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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Vince (not verified) replied:

As an Acoholic this view on addiction has never been even broached.I have hope that a psychological change can be obtained from the mental thoughts that this knowledge can produce and reinforce.This may change the victim mentality that seems to be produced by current treatment and general feelings addicts fall into. Power can overcome most of life's obstacles if the power comes from accurate knowledge. I will certainly try this myself. Thx for the help,your logic seems to motivate more hope and determination.

June 11, 20154:39am

Shauny B (not verified) replied:

Having come out of a 20 year addiction to many substances and been clean for nearly nine years, i would side with the choice side of the debate although underlying mental health conditions and traumatic events in the past prevent individuals gaining control of their lives again. More has to be done to address the underlying problems, mental health before a sustained, plan and goal can be found.

December 22, 201610:36am

Thomas H (not verified) replied:

After stopping and starting numerous of times over a 30 plus yr. period, the only conclusion I can come up with is, " it has to be a choice to use any substances". I truly believe if some external reason control my desire to use, how could I create a thought to stop. If I didn't have control. Because, " if you don't pick it up it won't get in you." I don't care how much of a desire to use.

February 20, 20178:09am

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