http://www.newscientist.com/article/mg20327181.800-review-addiction-by-gene-heyman.html

Review: Addiction by Gene Heyman

* 27 July 2009 by Gary Greenberg
* Magazine issue 2718.
* Book information
* Addiction: A disorder of choice by Gene M. Heyman
* Published by: Harvard University Press
* Price: $26.95/£19.95

IN 1942, doctors sitting on the Research Council on Problems of Alcohol found
themselves powerless to resolve America's confusions about alcoholism. The repeal of
Prohibition laws had taken chronic drunkenness off the police blotter, but physicians
were unable to claim it as their territory. Instead they were losing out to the
temperance-minded clergy and other public scolds who had inspired the introduction
of Prohibition.

So the doctors turned to a higher power: Dwight Anderson, head of the National
Association of Publicity Directors. Anderson's diagnosis was simple. People, he wrote,
wouldn't entrust their drinking problems to the medical profession until doctors
persuaded them that alcoholism was a disease. Establish in the public mind that "the
alcoholic is a sick man who is exceptionally reactive to alcohol", that he is "not
responsible for his condition", Anderson said, and "the 'yes' response [to doctors]
becomes automatic, uncritical, and on the emotional level".

Nearly 70 years later, researchers have yet to find a pathogen which proves that
addiction is a chronic disease like diabetes or asthma. As Anderson predicted,
advertising has trumped science; the "yes response" has become automatic.
Researchers have not yet found a pathogen which proves that addiction is a chronic
disease

Now Harvard psychologist Gene Heyman is the latest in a line of critics to challenge
the science behind the disease hypothesis. He objects particularly to the assumption
that the neurological changes in addicts' brains are causes, rather than symptoms, of
addiction. Citing both addicts' accounts and epidemiological studies he shows that
addiction remits at nearly double the rate of any other psychiatric illness, and that
many addicts give up their habits by age 30 without treatment simply because heavy
drug use interferes with their lives. These findings and others, he writes, "suggest
that addiction is not a chronic disorder, but a limited and... perhaps, a self-correcting
disorder".

While Heyman tacitly objects to Anderson's goal of relieving addicts of responsibility,
the book is nearly free of moralising, at least about individual conduct. Drawing from
behavioural economics, Heyman shows how the failure to sacrifice short-term gains
(getting high) for long-term gains (sobriety-aided productivity) is endemic to a
consumer culture, and how important a person's social context is to reining in the
penchant for pleasure. This, he argues, explains the effectiveness of Alcoholics
Anonymous: it re-socialises addicts, giving them a reason to make the harder choice.
Heyman implies that social institutions, particularly those that can guide by example
and incentive rather than by precept, are crucial to preventing and "treating"
addiction.

Heyman may accept the Protestant work ethic uncritically, but his approach is
refreshing, avoiding false dilemmas about free will and biological determinism. The
book suffers, however, from its detached, graphs-and-charts approach. Even the
first-person stories seem desiccated compared with what any doctor, friend or
relative has heard from a struggling addict.

This is not only a problem of audience appeal - Heyman's turgid style will lose most
non-academic readers immediately - but of argument. Heyman assumes that
rationality will carry the day. But as Anderson knew, when it comes to a problem like
addiction, which, in a society founded on free will, is mysterious, frightening and
even subversive, rhetoric is more persuasive than reason.

Gary Greenberg is a psychotherapist and the author of The Noble Lie (Wiley, 2008)