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New Book Reignites Disease Model Debate

July 6, 2009
by Daniel Guarnera
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Thanks to Gina Suslick, NAADAC Govt. Relations Intern, for guest-blogging this post.

The argument about whether or not addiction is a "disease" has been raging for years, but it was recently rekindled by the release of a hotly debated book by Harvard psychiatrist Gene Heyman. Heyman proposes that ongoing addiction is fundamentally a choice that can be changed with the development of motivation, new knowledge and value systems. An interview with him can be read here, and a chapter from his book, Addiction: A Disorder of Choice, can be read here.

Other arguments support Heyman’s assertions, such as those who believe that “free will” is what leads to addiction. Since the addict is choosing to use the drug repeatedly, whether or not the end result is physiological dependence does not matter. Still others argue that it cannot be considered a medical illness because addiction, unlike Parkinson’s, cancer, or the flu, requires that you consciously decide to take a pill or pick up a needle in order for it to come to fruition.

Heyman’s book seeks to add epidemiological data to support the addiction-is-a-choice argument. He suggests that addiction is more a long the lines of dieting or going to the gym: you can be successful if you want to, and if you make the choice to do so. Heyman believes that people naturally want to consume too much of everything, whether it be food, television programming, or even drugs. He makes the point that most people who don’t become addicted to drugs do so based on the fact that they don’t want to become a drug addict. So, as an addiction professional, I have to ask myself, does this imply that those who are addicted are that way because they--at some level--want to be?

Heyman does not dispute existing scientific evidence that drug use alters the brain’s functioning. What Heyman wants to demonstrate is the fact that drug use (even addictive drug use), does not alter our underlying ability to think. Heyman believes that addicts can consider the consequences of their actions, and therefore stop using once they do a rational cost/benefit analysis. He seemingly agrees that the physiological changes involved with addiction--especially withdrawal--make it extraordinarily difficult for many people to do a cost/benefit analysis without some help.

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The addict's craving the perceptual change that occurs when using has the power to shift his perception of what using will actually mean to him to a less threatening perception (one that allows him to justify resuming the relationship with the drug or behavior) that he never would have had before the craving came. The memory of a more desirable subjective state sits like a virus in the brain, and when activated by discomfort hijacks cognition. Discomfort creates the longing to re-experience what the drug does for the addict — a longing to 'be back in' the relationship with the drug. The idea that all people wish to overdo drugs is preposterous. Most people have a few drinks at a social occasion, then, offered more, say 'no thanks' because they feel ok the way they are, and they don't get the metaphysical change that the addict does. For the addict, once he's established an addictive relationship with the drug, the way he feels normallysoberisn't good enough anymore. If this is not understood by the helper, they will never be of any lasting help.
Kenny Glassman

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Daniel Guarnera

Daniel Guarnera is the Director of Government Relations for NAADAC, The Association for...