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Harvard Psychologist Denies Disease Theory of Addiction
May 21, 2009

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Addiction is not a disease but rather a behavior that can be controlled, according to a Harvard psychologist who points to the fact that some addicts can voluntarily quit using to support his hypothesis.

The Toronto Star reported May 16 that Gene M. Heyman, author of the new book, Addiction: A Disorder of Choice, writes that the public has been deceived by addiction experts. He agrees that individuals can be genetically predisposed to addiction, and that changes occur in the brains of addicts, but contends that the decision to use or quit remains voluntary.

Heyman disputes the notion that addiction is a lifelong illness, saying that the research underpinning this theory is skewed by the fact that studies tend to look at people who have sought treatment, not those who quit on their own and never use again.

People do not choose to become addicts, Heyman agrees, but while most addiction experts point to changes in the brain as the underlying reason for relapse, Heyman sees the issue as primarily one of self-control.

Heyman's take on addiction doesn't sit well with many experts in the field, who note that many addicts can't change their behavior despite devastating personal consequences, such as loss of health, family, and job.

"Where (Heyman) loses the argument is that there are clearly both biological and environmental or contextual factors involved, but he's basically saying that the context and the environment are everything and the biology is irrelevant," said Tony George, head of addiction psychiatry at the University of Toronto. "Well, what we know about the brain, and the brain on drugs, is startling." 

COMMENTS ON THIS ARTICLE:

Posted by Scott R Mote on 22 May 09 09:21 AM EDT
I tried to control my use during the years I received a B.A. cum laude, an M.A., a law degree, passed two bar exams, and practiced law. Oh, and I also was a pretty good athlete--recruited to play college football and baseball at Division I. I think I had pretty good self-control--except when it came to my genes, alcohol and drugs. Sorry, but I tried Heyman's way for nearly 20 years, to no avail. When treatment taught me about my disease and lack of control, I started a new life that is working, ODAAT, for 24+ years now.

Posted by John French on 22 May 09 09:23 AM EDT
All the arguments about will power are distinctions without a difference. By broadening his definition of addiction to include folks who are able to stop by their own will power, the good doctor proves his point. But his point is pointless when dealing with those millions of addicts who cannot stop by their own choice without support, whether from 12 Step recovery, chemo- or psychotherapy. But his opinions are selling a book, so more power to him.

Posted by Joe Diament on 22 May 09 09:29 AM EDT
I haven't read Heyman's book so I can't be thoroughly dismissive. I suspect however that he is basing his writing on anecdotal experiences with clients. This is akin to me making the argument that cigarettes are not addictive because I quite a 2 packs a day habit 20 years ago and can now smoke a pack a year without fully relapsing. I believe my biochemistry is the difference not exceptional will power.

Posted by Mike Dennis on 22 May 09 09:34 AM EDT
Everyone is entitled to their opinion. The fact that this bozo is from Harvard will, in some people's eyes, give it credibility. I question his motive for coming out with this. Must be purely for book sales and name recognition. Is an inflated ego a matter of choice and self-control. If so, I think he needs to control his for the betterment of society

Posted by John Haryy on 22 May 09 09:44 AM EDT
Pointless Mr French? I think not. The decision to use or not is still a choice. And although it is influenced by other factors, I, like you, am not a robot. I have over 5 years clean and it happened because I made a decision to change. I sitll believe the vast majority of individuals recover completely on their own without the help of us who work in this field.

Posted by Ebony Baines on 22 May 09 09:50 AM EDT
Heyman's theory frustrates me as an addict myself. Addiction is a disease just like Cancer, cancer can spreasd to other parts of the body even after doctors removed the core part of the disease the sme with drugs. Once an addict puts the drug down addiction shows up in many other areas of an addicts life. Thats where the Recovery process comes into play not from only dug use but the attitudes and behaviors that either caused or are a result of using. Addiction is definitely a disease that affects all areas of an addicts life.

Posted by Barry McMillen, MA, LADC on 22 May 09 09:51 AM EDT
This individual is, in my view, irresponsible. Being an employee of Harvard, one would think there would be a higher regard for the benefit of others.There seems to be only ego involved here. Perhaps Mr. Hayman is not aware that all people who use addictive substances are addicted to those substances. Mr Hayman needs to become an ex-employee of Harvard, if Harvard is, indeed, responsible itself or perhaps Mr. Hayman exhibits a typical behavior pattern promoted by Harvard University. Not good public realtions move at all.

Posted by lisa on 22 May 09 09:53 AM EDT
Addiction and Alcoholism is an illness which effects one's mental, physical and spiritual well being. I'm 45 yrs old and not until I hit by bottom and went into an extensive recovery program did I realize I'm an addict in every sense of the word. I was addicted to gambling,switch from one drug to the other to try to control my use and it never worked. I have to work at keeping my life balanced or I slip back into addictive behaviors and attitudes. I am very much involved with the 12 step programs,NA, AA, and Al-Anon. My life is awesome today, its not easy on some days but I get through them with prayer, support and not acting on obsessive thoughts. Today I'm 2yrs 9m and 17 days clean and sober...

Posted by Mark Nason on 22 May 09 09:57 AM EDT
Without reading Heyman's book, it is difficult to know what caveats he includes. Most likely, the issue is one of definitions. DSM-IV criteria for alcohol and drug dependence are so broad that a large portion of those who would meet the criteria are capable of returning to low-risk use. For example, see NESARC data on this (Dawson, et. al., 2005). For these folks, significant motivation to change and will power are often sufficient. So, studying these folks would largely support Heyman's contentions. However, some people who meet the criteria manifest loss of control of use as well as withdrawal. These symptoms indicate a more severe condition, and appear to be caused by significant brain changes. This condition meets the standard medical definition of a “disease.” Even for these people, will power to say “no” to the first drink is essential. For a variety of reasons, this will be easier for some than for others. Some will need extensive support. In addition, will power is often an essential component in managing disease. With heart disease and diabetes, for example, the will power to follow through with changes in lifestyle. Unfortunately, the alcohol and drug field has at times over-diagnosed who has this “disease.” This gives ammunition to skeptics. As a field, we need to be consistently more precise about our definitions. “Disease” or not, changing behaviors that are reinforced by significant brain changes is no small task. Many people will need help to do so.

Posted by David on 22 May 09 10:05 AM EDT
No matter how you word it, disease or choice, what ultimately seems to happen is that people control their behavior by not using. Whether that is through self-help, 12-step, therapy, etc. seems irrelevant because a decision is made and then acted on, and how long it takes is also not relevant to the final outcome.

Posted by Amy on 22 May 09 10:18 AM EDT
I think for people who are not addicts, it is very hard to understand how someone who has full control over their physical body has not control over drugs and alcohol. Probably similar to the way that I don't understand why someone who is obese would continue to eat Big Macs, because I've never had that problem. Yes, I'll admit that I chose to drink and do drugs, but there was no way for me to know that I would become an addict. Other people I partied with didn't become addicts, so why me, I don't know. Now that I'm 2 years sober, I'll concede that yes, if I relapsed that would be my choice. Going to AA meetings and constantly evaluating my reactions to everyday situations is the way I control my addictive behavior. But when I was actively using, I had no control over my addiction. It was not a matter of self-control because I was able to finish college, find a full-time job, pay rent on time, buy a car, workout at the gym, etc, but I could not stop drinking. And when I relapsed 9 months after treatment, yes it was my choice to drink again, but once the alcohol was in my body I lost all control over my ability to stop. People who are not addicts will say things to me like "why don't you just have one or two?" Thanks genius, I never thought of that! For me, if it was a matter of will power and self control (things that I know I have), than I could have quit on my own or controlled my drinking. But for me, it wasn't about those things.

Posted by alexb on 22 May 09 10:31 AM EDT
The premier therapy today seems to be cognitive-behavioral - which is based on the premise that people have s greater ability to choose behavior than they might have imagined. So people can choose to move away from addictive behavior. But that has nothing to do with whether its a disease or not. I have diabetis, and through choices I make I am able to remain free of any symptoms. But that doesn't mean I don't have the disease. Same with my alcoholism. I choose not to drink today after 26 years sober. But that is no measure of whether I have a disease or not. Does the fact that I can choose exercise and diet and to take medications mean that diabetis is not a disease? That's not a sound criteria for defining disease. I am powerless over the condition, regardless of my freedom of choice when it comes to controlling my behavior.

Posted by Craig MacInnes, BS, CADC on 22 May 09 10:58 AM EDT
I'm a recovering alcoholic/addict who also happens to be a Chemical Dependency Professional, and I often advise clients that even if you don't buy the disease model of addiction, why don't we just conduct an experiment for let's say 8 months or so & treat your condition as if it was a disease, using a 12 step solution, and see if you get better results than when you were just relying on will power alone? If at the end of the experiment you're not satisfied with the results, you can have it all back the way it was at the beginning. We'll cheerfully refund your misery! Many people won't even seek treatment until they have exhausted all of the other alternative methods of achieving different results. I don't believe Mr. Heyman's study is going to do a thing to relieve the suffering of a single drug addict. I'm sure that next month some researcher will claim to have invented a pill that allows addicts to resume using safely.

Posted by Andy on 22 May 09 11:06 AM EDT
I also did well in school, geraduated from college and served a as Deputy Sheriff for fifteen years. I was ambused on duty and following this incident I was bombarded with precription meds quickly becoming addicted. Soon tried to stop using. Used alcohol to detox from meds which is like changing seats on the titanic. I also lost my self respect, dignity,confidence and moral boudaries until I received substance abuse treatment in a 30 day program and supported by a long term SLE and 12 step support group, GOD and clinical therapy. I didn't want to lose my career, family and hard earned reputation. Substance abuse is a disease.

Posted by Kevin M. Passer, M.D. on 22 May 09 12:15 PM EDT
I do not believe the Harvard's report is helpful for our field. Dr. Nora Volkow says the definition of an addiction is a brain disease which causes a person to engage in behaviors which they know may have dire consequences, but they engage in the behavior anyway. So of course behavior is part of the problem, but it is what drives the behavior which is the real issue. Kevin M. Passer, M.D. Board Certified-Addictionologist

Posted by Jerry Januszewski on 22 May 09 12:33 PM EDT
Once again here's a so-called professional in the substance field who blurs or disregards the real distinction between substance abuse and addiction. I've not yet met someone who rejects the disease model of addiction. layman or clinician, who didn't have a pre-existing ax to grind with the philosophy of AA.

Posted by jmj on 22 May 09 12:38 PM EDT
I have been clean and sober for 15 years now. I wish someone would have informed that I could have easily just changed my behavior before I destroyed everything in my life for 25 years prior to getting my disease under control.

Posted by Bob Bunker on 22 May 09 12:46 PM EDT
Tell the jerk to read Milam's "emergent comprehensive concept of alcoholism." In it, Milam says there are three types of drinkers: the "normal" drinker, the "irresponsible drinker" and the "alcoholic drinker." The drinking of the irresponsible drinker looks like that of the alcoholic. The difference is that the irresponsible drinker can quit on his/her own, but the alcoholic drinker cannot. I imagine that this wisdom would be appropriate for the entire spectrum of addiction.

Posted by Philos on 22 May 09 12:56 PM EDT
Has he considered that people may be misdiagnosed? Surprisingly people that discover that they do not have cancer, seem to decide not to die from cancer. Substance dependence can have a wide array of causes. Sometimes when another issue is treated it has a cause and effect on other diagnoses. I respect Heyman's opinion, although To better describe a patient's ability to modify their behavior he should have used will rather than choice, as it would be a more appropriate term. Given the right circumstances any obstacle can be overcome with positive mental conditioning.

Posted by judy cooper on 22 May 09 12:57 PM EDT
Of course the "decision to use or quit remains voluntary." As a recovering alcoholic of 25 years duration, I can testify that I made that decision daily during the problematic period of my drinking, then on a daily basis since recovery. The ability to STAY sober has been daily also, but reinforced by inpatient treatment, outpatient counseling, and suppport from community based resources plus many mentors. Making a decision is the easy part. Following through with the lifestyle changes is the tough part. I hope that book sales of Heyman are not fueled by the sad hope of still suffering drinkers.

Posted by Franklin Percival on 22 May 09 12:57 PM EDT
Can we see the research paper and the citations, please?

Posted by Terrance Newton on 22 May 09 01:03 PM EDT
It's too bad that someone from Harvard has chosen this stance. There is a whole movement of these type of philosophers that have taken this issue on over the years. If as much research went in to addiction as what has went in to developing treatments for AIDS we might get somewhere. This guy reminds me of the alcohol industry. Market the party ad infinitum but; "Please drink responsibly." This message has convinced a number of people in our society that alcoholics are simply irresponsible people. Reminds me of the; "Just Say No" campaign by a former First Lady. This argument continues to keep the stigma alive and well while millions continue to go untreated and die while continuing to cause a great deal of cost to society. Sell your book professor. The rest of us will continue to shovel up the damage.

Posted by jrzshor on 22 May 09 01:11 PM EDT
he is actually correct. choice is at the heart of active addiction and of active recovery. CBT is about choice. continuing to use or not use is a chioce. AA is about choice. Staying sober or not is a choice. Enter a tx program; choice of going or not. albeit, the choice is fleeting, confusing, scary etc. under no circumstance(s) does one NOT MAKE A CHOICE.

Posted by hphughey on 22 May 09 01:49 PM EDT
jrzshor It is not a choice when one chooses to quite for good and finds themselves sill using . For some it is like schizophrenia .

Posted by Terry Welf on 22 May 09 01:52 PM EDT
What better way to sell books than with a controversial opinion that gets visibility on the web? If this indivdual had done any research he would know there is a mountain of evidence that co-morbid anxiety is a major factor in addictive behavior. This in turn is related to kown neurotransmission processes that are not functioning as they should. If someone has MS hich we believe is ralated to faulty nerotransmission in the limbic brain sections, we call it a disease and treat it (e.g., baclofen for muscle spasms). For dependent behaviors related to similar disfunction, we call it addiction and say just stop. Go figure!

Posted by Alexis on 22 May 09 01:56 PM EDT
I just wanted to thank Join Together for making me aware of this book. It proves your organization is not so one sided as to block out opposing views entirely. I cannot however say that for most others in the field of addiction studies. I am currently studying for the CAADAC certificate at Loyola Marymount University and never knew that drug counselors could be so close-minded and fearful of their beliefs that shutting out all other possibilities was the only way to protect them. Sometimes I feel like I’m being forced to surrender critical thinking to a higher power as if any question is considered a sacrilegious relapse of disease model faith. I find critical books like this a breath of fresh air in the monotonous, dogmatic, disease model approach that dominates addiction studies.

Posted by KIM POTVIN MA,LADC on 22 May 09 02:18 PM EDT
The Harvard Psychologist must not be treating the clients I am seeing. I work with a population of addicts and alcoholics who do not drink and drug to go to jail, lose everything they own, live homeless in the streets, ect. The choice comes to pick up the first. Most REAL addicts/alcohols can not stop. Please good Dr. don't kill anymore addicts by telling them their problem is bad choices. PEACE

Posted by John Tinley on 22 May 09 02:21 PM EDT
Well once again a big brain thinks just will power can be used on addictions. This reactionist needs to practise in the 1920s not today. His opinion/theory is dangerous as many sick folks will read his garbage and die trying to "will" the addcition away. I was told a long time ago that "willpower" gets us only to where I landed......flat on my face a case of self will run riot. Try using that will power stop diarrea and see what happens Dr. It is about "choice" and finding Spirituality etc. I have been an addict for 56 years and helping other for 25......and thanks to turning my will over....to the care of a higher power....i am in remission and a Therapist now.

Posted by SamAlbert on 22 May 09 02:54 PM EDT
Wow. Why did we waste all those $$ on PET Scans, Brain Imagery, and all those other scientific proofs of physical differences in an addict as opposed to a non-addict?? We could have just this "Harvard" professor his opinion. After all he does "profess" for a living. Amazing how some people ignor facts.

Posted by Lisa on 22 May 09 02:55 PM EDT
Shame on him and shame on Harvard press. Publishing and promoting a book disregarding facts and research. This does nothing but encourage the stigma of addiction. SHAME! He is a psychologist and in no position to dismiss medical experts and experts in the field of addiction. I am glad to see a fairly clear consensus against this book! His outdated and uneducated "thoughts" don't even deserve an argument. However, if anyone is interested in the arguments against such foolishness you can start your research with literature published before 1900s!

Posted by Chuck E. on 22 May 09 03:01 PM EDT
Throughout history, people have argued this notion, but the emerging neurobiology and genetics studies have now given us the weight-of-the-evidence answer. Most people who argue this are only seeing the disorder of alcohol or other drug abuse (which is willful use), not chemical dependence (which is the disease). They're focusing on the wrong thing and are unaware of what hard science is telling us about chemical dependence. Books like this are killing people who need treatment, because they continue to think they're not strong enough until it's too late. The guy is just trying to stroke his ego by being controversial. He should become thoroughly informed before he writes a lethal book like this.

Posted by Cathy W, BS CADC on 22 May 09 03:54 PM EDT
We are all aware of the Biological, Psychology and Sociological triad. With a 10-10-80 split respectfully. I feel that addiction is not a disease in the sense that there are certain sociological pressures that cause the addict to manifest lack self control. It does not matter if you’re cum laude or have other accomplishments. There is some sociological force that is driving the addict to use. This is not a new theory at all. Robert Granfield and William Cloud have clearly showed that there is spontaneous recovery for millions and millions or people. These people choose not to discuss their past problems and are not anecdotal.

Posted by ROBERT on 22 May 09 04:00 PM EDT
I spent 25 years a herion addict. Got clean 11 years ago. I ahave a BA in addictions and work as a professional in d&a. I firmly think that once a person is given the tools to remain sober, it's a decision to use or stay sober. the guy is entitled to his own beliefs. What opened my eyes was hearing the hurt and disgust in my mothers voice when I had to tell her I was in prison again because of drugs. I didn't go to rehab or need support groups. Meetings make me want to scream listing to people whine. Not everyone gets sober through a blueprint. I made changes and stuck to them. Because someone doesn't agree with your methods doesn't make him wrong in his!

Posted by Ryan on 22 May 09 04:05 PM EDT
I think the distinction that a few people are missing here is that just because diabetes and drug addiction can be thought of as diseases, they cannot be thought of as comparable diseases. Diabetes is primarily a physical ailment, especially for a two year old who has type I diabetes, for instance. There is no will power involved. I think theories like Heyman are helpful to some addicts. One of the problems with the disease model of addictions is that it removes personal responsibility from the equation. To say "I had no way of knowing I was going to become an addict," or to compare addiction with diabetes; these ideas may be comforting, but are not helpful, and indeed untrue, when applied to most addicts.

Posted by Carey Wainwright on 22 May 09 05:20 PM EDT
I would like to read Dr. Heyman's book and the citations. Use, Abuse, then Addiction make up a continuum. Most of society stops using on their own. Those who continue into addiction experience a neuro-chemical change, as addiction is a 'brain-disease'. With psycho and/or chemo-therapy, a nutritious diet, exercise and some spiritual enrichment, people with the disease of addiction also recover. Man is a communal creature and we need one another to overcome those obstacle that we cannot conquer alone!

Posted by Mary Branch on 22 May 09 05:53 PM EDT
I believe addiction is a disease that has definite genetic components, and every one reading this forum knows that science has backed this up. I recently learned that the disease model of addiction is also shunned by scientologists who also believe addiction is a behavioral choice. Achieving sobriety by any means is life saving. While I am at home in the '12 step' community as are millions of others world wide, many are not. Thank you Join together for covering all the bases.

Posted by Barry Schecter on 22 May 09 06:46 PM EDT
I have a very simple comment for the professor from Harvard. I would like to prescribe numorphan 40 mg. qid for 30 days. I would like him to describe the changes that occur in his brain, but most of all, I would like to see the choice that he makes on the 31st day. When he sees those little pills, I wonder how many days before he might ask for another. After all, since it is just a choice, I'd lie to see what choice he makes. I will gladly pay him 1000.00 cash for each day that he chooses not to take one, all I ask from him; retract his absurd article

Posted by Boogie on 22 May 09 07:32 PM EDT
A lot of so called "Addiction Experts" are getting nervous on this one. One expert opinion differs from another and pandomnium sets in. How ironic! We don't need experts to tell us what is known already by every "dope head" or "drunk" who is pimping or playing the system for all it's worth. It's easy to accept the bull and go along with the "disease concept" because if we go along with the truth, billions of tax payer dollars could be saved and all the bums would have to find another angle for employment. I ask the question of all the so called "12 steppers" out there,how many of you work in the so called addiction field. Get the answer to that question and you will see why there is so much anger about the truth of addiction. "Addiction is a choice" and hopefully one day all you disease concept, 12 steppers will get a life and move on, if you are truly restored, leave everyone else alone or otherwise continue to fight the truth and enjoy your cult. Barry, you sound foolish, get a life or continue your old one it's your choice, don't be a hater. Only a fool would take you up on a bet like that, duh..

Posted by Jose on 22 May 09 08:50 PM EDT
Alexis wrote...I never knew that drug counselors could be so close-minded ...I find critical books like this a breath of fresh air in to the monotonous, dogmatic, disease model. This is the danger of this professor’s book. That what has been proven to work for decades is considered dogmatic while this "Harvard" professor’s book is a breath of fresh air even though it was the “norm” before 1935. Sad but before this professor's book goes out of circulation; many an alcoholic/addict will die trying to control his/her disease through choice. Of course addiction is a behavior and therefore a choice but for some (the addict) it is an obsessive and compulsive behavior that choice can not control by itself. He points out that studies tend to look at people who have sought treatment, not those who quit on their own and never use again. Most people who seek treatment almost always meet the medical diagnosis of addiction not the same for those who quit on their own. Our stages to addiction are contact use, responsible use, habitual use, excessive use, abuse, chronic abuse and addiction. Except for addiction, they can all make the choice to quit with no to little problem. So when they quit on their own using only their willpower and choice, they confuse people into believing that an addict can do the same, which is not true Heyman also disputes the notion that addiction is a lifelong illness. All he needs to do is go to an AA, NA meeting to prove this wrong.

Posted by Rokki on 22 May 09 09:10 PM EDT
Have Heyman get strung out on opioids and then come back and talk to me. Walk a mile in my shoes before you judge me

Posted by Nancy Cac Cert One on 22 May 09 11:06 PM EDT
It sounds Like this Man Is attemping to give himsself a way that "theory' Vs sickness isolates himself from the others what is he trying to prove?Many people can behave and still be addicted?That is Not the issues The AMA regonizes addiction as a Diseaes Maybe he is in denial

Posted by Boogie on 23 May 09 01:28 AM EDT
It seems if anyone goes against the AA priciples which is the AMA they are in denial, another great AA terminolgy. So,after reading the comments here I see now I may be subscribing to the wrong news source. Is everyone reading this source hooked so badly until they only have a one mind. As Jose said up until 1935 we were normal. So, we are not normal any more beause of a few millions steppers,gee! Someone please give me a source that can give a definite argument for the other side.

Posted by Raymond Conte MA CASAC on 23 May 09 09:42 AM EDT
I have a different take on this. The researcher fails to recognize the clinical distinction between the diagnoses of ABUSE and DEPENDENCE. My experience in the field of 35 years has shown a significant under reporting of individuals with an abuse diagnosis in treatment. Yet they are there, in very large numbers. The value of this report should be in finally beginning a dialogue that can develop an effective research based treatment model, rather than continuing with the one size fits all model. Would we be satisfied with a pediatrician that treats our children with a sprained ankle and a broken ankle, in an identical manner. Yet this is what we have done, and continue to do. Clinically we see the progression from abuse to dependence every day with our patients. What a great opportunity to change this. And yes, at the end of the day Addiction (dependence) is a disease of the brain. However, I believe that abuse (non yet dependent) is a "disease" of the mind. Let's go to work as a field to address this!!

Posted by crashtestaddict on 23 May 09 10:48 AM EDT
Guess that being at "Haaavaaard" isn't a bar to either being an idiot, or attempted idiot. He is, however, not entirely stupid, in that he knew full well that his position on this would create controversy and in turn fuel book sales.

Posted by Frank Holt on 23 May 09 11:18 AM EDT
I know Gene Heyman and he really truly believes in his position. I do think it is not sufficiently informed by contact with addicts. He has taken the position that you can use Contingency Management to change the cost-benefit dynamics of a decision for an alcoholic or an addict to use alcohol or other addictive substances. In other words, for enough incentive (usually cash) you can get people to stop. Addicts can't stop when their personal health, relationships and economic survival hang in the balance. Maybe in a lab somewhere, with people who are abusers but not dependent. But not with addicts.

Posted by karen on 23 May 09 11:22 AM EDT
"disease an unhealthy condition caused by infection or diet or conditions of life, or inherited."...Addiction appears to fit the criterion.

Posted by R. Davis on 23 May 09 11:41 AM EDT
Interesting theory. Personally I believe that the solution to this diease or not a diease; is that we get to live a new and better life in recovery of this diease or not a diease. Also I applaud Mr. Heyman; it's not always easy to stand alone.

Posted by Frank on 23 May 09 01:02 PM EDT
If a person quits, they're not an addict, right? So by denying everybody who quits the beloved label of "addict", you're guaranteeing that "no addicts can quit on their own". It's a catch 22.

Posted by Psy on 23 May 09 01:04 PM EDT
Whether or not there is a genetic preference towards alcohol still does not defeat the point that picking up a drink, or putting it down for that matter, is a choice. Addiction is not a disease, it's a symptom of deeper problems. Is a person's life terrible because they drink too much or does a person drink too much because their life is terrible are are otherwise depressed. I think traditional disease concept "treatment" reverses cause and effect, which is easy to do, but also explains the dismal sucess rate of 12 step programs.

Posted by Pat on 23 May 09 05:15 PM EDT
To Psy, have you ever experienced the struggles of a loved one who has an addiction?? Have you ever seen a loved one who is voted "most likely to succeed" in their graduating class lose all their self esteem and motivation because of this uncontrollable disease? I doubt that you have! 12 steps may not be for everyone but the program has certainly saved a lot of lives for the addict and their families. The families stopped their enabling and/or ridiculing, etc. to get the loved one to stop using drugs or alcohol and the addict learned to stop hating him/herself and instead of giving up, kept on working toward sobriety. Some never are able to accomplish it but many are. They stopped feeling like their problem was just a problem of weakness and started looking at it as an uncontrollable disease that required help to overcome. This Harvard student still has a lot to learn!!!! Personal experience is the best teacher!

Posted by Psy on 23 May 09 06:13 PM EDT
You claim the program has saved lives. Do you have anything other than anecdotal evidence to back that up? Double blind, perhaps? It seems to me you're "selling" a product as a "cure" and you can't even prove that it works! Yes, I have seen people, close friends, destroy their lives with heroin and other drugs (or use drugs to cope with their destroyed lives)... but I have also seen them quit on their own without any intervention. I believe these people represent a silent minority (and have just as much evidence to back my believe up as you do in supporting 12 step). I belive that if 12 step programs really worked, they would have evidence to back it up. As it is, there is nothing to suggest it's anything more than a religious placebo that happens to be endorsed by the state.

Posted by Boogie on 24 May 09 01:32 AM EDT
Who needs 12 steps to stop doing something dumb. You took one step to start and all you need is one step to stop. It's time for change, it's time to stop letting these 12 steppers control the system. Write your legislators and let them know enough is enough. Give people their freedom to drink or not to drink or close down the liquor industry. ( oh, we tried that) which proves addcition is not a disease otherwise why aren't we sueing the US government for "life endagernment". Duh! Get Real 12 steppers, it's your own fault. TAKE FULL RESPONSIBILTY or as you so easily say to others in cult fashion You're IN DENIAL of the truth it's been headed your way since the day of your leader, Bill, whokept falling off the wagon with that same old excuse, "ONE DAY AT A TIME" Who needs to keep count on their last drink or when their next one will be. Drinking is for your enjoyment and if you don't drink, don't condemn yourself with labels. Go figure!

Posted by Psy on 24 May 09 07:19 AM EDT
Actually, as far as I know, Bill had no problem staying on the wagon and died a very rich man thanks to book royalties (which he stole by fraudulently claiming sole authorship). It was Dr. Bob and the others who more or less drank themselves to death.

Posted by Yvonne Heim on 24 May 09 09:48 AM EDT
I work in a prison drug/alcohol program, and I liken Dr. Heyman's opinion to that of the correctional officer's opinion "that punishment is what offenders need so that they won't want to return to prison." There are a few who don't return, but unfortunately many with a drug/alcohol problem relapse and find themselves right back in prison. If addiction is not a disease, then why would someone want to live a life of harsh punishment instead of a free life.

Posted by Psy on 24 May 09 10:55 AM EDT
Maybe because you taught them it was a disease, that they can't control themselves, and as a result, they don't. Nothing upsets me more than a saavy criminal who says "it's not my fault, the disease made me do it!". People make choices. Sometimes they make bad choices. Just because people sometimes make self destructive choices does not mean there is a disease involved. Again, it's a cop out. On the other hand, while I believe in personal responsibility, I also believe in self ownership, and that it's not the governmet's business to tell people what they put in their own bodies. Judging people by their actions is just. judging people by personal choices and what they statistically might do is prejudices, as surely as prejudice on the basis of religion. Just because a Muslim may be statistically more likely to blow something up doesn't make it just to start locking them up pre-emptively. It's the same with drug users.

Posted by Kevin McCauley, MD on 24 May 09 06:43 PM EDT
If I may ... for the last ten years I have made the question of whether or not addiction is really a disease my full-time job. It is a surprisingly complex puzzle that resists simple answers on both sides. Nevertheless, I believe it is the most important question there is about addiction. Personally I welcome any thoughtful contribution to the debate, including Dr. Heyman's. His basic argument has been around for a while (see HUP: Drug Addiction and Drug Policy, 2001). Clearly he's developed his argument further, and I eagerly anticipate reading his new book. First, we have to set aside some confusing issues: the phenomenon of withdrawal (important, but not definitive of addiction), the shallow logic and dogmatism of the past in the treatment industry (bad, yes, but getting better), the successes and limitations of 12-Step recovery (to which I owe my own sobriety, nevertheless I do enjoy critically deconstructing it), the fact that spirituality is important to many who recovery (to others, not), and yes, the unpleasant behavior of addicts (lots of patients have nasty symptoms that are harmful to others - try cholera). These are distracting issues not central to the question at hand, which is to determine if there is a logical, coherent, evidence-based argument that addiction is (or is not) a disease. The definition of a "disease" is ...

Posted by Psy on 24 May 09 07:48 PM EDT
So you belive addiction is a disease of choice? So a person who is an "addict" does not have the ability to choose. Correct? So because a person does not truly have free choice, treating them against their will is really giving them back choice, right? Problem is: even if people are truly powerless, who gets to make that distinction? What's your opinion on that?

Posted by Anonymous on 24 May 09 07:52 PM EDT
Further. Do you believe that there are cases in which teching a person a doctrine of powerlessness can induce a form of learned helplessness. At AA meetings it's often emphasized that if you're in one, you have a problem otherwise you wouldn't be there (what Lifton would call mystical manipulation). You don't think that implies that anybody who is court sentenced to AA is automatically an alcoholic. Do you think that could explain the *increased* binge drinking tendency of AA members over the control group in the Brandsma study? Is it possible that for some, 12 step programs may actually cause harm?

Posted by Boogie on 25 May 09 01:15 AM EDT
Making amends is a bunch of phooey, which can get you hurt or killed. Because if you have to apologize for it, you remembered doing it and if you remebered doing it and you chose to do it and you did it willingly, whether under the influence or not, Duh. What is there to really say to the family of person killed by a drunk driver. How do you make amends for that. You may ask for forgiveness, but no one is that forgiving, believe it or not. This is something that the victim's family will live with the rest of thier lives and you really believe because of a 12 step program this will wipe your slate clean and bring that dead family member back. That's the only amends that would work for me. The big reason experts are suddenly paraniod is some one is rocking their world. I believe the lies are finally catching up, it just took seventy four years to do so. It's going to be hard to turn the lie around, to do so will change the whole "recovery industry" which is controlled by "so called alocohlics and addicts" and their sympathizers", mainly the AMA and the US government. Remember this is a get out of jail free card for the screw-ups in government and other high places as long as we call this thing a disease which trickles down to the other knuckle heads and they get on the ban wagon. The fight is on! Ring the Bell!

Posted by Anonymous on 25 May 09 05:56 AM EDT
"Remember this is a get out of jail free card for the screw-ups in government" LOL. Ted Kennedy cosponsored this, no surprise:... http://www.govtrack.us/congress/bill.xpd?bill=s110-1011 ... It's noy my fault I drank and drove. It was the disease!

Posted by Robert Curley, News Editor, Join Together on 26 May 09 08:09 AM EDT
FYI, here is the link to Heyman's book for those interested in looking more closely at his theory: http://www.hup.harvard.edu/catalog/HEYNAT.html

Posted by Robert Curley, News Editor, Join Together on 26 May 09 08:14 AM EDT
While we appreciate the passionate and thoughtful discussion regarding this story, we remind readers to be mindful of our comments policy, specifically: "Serial comments intended to circumvent the 250-word limit may be deleted." Please keep your comments brief and focused as this policy will be enforced.

Posted by David Scott, MA/LAC on 26 May 09 08:47 AM EDT
No one says, "When I grow up, I want to be a drug addict." No one becomes an addict after using just once, or even a few times. Addiction is a combination of choice and disease. I don't become addicted if I don't choose to use in the first place. If I consistently choose to use often enough and in greater amounts, I create my own addiction. There is where my responsibility lies. Once my use turns to compulsivity and becomes out of control, I no longer have the ability to choose not to use. In full blown addiction, I use because I have to, not because I want to. Are substance abuse and substance dependencies over diagnosed? Yes. Can substance abusers, with education and guidance, return to low-risk using? Yes. Can someone get sober without the 12-steps? Yes. Should the 12-steps be applied to everyone in treatment? No. The 12-steps are great, but not the only means of recovery. Many alcoholics and drug addicts have gotten sober by using the 12-steps and Bill Wilson should not be faulted for his efforts. Many alcoholics have gotten sober by using CBT techniques and “Rational Recovery” and these methods should not be discounted either. Isn’t there enough room in the recovery community for a diversity of ideas? Debates like these are great for the field and bring new perspectives and discovery.

Posted by John Hicks on 26 May 09 09:17 AM EDT
Mr. Heyman only points out "another way" to look at addiction! Good for you Mr. Heyman Jh

Posted by anonymous on 26 May 09 09:40 AM EDT
Addict for over 30 years, quit on my own, its your choice to quit, you can read 100 books, don,t care. If you do not want to, you will never quit. Oh, Have 3 degrees, so what ? personnel benefit

Posted by Victor Braatz on 26 May 09 09:44 AM EDT
Dr. Heyman is right, Disease model advocates shun Recovery for Treatment models that do not work. Thinking dictates Behavior, and there are many reasons that some people succed in beating addiction and others do not, but it is not beacause of some Disease of Dependancy. Most who do not succed display co-occurring mental disorders which the disease model altruist refuse to address. Dr. Heyman is not the first to dispute the disease model, Dr. Alber Ellis one of the founders of CBT and REBT wrote volumes on the crutch that is the disease model...

Posted by Zapper on 26 May 09 09:47 AM EDT
An old timer in AA (35 yrs sober), who was also a certified substance abuse counsleor gave me some advice about the difference between an alcoholic and a 'normal' person. He would simply ask the person how many DUI's they had and if the response was more than one then they were an alcoholic. When I questioned his theory he said; 'Only an alcoholic would be stupid enough to put him/her self through all that legal trouble and expense more than once.' It made sense to me and I imagine if other people had other consequences besides DUI's, the same answer would be true. As a recovering person and substance abuse professional, there are many ways to get AND stay sober. For this alcoholic, the 12 steps of AA was my answer. As a previous writer said, try it for 6, 9 or 12 months and if it doesn't work; we'll happily refund all your misery.

Posted by David C. on 26 May 09 10:09 AM EDT
The scary thing here is not that there is a different view of "addictions" than the dominant disease model but that there is such a strong, automatic, pre-dominantly negative reaction to the idea without having even read the man's work. He is not the first or only scientist to have voiced these ideas in the face of guaranteed opposition. It is clear from most of the comments here that there is great prejudice against this man and the idea he reportedly has written about. Contempt prior to investigation! Not many if any of those commenting here have actually read what he has written and probaly won't give it a read either. Too bad we don't all take a more open minded approach and keep the mind set that we can alays learn more and improve. If we think that the book has been written on how people with alcohol & drug problems change then what we have is a cult not a caring community or a profession dedicated to objective truth and best practice. One size does not fit all and if you think it does then you have become a relegious fanatic cult.

Posted by Pat on 26 May 09 10:14 AM EDT
I find it extremely interesting that the comments by the majority of ones who believe addiction to be a disease and who are not anti AAA are factual and courteous while many of the anti disease believers are rude, discourteous name callers!!! Why the hostility??? Do you have an axe to grind? Maybe you have problems other than addiction?

Posted by Profbam on 26 May 09 10:15 AM EDT
From the website for the book: "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." Although I am not an alcoholic or an addict, I have sat in on many 12-step meetings and I take my grad students to the local state facility to meet the "real pharmacologists". I do not know how many times that I heard, "The first time I took a drink, I knew that was what I wanted to do," from the alcoholics. And, "The first time I shot an opiate, the void at the center of my soul filled up with warmth and I felt whole for the first time," from the narcotic addicts. There is no doubt that their brains are chemically different. There are others who slide into addiction and for them it is much easier to choose to stop. In fact it is problematic in the treatment literature in that many use subjects who meet DSM definition of alcohol dependence, but clearly are not alcoholic and so one does not know what to do with the data. When Project MATCH came out, I read the inclusion/exclusion criteria to a room full of providers who were laughing because I had eliminated about 90% of their clients. I believe the good Prof. Heyman is mixing the groups into one shoe fits all. He needs to get out more.

Posted by John Epling MD on 26 May 09 10:18 AM EDT
Most diseases represent a loss of control; addiction a loss of control over the use of a substance or behavior. Pneumonia a loss of control preventing growth of bacteria or virus in the lungs This might be considered self willed in that the individual chose to expose themselves to such agents by choosing themselves to an infected person. Makes sense to me.

Posted by James Dunn, MHS on 26 May 09 10:22 AM EDT
The first problem I see in this debate is that many seem to think that alcoholism is monolithic. It is not. There are as many different "types" of alcoholism as there are alcoholics. But there does seem to be two broad categories; the "genetic alcoholic" and the "behavioral problem drinker." One (the genetic alcoholic) has the full-blown disease while the other does not. The behavioral problem drinker is similar to Jellinek's "Type I" alcoholic with later onset, less severe course, and overall lower levels of tolerance. The problem of course is that Heyman's theory works perfectly well for the behavioral problem drinker. This is simply because his or her drinking is rooted in behavioral adaptation in the first place, so behavioral modification can and will work if done with a talented counselor or therapist. Of course Heyman's theories will NEVER work for the genetic alcoholic and could easily get them killed. The genetic alcoholic simply requires a different clinical focus. Until this field understands and accepts that there is more than one influence, and therefore more than one answer, we will be stuck in these endless debates which ultimately seem to be more about apples and oranges (and researcher's egos) than anything else.

Posted by Anonymous on 26 May 09 10:35 AM EDT
well,i think the problem will be solved if we define the disease word itself .

Posted by Anonymous on 26 May 09 10:39 AM EDT
The addiction/disease debate will continue until we fully understand and integrate the element of sleep disturbance upon predisposition, abuse and treatment. Brain impair- ment of pathologic dimensions can contribute, along with aging, to permanent sleep impairment, indeed a "disease" of the brain. Treating sleep deprivation still awaits adequate pharmacologic research, nothing yet works to allow "catch- up" sleep replacement. EXCEPT: how does Ibogaine, a psychedelic herb, reverse the pathophysiology of the addicted brain, with little or no withdrawal nor craving in 24-36 hours? Time to bring psychedelic "herbs" into our addiction treatment bag! See Ibo-gaine on the Web.

Posted by Jos on 26 May 09 10:41 AM EDT
I think it's great that we are talking about this. There are many alternatives to just the 12 steps and I think we need to tailor treatment for each individual. Thanks JT for providing opposing views.

Posted by Michael on 26 May 09 10:43 AM EDT
Debates like this is what 'made' the recovery from subbstance mis-use issues possible. In the words of Kramer.." I am lovin it Jerry" Keep up the good work to all who contribute to my well being...especially Join Together.

Posted by Pat on 26 May 09 10:47 AM EDT
In response to psy, no I do not have evidence, other than anecdotal, to know that 12 steps does in deed work for many. I am not in Research and have not conducted any "double blind" studies nor am I aware of the various studies conducted. However, I do not believe the medical field would have labeled addiction a disease if they did not have some positive proof. Speaking of blind, I believe one would have to be totally blind to not have seen successes from the AA program. I also know many people AA did not work for. However, I have seen success from addiction medications for some of these, which further proves that addiction is a disease. I hope and pray that more research is done on finding medications that will work toward treating addictions. I truly believe it is a disease and there are medications for curing or at least controlling it as with other diseases. Some diseases , such as cancer or diabetes, may not be curable but at least it can be controlled. Rather than looking at addiction as a weakness and something that just requires will power to cure, I believe more emphasis should be placed on treating it as a disease and more money spent on research to find a cure! Money spent on research will be a tremendous savings to our country in the long run, I truly believe.

Posted by billinsandiego on 26 May 09 10:47 AM EDT
Good response David, and I fully agree. The disease concept has become an article of faith, rather than a testable hypothesis. Perhaps the good doctor should be shown the instruments of torture - it worked for that heretic Galileo - to convince him to change his mind. Eppur si muove! What I really love is the new term "brain disease." Why don't they use the more common term "mental illness", it works for schizophrenia, bipolar disorders, major depression, et al. Doesn't it really mean the same thing - problems with brain chemistry. The idea that alcoholism/addiction as a disease has always been problematic. Strong advocates for methadone maintenance say that those who recover from heroin addiction and live drug-free were not really heroin addicts. Those that disparage addicts who spontaneously recover (either without support or solely through a 12-Step application) may simply be trying to justify their own beliefs. We should keep this dialog open - not shut it off with threats.

Posted by R Maslansky on 26 May 09 10:51 AM EDT
As an internist working in this field for 40 years... Oh well, credentials, predentials. I have abandoned most sermons, most theories, most labels and in their place treat everyone of my patients as unique and special. I'm reminded of Bertrand Russell's rejoined when he was asked, "Do you believe in 'free will?' "YES", he answered, "I HAVE NO CHOICE!".

Posted by Nicolas Eyle on 26 May 09 11:02 AM EDT
I'm amazed, not that Heyman's ideas are being trashed by other professionals, that is understandable. What is interesting is that none of the criticisms mention the earlier works that also support this idea. Has nobody read "Addiction is a Choice " by Jeff Schaler, or several works by Tom Szasz? One would think that all these commenters with "MD", "CASAC", or other letters after their name would not be so surprised at someone offering an alternative to the disease model for addiction.

Posted by James Perry on 26 May 09 11:08 AM EDT
This is 2009... Good to sell books. Good to sell lectures. Harvard again, like in the 80's. He must be laughing. After 25 years in the field, I have learned a major key: I ask the patient: "Why do you want to see me?" Answer: "I can't believe this is happening to me". Question; "What happens to you?" Answer: " I just can't quit." Explain: " I make the choice to quit, but I can't." Let's change the subject. Hope not too much time will be spent on this issue. Addicts - who can't stop - are waiting for help. Harvard is not the lieu.

Posted by Fred Garr CAP (Certified Addictions Professional..Florida) on 26 May 09 11:10 AM EDT
Definition of Disease (short & sweet)---> a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.

Posted by Pat on 26 May 09 11:16 AM EDT
To all of those who believe addiction is all about choice and that one can stop their self destructive habits by simply using more will power, how do you recommend instilling more will power in these millions of addicts? Would a good strong kick in the rear suffice? Or do you recommend sending them to expensive psychotherapy so they can sit there and ventilate for an hour for an undetermined length of time? Or do you think that by simply telling them they do not have a disease and they should stop feeling sorry for themselves and just straighten up will work? What is the goal here?

Posted by Roberto on 26 May 09 11:19 AM EDT
I agree that many people can stop using on their own, but the question is, can they go back to using without abusing. If Dr. Heyman’s hypothesis is correct, an alcoholic can have a devastating life related to compulsive drinking, then stop and go back to moderate, non-abusive drinking. I have seldom, if ever, seen that to be the case. A person with a true addiction can, of course, stop using on their own, most of them do. However, they cannot go back to using without returning to addictive behaviors.

Posted by Brian S. on 26 May 09 11:21 AM EDT
Call alcoholism and addiction what you want. While the 'experts' are busy writing about nothing they have experienced, those of us who've seen an indescribable darkness, and are fortunate enough to be alive, are sitting in a room with others just like ourselves, learning how to live. AA and NA have proven to be miracles for my hopelessness. I'd suggest that anyone interested in addiction read the first 164 pages of 'Alcoholics' anonymous, before expressing any opinion on the subject. Though incredibly sad, it happens to be a beautiful story. While those of you 'normal' people argue, I think I'll go to a meeting.

Posted by Bruce Lorenz on 26 May 09 11:25 AM EDT
I think that Dr. Heyman's position is prone to the same sort of ideological flaws that cursed the addiction field for years. Addiction is either this or it's that. Well, it seems that the condition is many things. You can manage diabetes in many cases through strictly voluntary action. The same can be said for asthma and hypertension in many, if not most, cases. Does that mean that they are not diseases? I don't think so. Another poster referred to the writings of "Tom Szasz". While I envy his familiarity with the eminent doctor I don't share his attraction to Dr. Szasz's positions. His writings provoke a lot of thought and a fair amount of debate: The Myth of Mental Illness did much to awaken concern for those suffering from mental illness. It didn't erase the physical and biological foundations of many of the conditions it addressed. I won't comment on Heyman's motivation for writing the book because I have no reason to question it. I do think he misses the point. Addiction treatment has always been about choices and behavior change. That part hasn't changed in fifty years.

Posted by Gary O. George, Ph.D. on 26 May 09 11:26 AM EDT
I have been addicted to tobacco and food having a genetic predisposition to each from both sides of my family. I have been a client and I have 35+ years of clinical experience with drug addictions treatment and review of research. I conclude that addiction is a function of genetic predisposition, environmental influences, thinking patterns, belief systems, choices, and changes in brain chemistry, but it is not a disease. Will power is an antiquated term used to blame the client (which many continue to do using more "politically correct" terms). It does take a decision/commitment to change and a willingness to examine thoughts, emotions, behavior, and beliefs in determining what is supporting the addictions. Treatment is then based upon changing some of these, risk management (relapse prevention), frequently changes in spirituality, and often drug therapy. There are no panaceas and that is one of the reasons we have individualized treatment. I agree that these debates are futile and only serve to enhance egos (we disagree therefore I am right and you are wrong). We need to focus on what will work for each without being so narrow minded as to reject treatment modalities because I do not believe in it, I did not use it myself, or it is not the one I developed. Examine the well controlled research on what works and use all of these in your treatment "tool chest" rather than forcing the client to fit your theory or what worked for you.

Posted by Kenneth J on 26 May 09 11:53 AM EDT
I had thought for most of sobriety that the disease concept was a fact. But over time I recognized that addiction really isn't a biological problem but rather a psychological problem. I may have a predisposition for drug and alcohol abuse which means I am more susceptible to habit forming behaviors like gambling, exercising, drug use and alcohol use. In fact, I have had problems with them all. My belief and I have not read the professors book yet, is based on my experience and my experience has shown that the disease concept is just that a concept and is aligned with explaination of a problem than a diagnosis of a problem. In the end it is just a semantics issue and the prognosis has little to do with whether or not alcoholism and drug addiction is a disease or not. It doesn't matter. Believe what you want.

Posted by Boogie on 26 May 09 11:54 AM EDT
It's not AA principles that are at question, becase AA puts God first and they stay out of controversies like this. It's the Recovery / Treatment industry who have found a way to exploit the AA priciples and profit from peoples bad choices. This is America, America is about capitalism and the R&T industry has made this " disease concept" is a goldmine. AA is a free commitment, however, 12step programs are basically a "forced program" and anything can be the "higher power". Let's take a time out and think about that. Who's on first?

Posted by Orange County Detox on 26 May 09 11:59 AM EDT
There are plenty of people that would have you believe that alcoholism and drug addiction are diseases. It is dificult to prove this idea. Just because the AMA has said it is a disease is actually not proof that it is a disease. We have been searching for proof of this concept for years and have little scientific data to back up the concept. In fact it is probably easier to build a case to disprove this idea through science than to prove it.

Posted by Psy on 26 May 09 12:02 PM EDT
"As a previous writer said, try it for 6, 9 or 12 months and if it doesn't work; we'll happily refund all your misery." But that's the thing. That AA cliche right there demonstrates the arrogance of 12 step programs. The implication is that you either work the steps, or you DIE because addiction is inevitably a progressive and fatal disease. It's silly. The science does not back it up. http://www.peele.net/lib/diseasing3.html

Posted by Sharon M Freeman, PhD, MSN, PMHCNS on 26 May 09 12:04 PM EDT
I am surprised, given the preponderance of scientific data available, that an educated expert is choosing to form an opinion on whether or not a phenomenon has a biological basis by selectivey discarding the data that does not match his theory. I support his right to his opinion however I would caution readers that the opinions expressed are those of one individual, not those of science as a whole. Science being composed (at this point) of hundreds if not thousands of expert opinions supporting the concept that addiction (defined as loss of control over a substance that alters mood and creates tolerance and dependence on the substance) is biopsychosocially driven. The triad foci theory is much more robust than any previous hypotheses about the illness. This illness in particular causing a structure, or structures, in the brain to function differently in individuals who have, or who develop addictive disorders. I hope this publication is read with the above thoughts in mind and does not cause any harm to those who are desparately seeking the treatment they will require to bring this illness to remission.

Posted by Anonymous on 26 May 09 12:15 PM EDT
"In response to psy, no I do not have evidence, other than anecdotal, to know that 12 steps does in deed work for many. I am not in Research and have not conducted any "double blind" studies nor am I aware of the various studies conducted. However, I do not believe the medical field would have labeled addiction a disease if they did not have some positive proof. Speaking of blind, I believe one would have to be totally blind to not have seen successes from the AA program." A sucess is only a sucess if the person would not have recovered otherwise. That is why studies are necessary and that is why anecdotal evidence is useless. Your statement that the medical authorities would not have labeled a disease if there wasn't fact is similarly based on assumption and faith. Why not have a little less contempt prior to investigation and look into exactly how and why the AMA labeled alcoholism a disease (and why the supreme court rejected the idea in '88).

Posted by Psy on 26 May 09 12:24 PM EDT
Pat Wrote: "To all of those who believe addiction is all about choice and that one can stop their self destructive habits by simply using more will power, how do you recommend instilling more will power in these millions of addicts?" ... Maybe a good place to start would be to stop teaching people they are powerless over substances and start teaching them ways to control themselves and learn self discipline. Sure there might be genetic predispositions to behavior, but exercising those predisposition is still a choice. Of course it's easy to say "well those who can choose aren't addicts", but that statement then becomes self-reinforcing. If you die, it's addiction. If you don't, it's not. So if diagnosis is based on prognosis, how is it really fair to label anybody an alcoholic?

Posted by Johnny on 26 May 09 12:27 PM EDT
Addiction is not a disease. Its a theory, a concept, all you see is symptoms. If you can show me in a blood test, or an X ray, or any other form of medical device that can prove what addiction looks like, but you cannot. Its a behavior, symptoms, you can control it. Unfortunately the drugs and alcohol have done so much damage to the neurological and biological body, it makes it very hard for anyone to try and balance a checkbook, pay bills, clean their home, get to work on time, so on and so on. But does that mean the person is a total incompetent individual? NO! those are just symptoms, get it ? If a person want to get better the brain must heal, this takes 2-5 years before the brain of an addict heals on its own. "Wake up you quacks" that actually think its a disease. LOL heal the brain stay off drugs for at least 2 years and your symptoms will vanish !!! lol this is not rocket science. I made the choice 5 years ago and now my life has changed! Am I diseased or incurable?? LOL for thousands of years people thought the world was flat, that was also a theory, until someone came along and proved it was round. SO............... pipe down and listen I can assure you that in about a year or two you will be eating your words :O) Open your ears and listen good luck .....................

Posted by Americanlady on 26 May 09 12:30 PM EDT
Gee, what if we substitute the word cancer for addiction. “Cancer is not a disease but rather a behavior that can be controlled. Some Cancer patients can voluntarily change their life style habits to support this hypothesis. Individuals can be genetically predisposed to cancer, and that changes occur in the body, but the decision to prevent remains voluntary. The notion that cancer is a lifelong illness may be disputed and that the research underpinning this theory is skewed by the fact that studies tend to look at people who have sought treatment, not those who prevented cancer on their own and never used cancer causing agents. People do not choose to have cancer, but while most medical experts point to life style choices and environmental factors as underlying causes, One may see the issue as primarily one of self-control. Many cancer patients can't change their behavior despite devastating personal consequences, such as loss of health, family, and job. There are clearly both biological and environmental or contextual factors involved, but he's basically saying that the context and the environment are everything and the biology is irrelevant”. How does Mr. Heyman feel about that? His book is pointless and does nothing to help those in the addiction field.

Posted by Anonymous on 26 May 09 12:40 PM EDT
I am saddened to see this very old issue still getting press. It was around over 30 years ago when I entered the mental health and addiction profession. Regardless of addiction etiology, what deserves attention, beyond the sophmoric, philosophical debate about disease versus behavioral choice, is the fact that addicts continue to die daily due to inadequate treatment funding and insufficient treatment capacity. I will leave this debate to the academics and philosophers among us.

Posted by Psy on 26 May 09 12:50 PM EDT
@americanlady: Cancer cannot be controlled by choice. Cancer is a disease. "Addiction" can be controlled by choice. Is it then a disease? All these 12 step members who quit... are you saying you did not choose to quit? Who, then, chose for you? What, exactly, is keeping you sober? I suspect you don't want to answer that question as you'd rather pretend the 12 steps are based on some sort of science.

Posted by Jean on 26 May 09 12:57 PM EDT
I can never figure out why people become so passionate about this long standing argument. As an addiction specialist I refuse to label my clients as an addict or alcholic. I teach them that their use/abuse/dependency has changed their brain forever one way or another (physical/disease/chronic)and that through cognitive/education/coping skills they can choose to control their behavior. However, thinking they can use and it will not get worse is as much as fallacy as having a heart attack and eating big macs every day. Who really cares if you are not an MD disbursing meds. Both theories have validity and as long as you practice with factual information and people get better -- work out of the box people!!!

Posted by Julie H. on 26 May 09 01:33 PM EDT
I have an addiction (which I believe to be a physical allergy coupled with a mental obsession) I really don't care what you call it - I'm just glad there are other options for "getting over it" other than "just change your behavior" -which I tried to do for 35 years and it almost killed me.

Posted by Pat on 26 May 09 01:49 PM EDT
If there is all this evidence that addiction is not a disease, why is it still labeled a disease by AMA? I agree with Americanlady. Stating it is not a disease does nothing to help those suffering from addiction. Also, there are many diseases that do not show up on objective tests such as a brain concussion, fibromyalgia, etc.. However, it is my understanding that pet scans of an addicts brain do reveal an abnormality that is not seen on non addicts scans. Call me naive, but I do not believe there are many addicts out there who do not want to get well and live a normal life again. Many have lost everything because of their disease and there are many suicides committed by addicts because of their inability to be "normal" again. Can you honestly say these people would rather lose everything and/or commit suicide if they could just stop???

Posted by T Patterson Washington DC on 26 May 09 02:15 PM EDT
It has always been about choice in the beginning however, the disease of addiction removes or distorts the notion there is another choice once addicted.The addiction becomes a learned behavior for it to substain itself . Becoming drug free has never been a real obstacle however, achieving substain abstinence has. An addict on its own cannot introduce another choice or address thier issues that allowed addiction to control thier behavior without some sort of intervention like 12 Step, formalize treatment, or an act from GOD on rare ocasions. During my thirty-two years in the treatment field, the behavior or thought process of an addicted brain has to be challenge through the many therapies that are now available to us. The HBO seris on additions where Dr. Nora Volkov spoke about the addicted brain has been a major teaching tool for me in individual and group counseling sessions. It has allow patients to be educated about thier disease and to assist them to reconnect to who they really are and thier potential for a quality life versus who they had become. Metaphorically reintroduce Mr.HYDE to Dr. Jekyll.In closing, it is my hope that this dialog remains open and we continue to explore all intervention stragedies that will empower our patients to ultimately be able to choose a drug free lifestyle.

Posted by Michael D on 26 May 09 03:10 PM EDT
Finally, a breath of fresh air! We've been facilitating clients with this understanding for many years now and we've had tremendous success -- a much lower recidivism rate than the 12 Step "powerless" approach. Granted, I do not know this psychologist's whole theory but, in principle, it sounds like we'd agree. It is a choice -- it's not as simple as that, clearly, and our model takes all factors into account, but we do put the power where it belongs, which is with the client. Nice to see a psychologist willing to step up and suggest what so many have known for so long! Waking up everyday telling yourself you are a breath away from drinking again just doesn't make sense, and we find it ridiculous, at our center, that AA is forced down people's throats as if it's a bona find "theory" when so many clients can't stand it, and when no real research ever even went into the whole 12 Step approach anyway, beyond armchair psychology. Sadly, it seems AA has sold out to the courts, and don't even follow their own principles and traditions anymore, considering that AA was never supposed to be place where people are forced to go. At day's end, of course, if people find that thinking they have a disease works, then by all means find recovery where it can be found, but what a relief that someone in the mainstream has finally put forward some alternative thinking to help support the work of practitioners such as ours who have been successfully utilizing a cognitive behavioral model.

Posted by Psy on 26 May 09 03:10 PM EDT
Pat wrote: "If there is all this evidence that addiction is not a disease, why is it still labeled a disease by AMA?" ... because of social politics. So many people hold that addiction is a disease as a matter of dogma... it's threatening to consider any other alternative. Many comments on this page even accuse Heyman's ideas (which are not necessarily new) as having the potential to cause serious harm or even kill people. It's frightening.

Posted by ROBERT on 26 May 09 04:22 PM EDT
That this thread lasted since last week is amazing.I never felt comfortable saying I had a disease in my 25 years as a heroin addict.Maybe if I did I wouldn't have had to spend so much time in prison. I could have just said to the judge it wasn't my fault, I have an disease and can't help myself! I bet that would have gone over big. If you think it's a disease, it is. If you don't, it isn't. For myself, after doing heroin for 25 years and finally saying I had enough, I like to say I took responsiblity for my life and changed; no NA, AA or any other support group. But that's me, that's what worked for me, not the next guy, just me. Everyone is different and should be treated as such. I'm in the d&a vocation. I love it when I hear old timers tell my clients that they aren't sober because they are patients at a methadone clinic or take new comers to meetings, like AA, and the new person introduces themself as a addict and is told not to do that at "their" meeting. Does wonders for the new person and their opinion of support groups. There are many tools out there to help people, don't act like it has to be one way!

Posted by Army Vet on 26 May 09 05:56 PM EDT
I understand will power and self control. It did not work for me as a disabled veterans with PTSD. Now that I am getting ready to graduate with my degree in drug and alcohol studies I can honestly say that my brain changes when I add alcohol and drugs to it. He nce the dis-ease begins. I am sure that there are those who can quit and control there using and drinking but from a veterans point of view the disease theory has kept me sober for 5 years. There is a difference when you make money off of a theory, you can brainstorm just about anything. I had plenty of bright ideas that were substance abuse enduced.

Posted by Psy on 26 May 09 06:44 PM EDT
Just because your brain reacts to drugs/alcohol does not mean you have a disease. It reacts in everybody. that's the whole point. PS: Bill Wilson died a very rich man.

Posted by Mark Publicker on 26 May 09 07:08 PM EDT
So, if patients who have diabetes, cancer or hypertension experience a spontaneous remission, by this reasoning, this disorders would no longer qualify as diseases.

Posted by zerfinity on 26 May 09 08:08 PM EDT
I'm surprised that no one has mentioned the possibility that both the disease model and Dr. Heyman's model could be true so I'll offer my thought on that. I'll start with addiction as a disease. The addiction (with some differences depending on the substance) impacts the reward centers of the brain and interferes with the functioning of the prefrontal cortex. In other words, addiction damages the brain's ability to make decisions and to exhibit self control relative to the substance. Recovery from addiction is often characterized by establishing external behaviors to compensate for the brain's function. For example, I get a sponsor to say "Don't go to that party", instead of having a little voice in my head saying "Don't go to that party." Why are some people able to quit without treatment based solely on decision and self control? It is possible that these people make the decision prior to the addiction causing the damage to the brain that I've mentioned, or that similar to those who go through treatment programs, they intuitively add compensatory self-control functions in their social support networks. The disease model emphasizes the reason the addict is out of control, Heyman's emphasizes that restoration of self-control is the solution. That's my two cents. I'll be checking the book out of the library to see more detail about his arguments.

Posted by John W. Haley on 26 May 09 09:11 PM EDT
Addiction is a mental health disorder, obsesive compulsive. It may be passed on geneticly. Or it may be learned from ones enviornment. The key to recovery is to recognize your O/C behavior and use it in a poitive direction where rewards are recieved thus continued focus in a poitve direction.

Posted by Tim M. on 27 May 09 04:34 AM EDT
It has been mentioned that the Supreme Court had said that alcoholism isn’t a disease in 1988. The Court clearly states that they are not making a decision on this matter. The courts opinion states: “This litigation does not require the Court to decide whether alcoholism is a disease whose course its victims cannot control. It is not our role to resolve this medical issue, on which the authorities remain sharply divided. Our task is to decide whether Congress intended, in enacting § 504 of the Rehabilitation Act, to reject the position taken on the issue by the Veterans' Administration and by Congress itself only one year earlier.” - TRAYNOR V. TURNAGE, 485 U. S. 535 (1988) BTW, I’ve been following this progression of thought and although I’ve seen many insightful threads develop, I wanted to give special thanks to Kevin McCauley, who’s post was extremely helpful, both personally and professionally. It’s a shame that your post was too long and got edited down…I consider myself lucky to have seen the unedited version. The book Alcoholics Anonymous says something to the effect of…If a person can do the right about face and drink like a gentleman; our hats are of to them. It also has a suggested test to see if AA is right for the prospect…are you ready for this…it tells a person to go drink! IMO that doesn’t sound terribly draconian. If you want to go to AA, then go to AA. If you don’t, then don’t.

Posted by Shawn on 27 May 09 06:56 AM EDT
It is likely that this news article and the one from the Toronto Star are distorting Dr. Heyman's actual hypothesis. He might not actually deny that addiction is a disease. I do not see any quotes from the book that suggest that he denies that addiction is a disease. I think that he is merely stating that addicts quit using of their own volition. Addicts can and do control their use. This does not mean they do not have a disease. I can not see how disease and choice are mutually exclusive. People with diseases make choices to control them all the time.

Posted by Robert Curley, News Editor, Join Together on 27 May 09 08:20 AM EDT
Just a quick note on lengthy comments: Join Together welcomes commentary longer than 250 words -- this just simply is not the forum for it. We encourage readers who want to make their points in a more detailed fashion to submit a letter to the editor or commentary to editor@jointogether.org for consideration.

Posted by Ken on 27 May 09 12:16 PM EDT
What is most interesting about the comments to this book is that it underscores the insular nature of the addiction field and its unwillingness to engage in research and innovation in treatment. We have made few changes in treatment modalities in 25 years and when people fail or relapse in treatment rather than questioning the efficacy of the treatment program we blame the victim and say they haven't "hit their bottom". Alcoholism and addiction are far more idiosyncratic and complex than the unitary approaches in the field are willing to admit. There are multiple factors that determine its onset, course of development and responsiveness to treatment intervention. Dr. Heyman's views, should be embraced with more open minds with regard to its possibilities for fresh ideas and innovation in a considerably closed-minded field of practice.

Posted by Suzanne on 27 May 09 04:23 PM EDT
I am so glad to know that my husband, his 2 brothers, his sister, uncles, and father all lacked self-control. He died at 42 of cirrhosis, had a stratospheric IQ, a loving home, great job and many friends. But I guess he just kept drinking, like everyone in his family, because of a lack of willpower. That warms my heart. What this doesn't explain is why new drugs seem to be working to curb the desire for alcohol, cigarettes, etc.

Posted by Boogie on 27 May 09 06:53 PM EDT
Question? If someone enjoys eating a certain food, although that food may be considered unhealthy to some, but not to this person and that person refuses to give up that food, do we consider that person to have a "disease" or is he just "chosing" to eat what he likes?

Posted by Kshird, LCPC on 28 May 09 09:24 AM EDT
WOW! I've been viewing this website for many years and have never seen the volumn of responses this issue has provoked. With so much said already I just want to add some info on feral children. These are children who have not been exposed to appropriate human interactions and, therefore, are usually unable to communicate through verbal language unless they are exposed to language by age 6. This tells us that the area of the brain that controls ones ability to speak language (Broca's area), when not excited, ultimately shrivels and disconnects, and ultimately shuts down. I believe that the true addict, as some have defined here, experiences similar brain changes that make it difficult for their brain to fight addictive behaviors. Any time we alter our brains, we will experience vast changes in our behaviors.

Posted by Pat on 28 May 09 09:25 AM EDT
It appears to me that the real question is, do we go to a psych. for treatment or do we go to a medical doctor for teatment of addiction? For years addicts have primarily been referred to persons in the psych. field for counseling with a very small success rate? Why is this? If there is no disease or physical abnormality related with addiction, shouldn't there be a better success rate going the psych. route? I believe, at this time, more research is needed in the study of genetics and in medications that work on the abnormal functioning of the brain of addicts. Psychotherapy has been used for years. It is not working!! There are finally some positive things happening as a result of looking at addiction as a disease and finding medications, etc. for treatment. Why can't professionals in the medical field and the psych. field work together to find a treatment that works for this fast growing concern to our society?

Posted by Charles Bishop, Jr. on 28 May 09 01:48 PM EDT
Let's see...about 120 postings...disease, allergy, sin, addiction, biochempsy bug, weak will, sub-mirco-plasma particle, sugar craving, etc. etc. etc. Maybe just a spiritual sickness with the remedy several million sober drunks, God, a Sponsor, the the 12 Steps. Works for most... in the absence of consensus about what it is, etc.

Posted by rac on 28 May 09 04:03 PM EDT
Not matter how long one has been working in addictions, (20/30 years or more) there is always another addict who will come along and completely floor you as to depths of dispare they will put themselves through for their next drink or fix. Thier life is hell and mesery, and yet, they continue on with addiction. Thier life looks nothing like anything someone would choose. There is no fun and little pleasure only this overwhelming obssesion to to use despite the cost. When you see this first hand it just has the appearance of sickness not choice. Given years of witnessing this behavior, at a minimum it is a sickness of some sort.

Posted by Peter on 30 May 09 05:59 PM EDT
I think Mr. Heyman's mistake becomes most obvious when he refers to two groups; those who chose recovery processes (sometimes experiencing relapse) and those who quit on their own. I've heard this failure to see two groups who only seem similar numerous times such as when a non addict takes on the manifestation of addiction, without becoming a true addict; such as during a war. When the war is over the wounds - physical and emotional - heal over time and the only remaining dependence is physical which is the easy part to deal with. These people are reacting to a situation and only taking on the mantle of addiction; not developing the true disease as myself and others have done. Abuse of sugar snacks and related substance could make me appear diabetic but, if my diet is correct it be revealed that I'm not a true diabetic. I've come to feel sorry for people who repeat this tired old error.

Posted by Anonymous on 30 May 09 07:51 PM EDT
I was addicted to heroin while at the same time abused alcohol, cocaine,xanax and marijuana. I wish when I when I went into withdrwal I could of gotten passed those uncomfortable feelings and made a better decision. I do understand after the substances are out of your system it becomes a choice, but even at that point it's still frustrating. I thank god for the people who educated me on the disease and how to work through the cravings to chose not to use. It is when that happens you have better shot at making a choice. To all the addiction specialist thank you and keep doing what your are doing. Dr. Hymen no offense to you but people have to be taught how to make that choice, if they arent the disease will never be put into remission. Addiction is a disease it causes changes in the brain just like some other diseases, so let's call the animal that's yellow, quacks and walks a duck.

Posted by Psy on 01 Jun 09 04:43 AM EDT
Anonymous wrote: "addiction is a disease because it causes changes in the brain". So does chocolate. So does a .45. So does sugar. So does not eating. So does sex. So does just about anything... physical reactions to various stimuli does not make a disease. Whether the changes are permanant or not does not mean anything. What if addiction is just a *bad habit* that can be broken like any other bad habit with enough willpower and self-discipline (which can be learned or taught with help from others). Sure, sometimes asking for help can be beneficial, but I dont believe the answer is saying "i'm powerless" and giving your willpower up to the flying spaghetti monster placebo. Self control and "powerlessness" are polar opposites.

Posted by Anonymous on 01 Jun 09 04:47 AM EDT
To AA members: If a rock, toilet, seat, or tree works just as well as Jesus, Allah, or Kali, who is really in control? That's right... You can choose to attribute your recovery to whomever you choose, but the truth is the only person in charge of yourself is *you*... so if you're sober, be proud of what you have accomplished on your own.

Posted by bnski on 03 Jun 09 12:53 AM EDT
Of course it's a choice. I always said, and absolutely believed, that I could stop anytime I wanted to. The problem, of course, was that alcoholic "I" didn't want to. Similarly, I "chose" while intoxicated to do a lot of foolish and regrettable things that I later had no memory of whatsoever. Like choosing to leave one place and drive 20 or 30 miles before "waking up" while operating a moving vehicle with no orientation or inkling as to its location, direction, etc. Not a rational choice? Of course not. It almost never is for the alcoholic. Even stone cold sober, all things being equal, give an alcoholic the "choice" to drink or not to drink, and the alcoholic will invariably "choose" to drink. I haven't read Heyman's book, but any argument that relies on "choice" to explain addiction is bound to fail because choice presumes that all actors possess similarly unencumbered free will and are therefore free in a meaningful sense to choose.

Posted by Gene on 10 Jun 09 02:17 PM EDT
The amount of comments here is just one example how the 12 steps doctrine has been influenced "the science of addiction". On the other hand it is a current politic of NIDA. Let's put the placebo effect of current addiction treatment aside, the results will speak soundly -- current treatment is not effective. Could the dominance the one doctrine be a drawback for the development of new more effective approaches? Should we move from pseudo science based treatment to evidence, science based treatment?

Posted by Richard N on 22 Jun 09 07:25 PM EDT
Tough one. I do understand where he is coming from. I have found that self control is an essential element as I am an atheist- making 12 step programs pretty uncomfortable. I am also dual diagnosed and take antidepressants which have made staying straight much easier. Been 3.5 years and counting. I, also, have become an addiction specialist- that really helps me to understand all avenues of therapy.

Posted by Boogie on 24 Jun 09 01:50 AM EDT
"Steppers" amaze me, they say stepping works, but they can't quit counting the days or years since their last drink or high. Something is wrong with that picture and it send a very bad message to our youth. It you want a drink, then drink, otherwise don't impose your philosophy on those who simply was at the wrong place at the wrong time and got caught. Now, you want the system to call them alcoholics so you (steppers) can braiwashing them in to believing they have some mythical "disease" or they're in "denial". Let's get real America, enough is enough!

Posted by H. Douglas Gaston, MA, LLPC, CAAC on 29 Jun 09 09:14 PM EDT
It is very refreshing to finally someone of this standing challenging the ridiculous disease model. To compare alcoholism to cancer is insulting to anyone who truly has an illness. The disease model simply allows people to fail to accept responsibility for their BEHAVIOR. I am eager to see the day when the whole DSM IV is exposed for what it is: FICTION

Posted by Gerald Duke on 21 Sep 09 10:55 PM EDT
I am a recoverying addict of 10 years. As I have read the other postings, who ever this guy mr Gene M. Heyman is have never walked the path of an addict. I had tried for years to just quit. I tried just quiting and I just could not stop. I wanted a career in the military and I screwed that up. I finally one night was arested for cocaine. I was sent to a recovery program. That was sometime late 1998. I still didn't stop. I used one more time. After going and telling on my self then did someone really made me look at what I was going. I started working the 12 steps. Realizing that I need to treat it like I had a disease. I understood how dangerous my using was and only after seeing how the disease was I started to understand the treatment. I wish that some of these so called expects like H. Douglas Gaston, MA, LLPC, CAAC would understand that this cannot be learned from a book if you have never walked down that path. It is like having street smarts. No book can exactly explain everything. You have to experience it. By the way I am a network and boardband tech for the last 15 years. Also 3 years military school. Self control doesn't have the first thing to do with addiction. If that was Mr. expects.then why have you come up with a way to end addiction?

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