Magazine article Clinical Psychiatry News

Is Addiction Really 'Voluntary?'

Magazine article Clinical Psychiatry News

Is Addiction Really 'Voluntary?'

Article excerpt

This book continues discussions about addiction that focus on the nature vs. nurture debate. The author, a research psychologist affiliated with McLean Hospital and Harvard Medical School, Boston, leans toward the role of nurture/environmental influences in explaining addiction.

In doing so, Gene M. Heyman, Ph.D., discounts addiction as a disease. This emphasis is not the book's key strength, however. Instead, it is Dr. Heyman's rich discussion about the voluntary vs. involuntary aspects of addiction that makes the book a significant contribution to the field.

In addition, this is a timely discussion in light of proposals to put an end to separate diagnoses for substance "abuse" and "dependence" in the DSM-5 ("'Substance Use Disorder' Diagnosis Gains Favor," July 2010, p. 17). However, Dr. Heyman does not specifically address those controversies.

The opening paragraph of Chapter 5 has a wonderfully amusing commentary about how classifications can reflect different understandings of basic terms and lead to radically different (even scientifically wrong) conclusions. Of important note, Dr. Heyman clarifies that his use of the word "addiction" is synonymous with the DSM-IV definition of dependence rather than abuse. Indeed, most of his data are presented from the dependence perspective.

Dr. Heyman begins with a fascinating historical perspective showing different social responses to addiction phenomena. He begins with 17th and 18th century opium eaters--well-to-do people, drinking laudanum, medically related and often medically prescribed. What follows in the mid-19th century is a historical progression to opium smokers, including Chinese immigrants, opium dens, and smoking concentrated opium introduced by tobacco smoking (the true gateway drug in history).

History then progresses to the sniffers of the heroin synthesized in 1898 by the Bayer Co. What started as medicinal and curative for centuries became addictive, with the opium smokers and heroin sniffers leading--in the United States--to the Harrison Narcotics Tax Act of 1914, which essentially criminalized addiction.

The presentation in Chapter 3 of some personal accounts of mostly opiate and cocaine dependence helps build the case for his argument that "quitting drugs becomes part of the story of addiction" and that the claim that "addiction is a chronic disease may not be true" (p. 64).

Dr. Heyman presents very valid data, such as the Epidemiologic Catchment Area studies, from a "glass half-full" perspective that does not support addiction as a chronic disease. …

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