I found an old essay by Gene Heyman which covers many of the same points he eventually covered in greater depth in his 2009 book Addiction: A Disorder of Choice.  For those who are nerdy about addiction and want to read a deeply philosophical piece on how it is a choice, I highly recommend it.  Here’s a link to the paper, Resolving The Contradictions In Addiction, and here’s an excerpt:

These stories illustrate an important and unresolved problem in the understanding of human behavior. Drug consumption is a goal oriented act. The behaviors are learned, not reflexive or innate. It requires planning, effort, and in some cases artfulness to secure drugs in the amount necessary for maintaining an addiction. Yet, according to the diagnostic manuals (e.g., DSM-III-R and ICD-10), the feature that defines addiction is drug use which is “out of control” or “compulsive.” By these phrases, the manuals mean that addicts “take more drug than they initially intended,” that drug use persists despite a wide array of ensuing legal, medical, and social problems, and that after periods of abstinence, however long, addicts relapse. In other words, according to authoritative clinical opinion, addiction is not simply frequent drug use, it is loss of control over drug use.

But how can a behavior be “out of control” or “compulsive” yet require planning? For example, if addiction is interpreted as a compulsive, out of control state, but drug seeking is a coordinated series of directed learned behaviors, then logic yields apparently meaningless statements such as “addicts are those who plan to use drugs in uncontrolled ways.” On the other hand, biographical and clinical data show that addicts repeatedly attempt to remain sober, but, despite their efforts, fail to do so (Alcoholics Anonymous, 1976; American Psychiatric Association, 1987; World Health Organization, 1992). These puzzles are at the heart of the long-standing debate as to whether addiction is best classified as an involuntary state, e.g., a disease, or a voluntary state e.g., a preference.


Share This