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Review: Addiction by Gene Heyman
BOOKS & ARTS
Challenging certainties on addiction It has become the norm to refer to addiction as a disease, but where is the science to back it up? Addiction: A disorder of choice by Gene M. Heyman, Harvard University Press, $26.95/£19.95 Reviewed by Gary Greenberg
assumption that the neurological productivity) is endemic to a consumer culture, and how changes in addicts’ brains are important a person’s social causes, rather than symptoms, context is to reining in the of addiction. Citing both addicts’ penchant for pleasure. This, he accounts and epidemiological argues, explains the effectiveness studies he shows that addiction remits at nearly double the rate of of Alcoholics Anonymous: it re-socialises addicts, giving any other psychiatric illness, and them a reason to make the harder that many addicts give up their habits by age 30 without treatment simply because heavy “Researchers have not yet found a pathogen which drug use interferes with their proves that addiction is lives. These findings and others, he writes, “suggest that addiction a chronic disease” is not a chronic disorder, but choice. Heyman implies that a limited and… perhaps, a selfsocial institutions, particularly correcting disorder”. those that can guide by example While Heyman tacitly objects and incentive rather than by to Anderson’s goal of relieving addicts of responsibility, the book precept, are crucial to preventing and “treating” addiction. is nearly free of moralising, at Heyman may accept the least about individual conduct. Protestant work ethic uncritically, Drawing from behavioural but his approach is refreshing, economics, Heyman shows how avoiding false dilemmas about the failure to sacrifice short-term gains (getting high) for long-term free will and biological determinism. The book suffers, gains (sobriety-aided 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 nonacademic 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. ■ MAT JACOB/TENDENCE FLOUE
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. 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
48 | NewScientist | 25 July 2009
Gary Greenberg is a psychotherapist and the author of The Noble Lie (Wiley, 2008)
Challenging certainties on addiction It has become the norm to refer to addiction as a disease, but where is the science to back it up? Addiction: A disorder of choice by Gene M. Heyman, Harvard University Press, $26.95/£19.95 Reviewed by Gary Greenberg
assumption that the neurological productivity) is endemic to a consumer culture, and how changes in addicts’ brains are important a person’s social causes, rather than symptoms, context is to reining in the of addiction. Citing both addicts’ penchant for pleasure. This, he accounts and epidemiological argues, explains the effectiveness studies he shows that addiction remits at nearly double the rate of of Alcoholics Anonymous: it re-socialises addicts, giving any other psychiatric illness, and them a reason to make the harder that many addicts give up their habits by age 30 without treatment simply because heavy “Researchers have not yet found a pathogen which drug use interferes with their proves that addiction is lives. These findings and others, he writes, “suggest that addiction a chronic disease” is not a chronic disorder, but choice. Heyman implies that a limited and… perhaps, a selfsocial institutions, particularly correcting disorder”. those that can guide by example While Heyman tacitly objects and incentive rather than by to Anderson’s goal of relieving addicts of responsibility, the book precept, are crucial to preventing and “treating” addiction. is nearly free of moralising, at Heyman may accept the least about individual conduct. Protestant work ethic uncritically, Drawing from behavioural but his approach is refreshing, economics, Heyman shows how avoiding false dilemmas about the failure to sacrifice short-term gains (getting high) for long-term free will and biological determinism. The book suffers, gains (sobriety-aided 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 nonacademic 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. ■ MAT JACOB/TENDENCE FLOUE
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. 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
48 | NewScientist | 25 July 2009
Gary Greenberg is a psychotherapist and the author of The Noble Lie (Wiley, 2008)