Addiction: A Disorder Of Choice?

NPR on Gene M. Heyman's 2009 book Addiction: A Disorder of Choice:

..the distinctive hallmark of addiction is the fact that in addiction the normal interplay we've just been contemplating between choice, value and preference breaks down.

And this is because addictive substances are, in Heyman's phrase, behaviorially toxic. They neutralize the value of everything else. Work, sex, food, friendship, children — looked at locally, nothing outweighs the value the addict places on his desired substance. If I take up the local perspective on whether I should consume my drug or go to sleep, or exercise, or make love, the drug will win out every time. Addictive behavior is the natural outcome of taking up the local perspective in the presence of behavioral toxicity.

Of course the more I use my drug, the more I come to tolerate its effects, and so the less pleasure an episode of drug use can afford me. This suggests that if I were to take up the global perspective, it would lead me in the direction of abstinence. After all, from the global perspective I'd realize that by using the drug less, the pleasure of using drugs would go up; abstaining from drug use would also enhance the pleasures of non-drug activities. From the global perspective it becomes clear that I'd be a happier drug user to the extent that I minimized my use of drugs.

Why doesn't the addict take up this global perspective? And why doesn't this give him or her a route to abstinence? Why can't the addict manage this? This is an interesting and important question. And it is, of course, tantamount to the question: Why is the addict addicted? What is it to be addicted?

And now we come to the main upshot of Heyman's discussion, an upshot which is as provocative as it is, in a way, modest. The idea is this: if we are to understand addiction, we must view it precisely in this setting where wants, values, preferences and choices are in play. Addiction is in this sense a disorder of choice.

Interested in learning more? Read Addiction: A Disorder of Choice.

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