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Addiction is voluntary, author contends in new book
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CTV.ca News Staff
Date: Wed. Jun. 17 2009 10:08 AM ET
The idea that addiction is a disease and that addicts do not have control over their disease, has been a pillar of belief of the psychology community for decades. Yet Gene Heyman, a lecturer in psychology at Harvard Medical School, has set off a firestorm by questioning this time-honoured assumption in his new book, Addiction: A Disorder of Choice.
Heyman argues that addiction is very much governed by personal choice and is not an involuntary illness. He says the long-held belief that addicts cannot control their addiction may be well-meaning but is ultimately wrong.
The proof, Heyman says, lies in the number of people who are able to beat their addiction and the reasons they do.
"When people say that addiction is a disease they mean that drug users have become involuntary, that they simply can't say no," Heyman told Canada AM Wednesday.
"I asked the question: What factors influence drug use to halt in addicts? Things like values and laws, being worried about being arrested, financial matters and respect from family -- these are the things that influence decisions.
"And so I looked to see if those factors influenced drug use in addicts. And it turns out when you look at the literature broadly, that's exactly what happens. So I take a different conceptual framework."
The problem with the field of addiction is that people have restricted their analysis, says Heyman. They contend when you consider the terrible toll that addiction takes on the lives of addicts, "no one would choose to be an addict."
Heyman agrees that yes, addicts are self-destructive, but this does not mean they will not change their behaviour once the costs of continuing their addiction become too great."I began looking at biographies, at the epidemiological literature, at studies where anthropologists lived with addicts, and what we see again and again is the pattern of behaviour where the factors such as the desire for the respect of children or parents or worries about finances lead addicts to stop using drugs. So that's the real test," he explains.
He says when addiction experts tell addicts their addiction disease is "involuntary," it doesn't help them. If anything, it may give them a crutch to enable them to continue.
"What the data show is that most addicts actually quit. And this is encouraging. To be told that you have a chronic relapsing disease that has no cure cannot be helpful -- but especially if it's not the truth," says Heyman.
"But the truth, when we look at the data, is that most addicts quit, and they can be encouraged to quit much sooner. I think what is required to help someone quit is the knowledge that it is possible and that there's a better life once you do quit.
"Smoking is an addiction. And since the 1964 publishing of the U.S. Surgeon General's report, about 80 per cent of smokers have quit, and they typically quit on their own. So we know that people can quit an addiction."
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I applaud the budget, even though Health Care and education may stay unscathed. Sadly this cannot last and I worry to later this year where cuts will become enviable. If anything, this provides the Wildrose Alliance plenty of ammo when an election is called.


Comments are now closed for this story
Rene
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R/H Ontario
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ADM Saskatchewan
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A former addict
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Its time for individual responsibility and accountability for personal choices.
Laura Langstaff
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Debb
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You can be born addicted.
addiction and mental health worker
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graham from TO.
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Adam from Vancouver
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At the end of the day the only person who can change one's life is himself.
People must be held to account for their actions and telling them "It's okay, it's not your fault" isn't doing anyone any favors at all.
Karen
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Spike
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Joe
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A person's self-will is a matter of choice, and given enough determination and will-power we all have the capacity to overcome any addition. To believe otherwise or that it is in your genes is mere rubbish.
Joe from Ottawa
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Addiction is hard to quit, but it's not impossible. Physical withdrawal symptoms are not indications of disease, they are indications of chemical dependence.
Physical addiction is a disease by definition; an impairment of the body causing abnormal functioning. But to say it can be fixed without willpower or cooperation of the addicted person is asinine. The willpower is stage one, the intermediary withdrawal-coping drugs are just an aid.
Concerned Canadian
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This is an argument based on semantics. Addiction is not a "disease" in the sense of being caused by a virus, but it does depend on a physiological change in the way the body functions, so that substances like nicotine, heroin, methamphetamine and alcohol start to be used by the organism biologically.
Withdrawal from these substances is so painful and difficult because the body is literally starving for the drug.
But of course physiologies differ, and one person's addiction may be another's part-time recreation. Thus some people may be able to drop the drug while others cannot.
So when is an addiction not an addiction? If someone can stop using a substance, it could be argued that he/she was never an addict in the first place.
Without some objective way of defining "addiction" this study only proves that those who can stop using a drug can stop using a drug, and those who can't, can't.
This hardly seems like ground-breaking information.
Matt
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Fetal alcohol syndrome isn't an addition, it's a severe amount of damage inflicted on the fetus.
Nobody is arguing that addiction isn't real, or that it isn't a physiological reality.
What is being suggested is that the behaviour of continuing to feed that addiction is a choice.
Will
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Buba
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As Debb says too - ask the crack babies if they had a choice.
Take Responsibility For Your Actions/Choices
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Anything one puts into their body is a choice by them to do so. They have the same choice to stop! Disease based models for addiction have been proven they don't work!!! Over 90% of AA members relapse. Relapse is expected, and everyone is told they are going to relapse. This gives every recovering addict following the disease model a reason to "get out of jail free" when they do!
Don't get me wrong, of course the brain is changed when one abuses drugs or alcohol. However, this was a choice, not something that just creeps up.
Thus being a choice, the responsibility still lies on the addicts shoulder, rather than putting the blame on a non-existent disease.
After having been addicted to meth, family members who took years and a broken marriage to quit meth, and my husband quitting heroin without the aid of NA, I KNOW this is not a disease but rather a consequence of choices.
An open mind
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As for the babies born afflicted due to the choices of their mothers - yes, very sad, but they are not addicted in the same sense. I work with some of them. They do not deserve to be unfairly labelled as addicts. They were damaged as they developed in the womb. They do not need a fix to carry on every day, and were weaned off the drug quickly if they ever were. Their challenge is the stigma society applies to them. Again an open mind and some compassion applies.
DTD
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William
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Brian fr Langley
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To suggest addictive behaviour is beyond our control leaves us on that level. Our choices are what makes the human condition transendant. Or not.
Rob W.
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Dr Heyman also seems to make no distinction between the addict "types", a long held standard in the addiction field that most attribute to physiological differences, in addition to personal circumstance (ie. extreme abuse, neglect in early life, a severe trauma.) The classic "addict" or type III clearly has or indicates a very different physiological disposition than type I and has altered 5HTP and other receptors to the point where the overriding, survival enhancing reward mechanism of the brain for drugs has become indistinguishable from other reward behaviours such as eating, sleep, sex and even breathing. What Heyman, possibly in an unscientific fashion, is observing is studies done on individuals well after successful detoxification and restoration of brain function. While the addict is using, they simply will not have a choice for up to 48-72 hrs following their last use. (which is why they need to be locked down for this period and their movements strictly monitored and controlled.) After this period, "Choice" becomes a gradually increasing element. The reason for informing the addict that they have a progressive, incurable and fatal disease that they have no "personal" control over is describing the state of the individual under its direct influence, not entirely their state of mind in recovery and that they stand a strong chance of dying while in this state of overwhelmingly compromised judgement. The "progressive, fatal and incurable" tag is meant to describe what is likely to happen if the addict has even one exposure to their drug of choice, not their state of mind or abilities while in a state of recovery. There are a significant number of addicts, an entire class of addicts, who simply continue using to the point of death despite repeated visits to hospitals and stays in ICU's and eventually die with no discernable time in recovery.
Additionally, for the last 2 decades, they have known that addicts produces radically different substances in their bodies that may account for the "overriding" compulsion, called beta-endorphins (opiates) which are 300 times more potent than standard endorphins, that simply aren't found in non-addicts. (A coroner in the US accidentally stumbled upon what appeared to be sever opiate damage in brain sections of indigents who were known to be lifelong alcoholics.) This is why Naltrexone, an opioid antangonist, something used for heroin addicts, has such amazing success with alcoholics.
One of the overriding goals in recovery is to prevent even a single re-exposure to the addict's drug of choice. Even in successful and long term recovery, choice is somewhat compromised and regularly subverted by standard healthy mechanisms of the addict's mind (such as rationalization, censoring, memory blocking) periodically during their recovery in response to stress, daily pressures and emotional upheaval. These are well documented processes described variously as "ego, superego and id" and their struggle for integration. The "id" in the addict is now permanently marked by the pleasurable experiences and intensity from their time as addicts and the superego and ego can fall prey to it's influence (hence the need for constant outside support and counsel, sponsors).
There are some suprising oversights made by someone supposedly immersed in addiction study but can only guess he has not experienced addiction from the inside.
Niagara George
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By definition, a person is addicted when the actions they do become their normal life. When cocaine, heroin or even tobacco become your normal, you are sick.
Perhaps not physically sick, although even that is questionable. But, certainly you are mentally sick.
Mental illness has been accepted as disease for many years. Let's not open that debate!
Al
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Pip
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My question has always been with regard to new "diseases" - especially those defined by psychiatrists - "who benefits"? If the main benefit goes to a drug company, as opposed to the patient, should the "condition" have ever been elevated to the status of "disease"?
Just yesterday, it was reported that there is danger of sudden death from taking Ritalin, yet that drug has not been withdrawn. Ritalin is used to treat ADHD among children. To what extent is a diagnosis of ADHD the result of a teacher wanting a quiet class, and using what I consider to be suspect tests to achieve their ends? I have no empirical data, only the observational experience of 38 years in the classroom. I have not noted any child who was physically active - on the play yard, in active play and sports after school - who was considered to be ADHD by our shared psychologist. Diagnosis was far more common among those who had regular parental notes to avoid phys. ed, and who were never seen out at play.
In the case of ADHD and alcoholism, Is it more a matter of "Mens sano in corpore sana"? Would proper care of the body - including regular exercise - go a long way towards satisfying the need for the addictive substance?
Just an opinion.
beverly - alberta
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It's so very refreshing to see a professional in the field actually suggesting that we are indeed responsible for the choices we make every day..........as well as the resulting effect those choices have in our lives and the lives of our families.
No such thing as illnesses
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beverly - alberta
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The hard part is choosing NOT to continue. We all make choices - unfortunately others live with our choices as well.
Karen
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My husband has an incurable, progressive disease. He did not voluntarily start a habit that developed into a problem. Please do not equate his legitimate illness with addicts who made poor choices and don't want to be held accountable for it. It diminishes those who really are sick.
Thank you for being brave enough to publish an article that calls it like it is.
nc
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The true fact is that an addiction to anything is insidious. By this I mean that the process is long and varied. This is the same as someone finding out they have cancer or any other illnes. The process started years ago before the effects of the illness show up.
The addicted person has to find the way to return to a healthier state. The catalyst may be the things that Mr. Heyman stated. The addict has to accept that this is a better way of living. In all cases the addict has to develop a whole new social network.
If I were to tell a friend that you should not start smoking because you will be addicted. In the early stages that friend would tell me to bugger off. To them their is nothing wrong.
Steve in PEI
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Think about it. Pretty much no one has been saying that you can't choose to recover, in other words, that *using* is a choice. All those earnest people spouting "addiction is a disease" platitudes do want people to defeat their addictions and honestly believe that it's possible.
The point of viewing addiction as a disease is that addiction has potent psychological and physical components and is *not easy* to beat and keep beaten. Just ask any smoker. It's not like snapping your fingers and saying "ho hum I think I'll stop being addicted to nicotine today," and then you throw out your cigarettes and live happily ever after, but that's what Dr. Heyman makes it sound like in his sound bites. Deliberately so, because it incites controversy and garner's people's attention for himself, so he sells books and gets rich.
By viewing addiction as a disease we appropriately acknowledge its seriousness and help people take appropriate measures to get clean and stay clean. Sending the message that overcoming addiction is like snapping your fingers because *addiction* is a choice we make sends the wrong message and fails to prepare people for the real difficulty of the task.
Not to mention, just because you have succeeded in quitting, say, smoking does not mean that you are no longer addicted to nicotine. In that sense it is *exactly* like a disease.
In a nutshell:
- Starting is a choice. Using is a choice. This is the realm of personal responsibility.
- Addiction itself is a disease. Being addicted is not a choice so an addict must take special measures that a non-addict doesn't have to to avoid falling into destructive patterns.
- Dr. Heyman is a cynical poser who isn't really all that special.
Polly Wanna
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I've been in the rooms, I hear the speakers talk, that is all good therapy, and for sure, once you have developped a dependence, it is a real tough go to quit, but it can and is being done.
I did it. The rooms helped "raise my bottom" no question.
As far as crack babies, they had no say in the behavior, so you really can't include them, plus they are weaned off, and don't relapse...its not like a 5 year old, clean for 4 years, is looking to score.
SO, sad to say, you should embrace this as evolving science and progress, and work with it. Rather than condemn it with references to out of context half truths.
marat
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Leah, Medicine Hat
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JFC
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Matt
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Chinese Proverb
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Phillip M
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Matt
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"Another bandwagon for the blame the guilty, right-wingers to jump on."
Of course I blame the guilty.
Beats the Liberal habit of blaming the victim and the innocent.
Mental illness is a serious problem, one that is often misunderstood. We do a horrible job of treating it, and those affected by it.
The question is at what point does a desire become an uncontrollable compulsion?
Thinking about this from a different angle consider the following.
I often scratch mosquito bites, I try not to but some times I can't resist, other times I don't even notice I'm doing it.
Am I mentally ill? Is this really uncontrollable, or am I giving in?
Where do you draw the line?
I'm not saying addiction isn't a real problem, or that the need to fulfill it can't be extreme. What I, and others, feel is that feeding the addiction is more often than not a choice, you physically choose to go buy a pack of cigarettes, and you choose to smoke them, or to continue to smoke them if you didn't notice you did it.
This isn't meant to belittle the difficulty of overcoming some addictions, which for many addicts is almost an insurmountable task. But with health and effort addicts can choose to stop.
Joy
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Kathleen
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Ben
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Dana
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Jim BB
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Dean
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Mo
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yram
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Peter
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James (Guelph, ON)
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Addiction is not a disease that you can "catch" like HIV or Hepatitis. But all doctors, even this one, will agree that addiction results from a toxic change on brain chemistry. And if one were to look up the definition of the word "disease", they would see that among other things, it includes any chemical toxicity that causes an organ (like the brain) to function incorrectly.
In any case, this doctor's statements will do little to reduce the effects of addiction on our society. In fact, I suspect that by feeding society's ignorance on the subject, a few more addicts will not get the help and support they need from friends and family. Instead, those who should be helping the addict will instead blame the addict for creating the problem and thus drive the addiction further underground. Such a waste.
MRC in Ontario
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RS, Toronto
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Anne M
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My Dad was an alcoholic, and many times his kids went to sleep hungry, because to him it was more important to have his bottle, than to feed his family. We kids were raised in poverty, while he came home drunk every night.
When he died, he had nothing left to leave us, while our cousins inherited lots of land and money. Their Dad's took care of them.
Doug BC
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Then,at some point,an addict has to accept some responsibility for dealing with his/her weakness,and find a way to eliminate the temptations.As an ex smoker I recognized that I could not have "just one".I had to "choose" not only to not have just one more,or one per day,but also to not have them in my home.When my late uncle was recovering from alcoholism,he could have just "one more" for good luck.He had to entirely eliminate alcohol from his life.
One problem seems to be that few pwople recognize they have addictive traits until AFTER they become addicted to something.Then the challenge becomes even greater.I seriously doubt that most addicts start out with a goal of becoming addicted.And many fool themselves into believing they can quit any time they want to.Just try doing that my friends.It is much more difficult than most think.
Maybe it could be defined as an illness,AFTER a person becomes addicted.But I think starting is a matter of choice.And I do find it a bit troubling to place addicts in the same category as people inflicted with cancer,or diabetes,or any other ailment we have traditionally defined as a disease.Those people had no "choice" at all.
One thing seems clear.Few addicts will beat their habit until they accept their weakness,and make a conscious "choice" to beat their addiction.Those with illnesses that fall under the traditional definition of disease,have no such "choice".
Plabo
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Marty
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The truth is that addictions are often the result of both. That is why intervention should take into consideration both the "choice" and "disease" factors.