Note: This interview was broadcast on WGBH radio, Boston’s NPR station for news and culture, on April 17, 2011!
Faculty Insight is produced in partnership with ThoughtCast and Harvard University Extension School. This first interview of the series is with Gene Heyman, a faculty member at the Extension School and a lecturer on psychology at Harvard Medical School. Professor Heyman’s controversial new book, called Addiction: A Disorder of Choice, asks if addiction is a disease, and anwers: no!
Dr. Heyman must have skipped the courses on non-linear statistics and complexity theory. Addicts demonstrate very little conscious choice and are quite immune to logical/linear approaches to engaging in harm reduction or attaining sobriety. No two people come to addiction on precisely the same path. Other people can be faced with the same stressors and invitations to use psychoactive substances. Yet they remain firm in their resolve to not succumb to addiction for reasons that they cannot understand. This is not a conscious choice. The author finds that the influences of dopamine highs created in the brainstem and potentiated by drugs are ignored by the free-choice theorists. Add to this dysfunctional prefrontal cortex activity which should stop ill-advised behavior and the illusion of choice becomes another reason to use shame/blame in the treatment of alcoholism and substance abuse.
Finally all psychiatric disorders show a statistical spontaneous recidivism over the lifespan of the addicted person. My view is that this may be the result of accumulated damage to the brain, vital organs, cross-addiction to nicotine or other substances, and premature aging. Simply put it takes energy to be an addict and many are simply too burnt out and sick to follow the dictates of a disordered brain or free will. Insight garnered over decades of substance has nothing to do with the decision to become less self destructive. Many become “dry drunks” showing no changes to attitudes or cognitive distortions. Some haunt AA meetings freely giving advice to new members on how to get clean and sober which has no shread of clinical science to back it up.