DRUG ADDICTION. IS IT A DISEASE OR IS IT BASED ON CHOICE? A REVIEW OF GENE HEYMAN'S ADDICTION: A DISORDER OF CHOICE

Abstract

In Addiction: 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.