Addiction: Brain Illness or Personal Choice?

Responses to Gene Heyman's Controversial Research

Jun 15, 2009

According to new research by a noted Harvard psychologist, drug and alcohol addiction is not a disease as previously believed, but a matter of individual choice.

Challenging the orthodox medical model of addition is controversial and provocative, as demonstrated by the recent media spotlight on Gene M. Heyman's new book, Addiction: A Disorder of Choice (2009), and by the spirited and passionate responses in the wake of its publication. This article summarizes Heyman's argument and some of the immediate reactions to his work.

Most Addicts Quit Using on Their Own

In a recent interview with Maclean's Magazine, Heyman states his initial goal was to discover how drug use changes from voluntary to involuntary or compulsive behavior. Instead, what he found was that a large percentage of individuals with substance dependence had stopped using completely. They were not only free from the compulsion to use, but quit for a variety of reasons.

Studying biographies, histories and ethnographies of addiction, Heyman concluded that addicts can and will quit if the right conditions and incentives are in place: "When you read the biographical information, you see individual drug addicts [who've quit] saying, 'Well, it was a question of getting high on cocaine or putting food on the table for my kids.' Or, 'My life was getting out of control'"(19). His findings suggest that the decision to quit is consistently related to reward or punishment.

For Heyman, individuals who start using drugs or alcohol only think about what they want or need in the moment. Preferring immediate reward, they choose not to consider the wider implications of their decision until it starts to impact negatively on their life. Individuals do not see their behavior from what he calls a "global perspective" (20).

The thrust of his argument is that most people fitting the diagnosis of addict, quit using drugs on their own by the time they are 30. More controversially, Heyman claims that 60 to 70% of addicts who end up in treatment centres also have psychiatric disorders which interfere with their ability to stop using.15 to 20% continue to use into their 40s and it is this small group that clinicians come into contact with and base their disease theory on (20).

Responses to Heyman's Research

The Canadian Centre for Substance Abuse response to the Maclean's interview was unequivocal. While they agreed with Heyman that drug use patterns vary, that not everyone becomes a serious addict, and that behaviors do involve choice, they take issue with his central claim that addiction is contextual and environmental. For these scientists, drug and alcohol dependence is a brain function abnormality which can be understood and treated in the same way as diabetes or asthma.

Heyman either misunderstood the literature or ignored scientific evidence which shows "that addiction is indeed a brain-based medical illness characterized by a rapid progression from voluntary to compulsive use." In an article in the The Toronto Star, Tony George, head of addiction psychiatry at the University of Toronto, dismisses Heyman out of hand: "I don't think there's too many self-respecting scholars in the addiction field who would agree with him."

The problem with Heyman's argument, according to George, is that it ignores biology. This is a fundamental flaw because "what we know about the brain, and the brain on drugs, is startling." The key term is "compulsion". For Heyman, addicts are not biologically driven to use, but make choices, while the medical model is premised on the belief that addicts want to quit "but are unable to do so" due to altered brain function.

Yet Heyman does have his supporters. Howard Rachlin, author of The Science of Self-Control, writes "the book has the potential to revolutionize the behavior of anyone involved in the control of addiction including, most importantly, addicts themselves." David Laibson of Harvard University claims Heyman's book "should make us rethink our conventional, and inadequate, drug policies."

How influential Heyman's work will be remains to be seen. Certainly the monolithic recovery industry will not be immediately affected, however, Heyman's book does have the potential to erode the concensus on the causes and treatment of addiction. The real concern for organizations such as CCSA is that Heyman's work may increase the stigma surrounding addiction and discourage individuals from seeking help.

Sources

The copyright of the article Addiction: Brain Illness or Personal Choice? in Drug Abuse is owned by Marilyn Michaud. Permission to republish Addiction: Brain Illness or Personal Choice? in print or online must be granted by the author in writing.