Diabetes and Cancer to name only two. As an addict in recovery and a Diabetic I have been able to mange, for the most part my two illnesses through the same process. Cognitive Restructuring, that is I had to change my thinking which led to a change in attitude and consequently a change in behavior.
Thank you Mad,you said it perfectly!It would be awesome to recognize at risk youth in the school system. This could help them get out of it sooner. Nothing is for certain however reaching kids at an early age could prevent possible drug use. Making them feel valued and validated are key.