BREAKING NEWS

10-17-2019     3 رجب 1440

Drug Addiction: Is it a Disease or is it Based on Choice ?

July 11, 2019 | Umar Bashir

A disorder of choice, Gene Heyman surveys a broad array of evidence—historical, anthropological, survey, clinical, and laboratory-based to build an argument about the role of basic choice processes in the phenomena that comprise drug addiction. He makes a compelling, multifaceted argument that conceptualizing drug addiction as a chronic disease (like schizophrenia or diabetes) is both misleading and erroneous. In developing his argument, he points out that the best survey data available indicate that most drug addicts quit their addiction, a fact inconsistent with a chronic-disease model. He illustrates how basic, normal choice processes can lead to addiction, arguing that people do not choose to be addicts, but that normal choice dynamics can lead them to that condition. He points to a variety of factors that keep most from becoming addicted, with a focus on the role of choice governed by choice-by-choice contingencies versus choice governed by the outcome of sequences of choices, a difference in an under-described activity called framing. His view is consistent with the most effective treatments currently available, and provides a basis for continued basic research on choice as well as research on treatment and prevention.
A disorder of choice Gene Heyman makes a case for drug addiction to be a result of natural processes involving voluntary (i.e., operant) behavior, specifically choice. This approach stands in stark contrast to the current received view, at least as promulgated by the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), that drug abuse is a disease, specifically, “Addiction is a chronic, often relapsing brain disease similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease….” . Over the course of seven chapters Heyman makes his case by describing the history of drug abuse and addiction, societal responses to it, case histories from addicts, the epidemiology of drug addiction, “rational” and “irrational” choice, brain–behavior relationships, and approaches to treatment of drug addiction. These descriptions provide the bases for the focal points made, which are that normal, apparently rational choice processes can lead to poor long-term outcomes (e.g., addiction), and that an understanding of such processes offers a viable approach to the prevention and treatment of drug addiction. Of particular interest to readers of this journal is that the behavioral processes involved have been studied and characterized to a considerable degree by those who investigate operant choice. In addition, scattered throughout the exposition is a litany of evidence making the view that drug addiction is a disease, at least in the normal sense of that word, difficult to defend. In this review I endeavour to describe briefly and evaluate some of the key points made by Heyman about how normal choice processes play a role in drug addiction and to highlight his arguments countering the “addiction is a brain disease” view.
The first of the seven chapters provides an overview of the history of drug use and abuse, as well as information about its current prevalence. Although alcohol abuse has been documented from time to time for centuries, abuse of other drugs is a relatively recent phenomenon. Heyman notes that the first “epidemic” in the United States occurred in the late 19th century, before legal prohibitions were established. In addition to the perennial problems with alcohol abuse, the period was noted for abuse of opiates. Some of that abuse was centered in the wealthy “opium eaters” who abused laudanum. Interestingly, incidence rates from that period, before legal sanctions, were similar to current ones. However, abuse also extended to those of lower socioeconomic status, largely in the form of opium smoking in “opium dens.” Heyman makes the case that public concern raised by drug abuse among the lower classes set the wheels in motion for governmental responses. The passage of the Harrison Act in 1914 marks a pivotal point in the public response to drug use and abuse. That act applies to the tax code, and since that time the Federal response to drug abuse has been the purview of the Treasury Department, rather than the Department of Justice. The Drug Enforcement Administration (DEA), the successor to the Bureau of Narcotics and Dangerous Drugs (BNDD), is an arm of the Treasury Department. The activities of that organization and the criminal-justice system help to establish the current situation in which societally imposed penalties are applied to those said to be suffering from a disease.
As Heyman outlines, the current costs of drug abuse are enormous, including costs of enforcement and lost productivity, as well as incarceration, which has increased 10-fold since 1980. Importantly, he reminds us that drug abuse is a behavioural, or psychiatric, disorder. He also notes that drug abuse is the only psychiatric disorder that has two Federal research institutes dedicated to it, namely the National Institute on Drug Abuse (NIDA) and the National Institute on Alcoholism and Alcohol Abuse (NIAAA). Without explicitly noting the irony, he points out that since the official adoption of the viewpoint that drug abuse is a disease, and the expenditure of very large sums of research money by NIDA and NIAAA, prevalence rates of drug use and dependence have either increased or remained unchanged.

 

Email:---------umarwagay214.uu@gmail.com

BREAKING NEWS

VIDEO

Twitter

Facebook

Drug Addiction: Is it a Disease or is it Based on Choice ?

July 11, 2019 | Umar Bashir

A disorder of choice, Gene Heyman surveys a broad array of evidence—historical, anthropological, survey, clinical, and laboratory-based to build an argument about the role of basic choice processes in the phenomena that comprise drug addiction. He makes a compelling, multifaceted argument that conceptualizing drug addiction as a chronic disease (like schizophrenia or diabetes) is both misleading and erroneous. In developing his argument, he points out that the best survey data available indicate that most drug addicts quit their addiction, a fact inconsistent with a chronic-disease model. He illustrates how basic, normal choice processes can lead to addiction, arguing that people do not choose to be addicts, but that normal choice dynamics can lead them to that condition. He points to a variety of factors that keep most from becoming addicted, with a focus on the role of choice governed by choice-by-choice contingencies versus choice governed by the outcome of sequences of choices, a difference in an under-described activity called framing. His view is consistent with the most effective treatments currently available, and provides a basis for continued basic research on choice as well as research on treatment and prevention.
A disorder of choice Gene Heyman makes a case for drug addiction to be a result of natural processes involving voluntary (i.e., operant) behavior, specifically choice. This approach stands in stark contrast to the current received view, at least as promulgated by the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), that drug abuse is a disease, specifically, “Addiction is a chronic, often relapsing brain disease similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease….” . Over the course of seven chapters Heyman makes his case by describing the history of drug abuse and addiction, societal responses to it, case histories from addicts, the epidemiology of drug addiction, “rational” and “irrational” choice, brain–behavior relationships, and approaches to treatment of drug addiction. These descriptions provide the bases for the focal points made, which are that normal, apparently rational choice processes can lead to poor long-term outcomes (e.g., addiction), and that an understanding of such processes offers a viable approach to the prevention and treatment of drug addiction. Of particular interest to readers of this journal is that the behavioral processes involved have been studied and characterized to a considerable degree by those who investigate operant choice. In addition, scattered throughout the exposition is a litany of evidence making the view that drug addiction is a disease, at least in the normal sense of that word, difficult to defend. In this review I endeavour to describe briefly and evaluate some of the key points made by Heyman about how normal choice processes play a role in drug addiction and to highlight his arguments countering the “addiction is a brain disease” view.
The first of the seven chapters provides an overview of the history of drug use and abuse, as well as information about its current prevalence. Although alcohol abuse has been documented from time to time for centuries, abuse of other drugs is a relatively recent phenomenon. Heyman notes that the first “epidemic” in the United States occurred in the late 19th century, before legal prohibitions were established. In addition to the perennial problems with alcohol abuse, the period was noted for abuse of opiates. Some of that abuse was centered in the wealthy “opium eaters” who abused laudanum. Interestingly, incidence rates from that period, before legal sanctions, were similar to current ones. However, abuse also extended to those of lower socioeconomic status, largely in the form of opium smoking in “opium dens.” Heyman makes the case that public concern raised by drug abuse among the lower classes set the wheels in motion for governmental responses. The passage of the Harrison Act in 1914 marks a pivotal point in the public response to drug use and abuse. That act applies to the tax code, and since that time the Federal response to drug abuse has been the purview of the Treasury Department, rather than the Department of Justice. The Drug Enforcement Administration (DEA), the successor to the Bureau of Narcotics and Dangerous Drugs (BNDD), is an arm of the Treasury Department. The activities of that organization and the criminal-justice system help to establish the current situation in which societally imposed penalties are applied to those said to be suffering from a disease.
As Heyman outlines, the current costs of drug abuse are enormous, including costs of enforcement and lost productivity, as well as incarceration, which has increased 10-fold since 1980. Importantly, he reminds us that drug abuse is a behavioural, or psychiatric, disorder. He also notes that drug abuse is the only psychiatric disorder that has two Federal research institutes dedicated to it, namely the National Institute on Drug Abuse (NIDA) and the National Institute on Alcoholism and Alcohol Abuse (NIAAA). Without explicitly noting the irony, he points out that since the official adoption of the viewpoint that drug abuse is a disease, and the expenditure of very large sums of research money by NIDA and NIAAA, prevalence rates of drug use and dependence have either increased or remained unchanged.

 

Email:---------umarwagay214.uu@gmail.com


  • Address: Abi-guzar Lalchowk Srinagar 190001.
  • Phone: 0194-2451076 , +91-941-940-0056 , +91-962-292-4716
  • Email: brighterkmr@gmail.com
Owner, Printer, Publisher, Editor: Farooq Ahmad Wani
Legal Advisor: M.J. Hubi
Printed at: Abid Enterprizes, Zainkote Srinagar
Published from: Gulshanabad Chraresharief Budgam
RNI No.: JKENG/2010/33802
Office No’s: 0194-2451076, 9622924716 , 9419400056
Postal Regd No: SK/135/2010-2019
Administrative Office: Abi Guzer Srinagar

© Copyright 2018 brighterkashmir.com All Rights Reserved. Quantum Technologies

Owner, Printer, Publisher, Editor: Farooq Ahmad Wani
Legal Advisor: M.J. Hubi
Printed at: Abid Enterprizes, Zainkote Srinagar
Published from: Gulshanabad Chraresharief Budgam
RNI No.: JKENG/2010/33802
Office No’s: 0194-2451076, 9622924716 , 9419400056
Postal Regd No: SK/135/2010-2019
Administrative Office: Abi Guzer Srinagar

© Copyright 2018 brighterkashmir.com All Rights Reserved.