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Addiction: A Disorder of Choice [Paperback]

Gene M. Heyman
3.6 out of 5 stars  See all reviews (5 customer reviews)
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Book Description

1 Oct 2010
In a book sure to inspire controversy, Gene Heyman argues that conventional wisdom about addiction - that it is a disease, a compulsion beyond conscious control - is wrong. Drawing on psychiatric epidemiology, addicts' autobiographies, treatment studies, and advances in behavioral economics, Heyman makes a powerful case that addiction is voluntary. He shows that drug use, like all choices, is influenced by preferences and goals. But just as there are successful dieters, there are successful ex-addicts. In fact, addiction is the psychiatric disorder with the highest rate of recovery. But what ends an addiction? At the heart of Heyman's analysis is a startling view of choice and motivation that applies to all choices, not just the choice to use drugs. The conditions that promote quitting a drug addiction include new information, cultural values, and, of course, the costs and benefits of further drug use. Most of us avoid becoming drug dependent, not because we are especially rational, but because we loathe the idea of being an addict. Heyman's analysis of well-established but frequently ignored research leads to unexpected insights into how we make choices - from obesity to McMansionization - all rooted in our deep-seated tendency to consume too much of whatever we like best. As wealth increases and technology advances, the dilemma posed by addictive drugs spreads to new products. However, this remarkable and radical book points to a solution. If drug addicts typically beat addiction, then non-addicts can learn to control their natural tendency to take too much.

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Product details

  • Paperback: 216 pages
  • Publisher: Harvard University Press; Reprint edition (1 Oct 2010)
  • Language: English
  • ISBN-10: 0674057279
  • ISBN-13: 978-0674057272
  • Product Dimensions: 1.5 x 12.8 x 23 cm
  • Average Customer Review: 3.6 out of 5 stars  See all reviews (5 customer reviews)
  • Amazon Bestsellers Rank: 391,219 in Books (See Top 100 in Books)
  • See Complete Table of Contents

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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 20090526 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 20090612 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 20090620 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 20090623 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 20090725 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 20090815 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 20091119 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 20100315

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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Customer Reviews

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3 of 3 people found the following review helpful
By Richard Murphy VINE VOICE
This is a clear, well-written book that challenges popular wisdom on the nature of addiction, and in particular addiction to illegal drugs. The basic premise of the book is that addiction is a voluntary behavior, and not a disease.

The author is not saying that people choose to become addicts. Day by day they choose the easier route of continuing their self-destructive behavior, rather than taking a long term view. He stresses that the evidence is that, when the price of addiction becomes too high (risking the loss of family work or social position) the vast majority choose to give up their addictive behavior. This explains why the almost all of those taking heroin or cocaine in their teens and 20s give it up in their 30s. If not, the world would now be full of addicts in their 60s and 70s. He asserts that the apparent inconsistency with popular perception, given the known high failure rate of treatment for addiction, reflects that those who seek medical help are those who have already failed to beat their addiction on their own, and so are not typical drug users.

The principles of addiction he describes here also apply more widely. Anyone who has tried to get fit or to lose weight will recognize the challenge of changing the habits of a lifetime. If you only consider the short term, the easiest route is to give in to the temptation of the status quo, and it is only by taking a longer term view that we can achieve genuine change, but it is possible.

For the specialist, the complexities of drug addiction may well be familiar but, overall, this book is much more interesting to the general reader than its title and topic would suggest.

Highly recommended.
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5.0 out of 5 stars This book was a huge eye opener 9 Mar 2014
Format:Kindle Edition|Verified Purchase
Finally, someone has explained the process of addiction in a simple and easy-to-understand way.

I'd call this book a must-read, not just for addiction issues but for anyone on any kind of self improvement path.

I particularly loved the parts about Global vs Local decision making - that alone has changed my life and allowed me to implement healthy habits in a number of different areas.

Highly reccomended...
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3.0 out of 5 stars Like "a game of two halves..." 24 Jan 2012
By loogal
Reading this book was, for me, was like watching the football team that I support establish a commanding one-nil lead, playing beautifully in the first-half against the champions. (I'll come back later to what happened after half-time.)

The book starts out as clear as a whistle, as if to emphasise the title with the opening statement: "This is a book about addiction. It is also a book about what we choose to do... that is, it is also a book about voluntary behaviour." That this is significant, Heyman goes on to say, is not only because addiction helps us to understand voluntary behaviour; "it shines a light on its dark sides". What Heyman proposes is a theory of choice so universal that it also, controversially, includes addictive behaviour.

The argument he wishes to settle once and for all goes against the orthodox view of addiction. Writing from an American perspective, he targets the assertion made by the National Institute on Drug Abuse (NIDA) that addiction is a "chronic, relapsing brain disease". In the UK, it is more difficult to find such a body which nails its colours to the mast so firmly. The National Treatment Agency website is mostly concerned with "problematic drug users" and what to do with them, without mentioning a theory of addiction. Nevertheless the disease model influences `rehab', `detox' and treatment centres, and Alcoholics Anonymous and Narcotics Anonymous fellowships, up and down the country.

Heyman, as one would expect from a research psychologist and a lecturer in psychology at Harvard Medical School, presents with academic rigour and clarity an analysis of research findings.
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1 of 2 people found the following review helpful
5.0 out of 5 stars A reavaluation of the addiction myth. 22 July 2009
Format:Hardcover|Verified Purchase
Really interesting look at the statistics behind drugs use,which comes up with some conclusions. Also examines some of the assumptions and misconceptions which perpetuate the whole 'treatment business',even though it doesn't work. Bottom line is people have choices and nothing ( not even drugs) can take that away. Required reading for professionals and laymen alike.
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4 of 7 people found the following review helpful
1.0 out of 5 stars Please Rewind 8 Oct 2009
By Don B
One should really stand back and consider the worth of the thesis of this book from a practical standpoint, even if proved. It may have some small value as self-justification for politicians and the legal community since both are hesitant and ill-equipped to deal with any concept of diminished responsibility. It will likely not be regarded by the therapeutic community as anything more than an improper extrapolation from the concept of motivational enhancement therapy (MET); something it already accepts may serve a useful purpose toward recovery in some cases of addiction.

We all live in an ever-changing matrix of influences that affect our everyday choices. Not often are we presented with distinct or dramatic choices like those of physicians or pilots confronted with job loss as reported (it is the approximately 10% that failed who should be studied) or war veterans returning home to vastly different surroundings. The Vermont voucher study as a validation leaves me singularly unconvinced. The definition of who is actually an addict is questionable and reaching any conclusion about addicts based largely on statistical analysis with definition an unresolved issue bears very close scrutiny. Any anecdotal report of spontaneous remission or voluntary recovery could likely be matched with as many or more well-conceived and structured interventions that have failed.

The current version of DSM 1994 is detailed as DSM-IV-TR 2002 in the American Psychiatric Publishing text noted hereafter. There could be a vast difference between the condition of a person who manifests only the three criteria required to qualify out of the seven stated within a twelve-month period and a person who has "lit up every light on the pinball machine" for say three years or more.
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