The Choice Model of Addiction

Faculty Insight

Gene M. Heyman

Associate, Department of Psychology and Mind, Brain, and Behavior Course Instructor, Harvard University

Heyman, who lectures on psychology at the Extension School, is the author of Addiction: A Disorder of Choice, a book that has shaped how many psychologists perceive and treat addiction. In this video interview, he discusses the choice model of addiction with Jenny Attiyeh of ThoughtCast.

Heyman explains why viewing addiction as a choice can help improve treatment and policy surrounding substance abuse. Via ThoughtCast.

Video Summary

Gene Heyman, a lecturer on psychology at the Harvard Medical School and Extension School instructor, wrote a controversial book, Addiction: A Disorder of Choice

Although he uses the same definition of addiction as the American Psychiatric Association—“The persistence of drug use despite aversive consequences”—Heyman believes in the choice model of addiction, which flies in the face of the disease model.

Heyman points out that some psychiatric disorders can be influenced by outside factors, such as concern over legal consequences or respect from children and parents. Other disorders, like schizophrenia, can't be influenced by the opinions of others. A schizophrenic cannot ward off a hallucination to avoid embarrassing his or her children in public. Many drug addicts, however, are driven to quit out of concern for the opinions of parents and children. They are able to measure the costs and benefits to their addiction and choose sobriety.

Heyman wrote Addiction: A Disorder of Choice to inform the public that most addicts quit—that it is not the chronic relapse disease it is portrayed to be. Of all psychiatric disorders, it has the highest remission rate.

When researching the book, Heyman looked at every study he could comparing people who quit drugs to those who did not. The most common factor in the people who did not quit was the presence of an additional disorder, whether medical or psychiatric. Heyman believes coexisting disorders keep some addicts from seeking treatment.

In planning for treatment and setting policy, Heyman says it is important to truly understand addiction. He maintains that treatment for addiction does not need to based on a medical model.

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