Addiction: New research suggests it’s not an illness it’s a choice . This is the title of the front page article of the current MACLEANS newsweek magazine (Canadian). You can access the article by going to www.2macleans.ca . Go down to the Health section and click on the article.
The article is an interview with Harvard psychologist Gene Heyman. Doctor Heyman’s comments states his position that “… drug or alcohol addictin is not a disease, but a matter of personal choice. He suggests that the reason we have called it an Addiction is that we want to be humane.
I don;t know if Dr. Heyman is familiiar with the current research on addiction as a brain disease or not. What I do know is that I desperately fought alcohol and somehow could not resist the obsession of picking up that first drink. It is correct that nobody poured it down my throut, I did make a choice, But, I had reached that point where I had no mental defense.
This article, in my view, is a dangerous one. it gives one person’s opinion and reseach which may very well be flawed. Its danger lies in the possibility of policy makers and funders taking this view at face value and providing an excuse to reduce resources to much needed programs.
I am hoping that you wil take the time to read the article and submit your comments to the Blog. I look forward to your comments.
Jeff
June 1, 2009 at 6:38 pm |
Choice or Illness
Although a parent may have to make a choice between using and having their children, this doesn’t mean that the journey is not a long and painful one which can be filled with lapses.
Let’s also remember that heavy addictive use of substances causes many illnesses as well. Methadone was intended to be a short term solution but there are people who will be on it for life.
Brain functioning that becomes permanently impaired from alcohol and/or drug use.
Liver failure that cannot be corrected, heart, respiratory, many other illnesses that come from overuse of alcohol and drug that will never repair themselves.
Addiction comes when the body’s need for the drug (crave) outweighs the brains ability to make responsible decisions.
I believe that addiction, the illness, is not as simple as making a choice.
There are many people with many different perspectives, to say that this is the “new” perspective and given the breadth of circulation it got, is risky to all who are struggling or who are working their way through a long road of recovery.
June 1, 2009 at 9:43 pm |
I wonder how much research Dr. Heyman has done in the scientific arena. I know that the first drink or drug is a choice and after that the disease process of addiction – craving and mental obsession begins overwhcih I had no choice. I lost all power to choose even if I wanted to stop I could not on my own. The brain chemistry change that took place altered my power to choose as it interferes with the cycle of dopamine release. it impairs judgment and desires.
Thanks for alllowing for comments.
June 2, 2009 at 1:19 am |
I agree with Jeff when he said this kind of print is dangerous.
Those working in the field of addictions, as qualified workers, know the difference between choice and disease but for a doctor of psychology to state that dependency is “just a choice” is wrong and dangerous. Choice is something that we all have but there is that move from abusing to dependency that takes logical choice away and we then have a disease that is not an excuse but a constant struggle in getting back what we thought was normal choices.
This is one more reason why people in this field should be qualified and educated in this profession, and not just have a degree in human sciences with little of no knowledge of addictions.
Another reason why people in the addictions profession should start to stand up for what they believe in and challenge others who make statements like those of Dr. Heyman.
June 2, 2009 at 2:38 pm |
I couldn’t agree more Wendy: We Need To Stand Up. That is why this Blog has been set uo and why this week’s topic. We need to have more people involved. It is my hope that all of you who come to this site will tell your friends and colleagues about it. And further that we take our discussions and put it into positive action.
It was Ben Franklin who said,” We must hang together or we will surely hang seperately” That is no less true for us in the addiction profession.
Jeff
June 2, 2009 at 3:29 am |
Hi there, While an addiction may start out as a choice at some point the choice is lost. I think of myself with cigarettes. I felt panicky just at the thought of not smoking. It took me 4 good tries where I learned a lot to find out how to do it. I used Wellbutrin, 2 patches slowly brought down over time, nicotine gum and even then several times I was homicidal. Fortunately I worked in a health clinic at the time and one of the doctors asked me how I was doing with the quitting. I said I was not good and needed to kill or hurt someone. He gave me some sublingual ativan and it was magic. In terms of coping I was way past my limit and right on the edge of using. After the Ativan I could think again and was out of the frenzy I had been in. I believe I used the Ativan 3 more times in the coming months which got me over the bad parts. I am now 10 years clean. I still have a terror or going back to cigarettes as I do not know if I could do it again. It took everything I had to quit. So…. as for choice, I may have had in the beginning but once I was thoroughly addicted that choice was removed. I too believe this is a careless conclusion about addiction being a choice.
That is my thought anyway.
Lee
June 2, 2009 at 3:54 am |
This year I celebrated my 25th year of healthy, clean, sober living. I personally think quality of life is much more relevant then years of recovery. However, the 25th year was a nice bench mark.
In regard to “illness” versus “choice”, I will first start by saying that there is an old aboriginal saying that says, “First the man takes the drink, then the drink takes the drink, then the drink takes the man”. So in the beginning I did have a choice and I choose to take the drink, however, in the end, I became very ill. I went through the stages of fun, need, loss of control, and absolute destruction. In the beginning I was doing the talking and the walking, in the end the alcohol and the drugs were doing the talking and the walking and guess whose body, mind and spirit they were using? Indeed mine. The sad part is that I did not even know it due to my “illness”. I became the guru of AA and hid very well in the illness, thus unknowingly avoiding the solutions to learning how to live comfortably in my own skin without any dependency upon people, places and things. AA was my base foundation and still is to this day. However, I eventually found out that I was normal as any other human being with the exception of one thing, and that was that I could not put any alcohol or drugs into my body, therefore it once more became a matter of choice rather then illness. I came full circle.
Arguing if it is “choice” or “illness” is dangerous indeed, because we run the risk of missing the entire truth. I used for one reason and one reason only, because I could not stand myself, nor could others in the end. We can choose to live in the illness or we can choose to live in the solution. I think the real illness is that we think we do not have a choice and that we think we can not make a difference. The moment I stopped thinking and started feeling, I suddenly FELT, I had a choice.
Victor
June 2, 2009 at 4:39 am |
Choice or Illness.
I’m having a difficult time buying into Heyman’s theory that addiction is governed by personal choice. We certainly know that personal choice is a major factor in addiction but I will strongly argue that the suffering alcoholic/addict doesn’t make a choice, they simply do it.
We can theorize all day long “did the addiction develop after one chose to drink, or was the addiction already there?” (the ole chicken or the egg theory), but it is the addiction that is inside of us that hampers and erodes our ability to make a correct choice (of whether or not to drink or use).
I know many clients who have been sober for years (myself included) where choice is not an issue as we simply know we cannot drink or use. But the addiction still simmers inside of us and sometimes it rages because of other factors that have nothing to do with choice (emotions, life experiences, etc). You can take the “choice” away from the alcoholic/ addict, but the addiction will still be there.
June 3, 2009 at 3:08 am |
As an Addiction doctor and a Harvard alumnus, I find Dr. Heyman’s comments misguided and irresponsible. The evidence that Addiction is a brain disease, where the “substance(s) or behaviour(s) of choice” don’t matter much when it comes to the reward circuitry lighting up in response to a variety of triggers, is well established by extensive clinical experience and diagnosic imaging research. There is a huge difference between people who use alcohol moderately and those for whom alcohol use becomes a compulsion and “escape” from dealing with realities of life. The differences, genetic and/or acquired, in the brains of these two groups of people have to do with brain chemistry and architecture! Addiction is NOT a choice, recovery IS! Dr. Heyman seems quite muddled in his interview. He may become a better educator after he learns about and understands the difference!
June 3, 2009 at 9:10 pm |
This is the age old argument! It seems to me Dr. Heyman may not fully understand the difference between substance abuse and addiction. On careful study of the science involved in addiction and the mesolimbic system of the brain, one begins to get a feel for the nature of this disease. It is not something to be treated lightly or brushed off as a mere choice. I agree with Dr. Hajela that these are dangerous statements that could allow many reading the articles, which by the way is not published in a medical journal but in a magazine, to further blame the victim.
June 4, 2009 at 1:53 am |
such an ignorant comment, from I imagine a well educated man. this article automaticily had me questioning my beliefs and the work i have been doing to not only stay clean,but to also make me a better person in life.
i can stand up today and admit that i have made many bad choices in life, but i would be lying if i said that my addiction did not control me completely. from the moment i woke up to eventually when i went back to sleep my mind process was always thinging when, where and how i was going to get my next fix.
there are so many things i would like to be able to say but one of the things i have learned on my journey in life is: if you have nothing nice to say about a person, than you shouldn’t anything at all.
i will pray for you to night mr. heyman…
LIVE,LOVE,LAUGH & LEARN
June 5, 2009 at 3:48 pm |
It’s funny to me that the author of this blog and the comments all come from people who haven’t read the book or done any research on Dr. Heyman. If you did the slightest investigation into Heyman’s background (i.e., a Google Scholar search), you would see that he is an accomplished scientist, with funding from NIDA. Yet, just because his research doesn’t confirm your worldview all of a sudden his work is “dangerous.” Science is often about challenging our preconceived notions and showing the limits to current models. Heyman’s research identifies some limitations in the disease model and points to other research that highlights the role of choice. Now, it is the responsibility of disease model proponents to either respond by identifying holes in Heyman’s argument, conduct new research showing Heyman to be wrong, or to accept that the disease model has limitations. This is how science works. It is NOT appropriate to engage in name calling or to try to suppress dissenting views.
June 5, 2009 at 4:11 pm |
Rick, you are quite correct I have not read his material and should and will do so. One of the things I should have said right up front is that it is positive that an article on addiction was the lead article in this edition of MacLeans. I want to thank you for pointing out to us that the disease model has its limitations. I look forward to further discussion on these issues
Jeff
June 9, 2009 at 12:25 am |
I wonder if there is an element of both when you’re dealing with addictions.
Certainly, the substance has an immense hold and control over the user and the “choices” the user makes are not sound. But, as with mental health issues, the individual gets to make their own choices as sound or as baseless as they may be.
In nearly 25 years of addiction I made many decisions, most very poorly planned and thought out, about use, harm reduction, curtailment and eventually recovery. With over 23 years sobriety now, it occurs to me if recovery was my choice then I also must accept the responsibility of the poor choices of maintaining my addictions.
I am now an addiction counsellor. Through much of my addicted years I counselled in many different areas. I new there was help available through the medical professionals, medicinal support and groups like AA. While I “delivered my thoughts and ideas” on the subject regularily to my clients, I made a deliberate, not sound, but deliberate choice to not follow the advice myself. It was not until I was confronted with my hypocracy that I finally made the “choice” to seek help and eventually treatment.
My chances to make choices now are no more available, or even really often thought out, than when I was using. Everyone really has only very limited choices to make, often with poor skills to make them. Often there is little or no choice in a matter. We just think we have choice and in that way we delude ourselves and are as limited in our ability as much as the addict.
Choices; yes, sound or sane; not always, but they are and were mine to make and a few times in my life it seemed that was just about all I had.
June 21, 2009 at 7:12 pm |
Choice? Well, having read through much of the material, the interviews and looked a little more closely at the research, I have to say that Dr Heyman makes a strong case for recovery being a choice; but not so strong a case for addiction. In the interviews I have read, the only time real choice is talked about is at the beginning of the recovery process, and that because stopping is a choice, it seems to be assumed that the using behaviour must also be by choice. Sorry, I don’t buy it. In the articles and in the book, he slams current research as being biased due to the fact that 60-70% have concurrent disorders. Self medicating for ADD, OCD, ADHD, PTSD, and other mood and personality disorders remains the cause of many addictive behaviours. So how voluntary then is a choice made with a mind that isn’t functioning? I have made many choices in my life, many of the substance related ones bad, but I remain certain that choice does not necessarily imply that behaviour is voluntary.