However, Homer is portraying human nature not writing a psychiatric text. Thus, it seems fair to say that who cite selfishness and myopic choices as evidence of pathology e. These are quantitative, empirical laws of choice that predict how different species, including humans, choose between different commodities and activities, such as food, water, and exercise.
Their relevance to addiction and other self-defeating behaviors is that under some conditions they predict relatively stable yet suboptimal patterns of behavior. For example, Heyman and Herrnstein arranged an experiment in which the matching predicted the lowest possible rate of reinforcement. As predicted the subjects shifted to matching, lowering their overall reinforcement rate as they did so. This finding has been replicated numerous times e. Or, put another way, general principles that apply to everyday choices, also predict compulsive-like consumption patterns that are consistent with the behavior of addicts.
These choice laws reflect a basic, but often overlooked property, of most choice situations. One is optimal from the perspective of the most immediate circumstances, such as the current values of the options, taking into account just the most pressing needs and goals.
The others are optimal in terms of wider time horizons and the perspectives of others. For example, in settings in which current choices affect the values of future options, it is possible for the current best choice to be the worst long-term choice e. This is relevant because a common feature of addictive drugs is that they provide immediate benefits but delayed costs. According to this account, persistent drug use reflects the workings of a local optimum, whereas controlled drug use or abstinence reflects the workings of a global optimum.
Put somewhat differently, whether or not drug use persists depends on the factors that influence decision making, particularly values that emphasize global as opposed to a local frame of reference e. Scores of studies support this analysis e. We would have good reason to believe that addiction is a chronic relapsing disease. This is precisely the situation for much of the history of addiction research. In some studies virtually all of the participants were males with extensive arrest records, poor work histories, lower than average marriage rates, and lower than average educational achievement e.
That is, the understanding of addiction as a chronic disorder was based on a population of drug users whose demographic characteristics — we now know — match those that predict not quitting e.
In the s illicit drug use spread to college campuses and upscale neighborhoods. This new generation of addicts included individuals who were employed, married, and well-educated e. With these demographic changes, the natural history of addiction changed. More often than not, the pressures of family, employment, and the hassles of an illegal life style eventually trumped getting high.
With the exception of alcohol, addictive drugs produce their biological and psychological changes by binding to specific receptor sites throughout the body. As self-administered drug doses greatly exceed the circulating levels of their natural analogs, persistent heavy drug use leads to structural and functional changes in the nervous system. It is widely — if not universally — assumed that these neural adaptations play a causal role in addiction.
In support of this interpretation brain imaging studies often reveal differences between the brains of addicts and comparison groups e. There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.
For example, in a frequently referred to animal study, Robinson et al. In principle then it is possible that the drug-induced neural changes play little or no role in the persistence of drug use. This is a testable hypothesis.
First, most addicts quit. Thus, drug-induced neural plasticity does not prevent quitting.
Second, in follow-up studies, which tested Robinson et al. For instance in a preference test that provided both cocaine and saccharin, rats preferred saccharin Lenoir et al. Although this is a surprising result, it is not without precedent. In a longitudinal study of heroin addicts, Vaillant reports that the likelihood of going off drugs neither increased nor decreased over time , and in a study with rats, Serge Ahmed and his colleagues Cantin et al.
Twin and adoption studies have repeatedly demonstrated a genetic predisposition for alcoholism e.
However, all behavior has a genetic basis, including voluntary acts. The brain is the organ of voluntary action, and brain structure and development follow the blueprint set by DNA. Thus, there is no necessary connection between heritability and compulsion. That is, learned, voluntary religious and political beliefs have substantial heritabilities just as do many involuntary human characteristics. The relevance to addiction is that a genetic predisposition is not a recipe for compulsion, just as brain adaptations are not a recipe for compulsion.
Most addicts quit using drugs at clinically significant levels, they typically quit without professional help, and in the case of illicit drugs, they typically quit before the age of Thus, we can say that addiction is ambivalent drug use, which eventually involves more costs than benefits otherwise why quit? Behavioral choice principles predict ambivalent preferences, semi-stable suboptimal behavior patterns, and the capacity to shift from one option to another. In contrast, the brain disease account of addiction fails to predict the high quit rates; it fails to predict the correlates of quitting; it fails to predict the temporal pattern of quitting; and it is tied to unsupportable assumptions, such as the claims that neural adaptations, heritability, and irrationality are prima facie evidence of disease.
It is time to think about addiction in terms of what the research shows, particularly the more recent epidemiological studies, and it is time to abandon the medical model of addiction. It does not fit the facts. The matching law, melioration, and hyperbolic discounting predict that drugs and similar commodities will become the focus of destructive, suboptimal patterns of behavior.
This viewpoint fits the facts of addiction and provides a practical guide to measures that will actually help addicts change for the better. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
National Center for Biotechnology Information , U. Journal List Front Psychiatry v. Front Psychiatry. Published online May 6. Gene M. Author information Article notes Copyright and License information Disclaimer. June 17, Flash content requires the free Adobe Flash Player.
Department of Health and Human Services. Skip to main content. National Institutes of Health DrugAbuse. Have a drug problem—need help? Drug Facts. Follow Us on Twitter. Follow Us on Facebook. Subscribe to RSS Feed. If you are in an emergency situation, this toll-free, hour hotline can help you get through this difficult time: call TALK , or visit the Suicide Prevention Lifeline. We also have step by step guides on what to do to help yourself, a friend or a family member.
They do not represent the views of NIDA or any other federal government entity. Your name. Current state: Approved. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Instead, I adopted an impaired thought process of denial, dishonesty, minimization, deflection and blame. I continued to use and put my life and the life of my family in jeopardy. I wondered if I was crazy.
I certainly acted like I was. And yet, I could not stop. Addiction is hell both for the person caught up in it and the family who loves them. Left to choice, no one would ever choose to live like this. But there is one choice addicted persons make. While addiction may not be a choice, recovery is.
There are many myths about addiction. One is the addicted person needs to hit rock bottom. The other addicts must want to get well. Both of these myths are false. Working in a treatment center for 17 years, I met very few people who wanted to be there. Whether addiction is a disease, a brain injury, a mental illness or a choice, no amount of yelling, nagging, pleading, cajoling, rewarding, or controlling, will help.
Science has confirmed that addiction is a chronic brain disease that can happen to anyone. Despite this, there is still popular belief that. (Please see Counterpoint article by by John H. Halpern, M.D.). Is addiction a disease, or is it a choice? To think clearly about this question, we.
Consequences are what motivate change. If your person is resistant, involve professionals. There are many resources available to you. Get people involved.