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Is Addiction a Matter of Choice?
In this photo taken Wednesday, July 29, 2009, from left, Tim Plescia, Marvin Miller, David Elledge, Joseph Baker. Antoine Wade, Christopher Williams and Dustin Miller, gather in a circle for a serenity prayer at the end of a discussion group for drug and alcohol abusers at the Sacramento Recovery House, in Sacramento, Calif. (AP Photo/Rich Pedroncelli)

Members of a discussion group for drug and alcohol abusers at the Sacramento Recovery House, in Sacramento, Calif., gather in a circle for a serenity prayer at the end of a meeting on July 29, 2009. (AP)

Everybody knows addiction — alcoholism, drug addiction — is a disease. Conventional wisdom and years of reports tell us so.

Research psychologist Gene Heyman says no. Addiction, he says in a provocative new book, is a choice, or a series of choices. It is, he says, voluntary.

Most heavy drug users, for example, break free in their early 30s. Most diabetes sufferers, by contrast, do not.

Heyman’s thesis has drawn furious pushback. We’ll hear it. We’ll also hear him out.

This hour, On Point: Human choice, disease, and the dynamics of addiction.

You can join the conversation. Tell us what you think — here on this page, on Twitter, and on Facebook.

Guests:
 

Joining us in our studio is Gene Heyman, a research psychologist at McLean Hospital and a lecturer in psychology at the Harvard Medical School. His new book is “Addiction: A Disorder of Choice.”

Read an excerpt from the book (pdf).

From Center City, Minn., we’re joined by Marvin Seppala, chief medical officer at Hazelden Foundation, a nonprofit alcohol and drug addiction treatment center.

And from Washington we’re joined by Nora Volkow, director of the National Institute on Drug Abuse (NIDA) of the National Institutes of Health. She has been instrumental in building the case for drug addiction as a disease of the human brain. 

         Read about the “Science of Addiction” at NIDA

More links:

The Toronto Star reported on Heyman’s book in a piece headlined “Addiction: Could it be a big lie?”

Heyman is interviewed in The Boston Globe’s Ideas section and the Canadian weekly Maclean’s, and the book is reviewed in the Financial Times.

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  • Expanded Consciousness

    Can recommend this discussion. Took Gene Heyman’s course on addiction in the spring and he presents his arguments in a clear manner. “Choice” is a complex subject. Ashame you didn’t invite on a philosopher, as well.

  • Expanded Consciousness

    How does Prof. Heyman deal with the unconscious and choice? Psychoanalysts view “choice” as an endlessly complex matter and the self as forever embroiled in wars that pit one desire against another desire as they struggle for dominance (to be acted upon). Great insight is often required to free us up from certain entrenched (nearly “hardwired”) desires. Profound and personal understanding of the root cause is to be found in our biographical narratives.

    Free will may (or may not) be an illusion. Yet, freeing ourselves from the death-grip of compulsions may be our best hope. In other words, what may be needed it not to strengthen a positive, but to weaken a negative. Not to strengthen already strong constructive life drives (they are innately in place and strong in everyone), but to weaken and dismantle the ruinous destructive drives.

  • pw

    I look forward to hearing this on sat radio later this morning. The “addictions” of so many Americans has been really puzzling. Perhaps it can be explained by the overuse of the word “addiction.” Maybe we’re dignifying bad habits with an “important” word, relieving ourselves of responsibility for lousy, often deeply selfish choices!

    (The reports over the past several days about Mexican-American relations often casts the Mexicans as the bad guys in the drug trade. Quite apart from the less well known arms trade originating and flourishing on this side of the border, America’s cross-class “addictions” are just as responsible for the dangerous, destructive, costly drug trade as any Mexican bad guys.)

  • Katharine

    My mother has been an alcoholic for at least three decades. I have always struggled a bit with the “disease” explanation, as along the way she’s acknowledged that there is an issue yet has repeatedly avoided getting serious help such as AA, a support group, or longer-term psychotherapy. My sister and I did an intervention with her two years ago; this was effective in getting her into short-term therapy, during which time she continued to drink regularly. Now that she’s 71, she is either unwilling or unable to look with any real insight at the choices she herself has made, not only to drink but to see her life and the world. This lack of willingness to take responsibility goes beyond denial to a tendency to both blame and feel like a victim. I love my mother and am worried about the toll the years of drinking (and smoking) have taken. I’m also angry that she didn’t take advantage of the many resources she could have to get into recovery. The disease model seems to suggest that those of us who are connected to people with addictions shouldn’t be angry, that the addict can’t help him or herself. That has never felt like the complete truth, and I welcome the broadening of this conversation.

  • pw

    Katharine, that’s a remarkable post. It goes straight to the heart of the issue.

  • Ellen Dibble

    Isn’t it so that long-distance walking can stabilize the body’s chemicals as well as any drug?
    I’ll be listening to see how neuroses figure in addictions. I think we are in a too-aware world, without long dark, unilluminated nighttimes to scan our brains and get our minds “set.” Instead we have the idiot box to stare at, to dislocate just enough of the brain.
    The person who posted about her 71-year-old mother may be talking about the kind of addiction that goes like this: “I need to see myself and my world (marriage, children, etc) like this — just like this,” and when I need to mute any challenges to that worldview, there is the bottle.
    Talking about young people — don’t they shed addictions once responsibilities take hold, once they see they can’t afford the costs? Woodstock nation revisited reveals people who “used” till it seemed silly. Maybe young people emerging from a sheltering nest-like home environment without a lot of help in synthesizing reality, those people hit the real world uninsulated, and need what amounts to addictions until they get their balance. An addiction could be to kinds of enchantment, to a guru (Charles Manson?), to sex…

  • Jill

    I think a tough love approach is better. I had friends addicted to drugs and alcohol and we got very tough on them. It worked for all but one person and we cast her aside after repeated attempts to get her to clean up.

  • Putney Swope

    Katharine your a good daughter, I hope you’re getting some therapy. Your mother is also most likely depressed and drinking only makes this worse. The other problem is after so many years her brain is not functioning like a persons that does not drink or drinks moderately. Her ability too reason might be diminished or completely gone.

    The problem with this kind of idea is that it’s generalization of a complex problem.
    Sure, it’s a choice. It is a choice made by people with addictive personalities. Look at the fat, sugar, and salt factor and how this plays into brain chemistry.

    I’ll have to listen and see what the full idea behind this is. From what I’m reading here it seems to discount a whole lot of social economic conditions and who they play into addiction.

  • Esther Friedman

    Your guest said that addiction, or stopping addictive behavior, can be influenced by societal demands, such as family obligations. What about those who do not stop using, despite family or job responsibilities, etc.? What about those whose addictions lead them to homelessness? Do you consider addicts who wind up homeless to be healthy people who are choosing to live on the street?

  • Tim Tryon

    Addiction is a daily or hourly choice. Now 63, i quit all drugs in my early thirties, though i do drink a glass of wine in the evening. My comment: It is NOT alcohol and drugs, it’s alcohol and OTHER drugs.

  • Boris Garrimore

    This is incredibly on topic for me — I’m a long term addict with years off & on of depth-dredging drug use intertwined with months, and in some cases years, of often climactic recovery, sobriety– where life is great, progressively greater.

    Right now, I’m dealing with an approx. 2-year period of life right now where I have had a hard time turning my mind off–every couple/few months following a period of peace, serenity, relative prosperity, I will hit a little bit of depression, and a “machine” is kicked into motion, in my head, a drive to use cocaine, though don’t actually want to feel the sensation of cocaine. It’s the only way I can describe it; I risk losing my incredible wife, my adorable children, my great job, just to get the automaton of nagging desire to drive to the worst part of town and find the most immoral types, invite them and possible arrest & imprisonment into my car, and plainly self-destruct. I’ve done fluctuating periods of many AA/NA meetings, various styles of detox facilities & halfway houses & recovery programs. Nothing seems to stay or work anymore, and I pray daily, faithfully, intensely to just get this nagging & deadly broken-record thought pattern out of my head– or finally lose everything that is dear to me, and that is dear to those who rely on me. Is this a disease, or a choice? When I’m driving downtown, it’s gone beyond care & concern, and feel like I have no choice & no cares.

  • Jennifer Gentry PhD

    I think it is about time that the nature of addiction was reexamined. This new understanding of addiction should help us to better help addicts, not provide an excuse to disparage them.

  • David

    This guy is 100 percent correct.

  • EIO Boston

    This is the best point of view I have had on the addiction business.

    “You cnanot drow in the ocean unless you step into it’s bank”

    You cannot get addicted to something you do not put into your body.

    Best regards

  • Greg

    I would like to ask Dr. Heyman what he thinks about the decision by some people to use drugs recreationally.

  • antic disposition

    Great discussion!

    The important thing about this topic is that it actually gives addicts HOPE! I’ve always thought the worst part of the 12 step programs is the fact that addicts give away their personal power right on the first step and they begin to believe that they have NO CONTROL over their addiction. This sets them up for failure and excuses it beforehand, a self-fulfilling prophecy. Knowing you have a choice and that you have the ability is an incredibly tool of personal empowerment.

  • Bill F

    This DOES just seem like semantics.
    Call it a disease or not a disease… what difference does it make in practical terms? Is treatment different? What is the point of all this?

  • Kathy Cooper

    How does this compare to Anorexia? People who have to choose everyday to fight the urge to NOT eat.

  • Evelyn

    My drug has been food and I am currently in recovery. Part of my recovery is to have an open mind and listen to others, so I will listen and respect this opinion. However – in addition to putting forth a theory (that I respectfully disagree with) – that addiction is not a disease, what is your answer? My answer – treating it as an addiction – has worked where NOTHING else did. I COULD NOT STOP. I looked at others around me who could stop, and I did not understand how they could. This trait does run in my family. If it is not an addiction, what is it?

  • Joanna Drzewieniecki

    I don’t really see why this is so controversial. It can actually be very liberating to think that there is hope to permanently get rid of an addiction. It also challenges the approach of AAA which treats alcoholism as a disease and pounds this idea into its members. Thus all members think of themselves as perpetually in danger of re-addiction. It would be much more productive to help alcoholics find a path to permanent freedom by bringing them to the point to where they can truly implement a choice.
    An English former smoker, Allan Carr, came up with a high successful program for smokers to free themselves from cigarettes through “unbrainwashing” them from the idea they have no choice but to smoke. This helped me quit for two-years… now I just need to truly understand once again that I do really, honestly have the choice never to smoke again and that I am capable of making the choice. “Fear of failure” to quit is one of the greatest challenges for all addicts. And this is a psychological problem and not a medical one.

  • Bill F.

    I think this is really a matter of definitions. I would suggest that addiction is a brain disorder that doesn’t eliminate the ability to make choices, but drastically impairs it.

  • Gary Dolinsky

    Dr. Heyman’s book and research sounds very similar to the work of Stanton Peele, Ph.D. , J.D. in the early 1990′s. He has questioned the disease model for addiction and noted in his books that most people who stopped drinking or drugging did so on their own (their own choice) versus using a structured program such as NA, AA or a rehab facility.

    How does Dr. Heyman’s work differ and/or expand on the work of Dr. Peele?

    Thank you,

    Gary

  • minnie

    It seems as if the end result of this research is to reintroduce blame on the individual or to “brand” the person as immoral due to their choices. I wonder if there is someone in this man’s background who is an addict and with whom is is angry.

  • Christine

    Interesting conversation. What about nicotine? There is no question that it is an addictive drug, and that the main delivery system – smoking – is not something that most addicts quit in their 30′s.

    Nicotine addiction causes more death than all of the other addictions combined.

  • chuck galle

    I am an ex-addict – 12 years injectables , heroin, desoxyn, acid, anything I could get. Ex drinker (AA) 45 years, ex pot-smoker, 40 years. The definition of “choice” is the crux here. I chose to destroy my life. The reason are irrelevant to this discussion, but I also chose to recover my life, in ’71 from injectables, in ’97 from pot and booze. The idea of it being a disease is strongly held because it gives those in recovery hope. It can be”cured”, so they are then given encouragements to choose to stop. The argument is semantic and unresolvable at this time.
    chuck galle

  • Charlotte

    I think that the discussion about animals demonstrates the power of habitual programming. Once you get accustomed to getting your fix and feeling better, it becomes automatic — NOT a choice. It takes a combination of time, social support, willpower, surrender to the inevitable, and exposure to healthy habits in order to re-program yourself — which IS a choice.

  • Rex Henry

    In the words of the late comedian Mitch Hedberg:
    “Alcohol is the only disease you can get yelled at for having.”

  • Matt

    Great discussion!

    Apart from the discussion of whether addiction in essence is or is not a disease, what does Dr. Heyman make of the emotional and therapeutic value to addicts of being able to identify their addiction as a disease? In my experience it can be extremely empowering for addicts to identify the problem outside of themselves and not just a matter of their own weakness. Isn’t the “disease” metaphor an important therapeutic innovation?

  • David Glenn

    I have ADD and have been looking for information that might help me. I found a very interesting piece on the net from Rehab of Florida. They found a high corelation of adictions and ADD. Their investigation indicated low levels of dopamine in the frontal cortex of the brain and that the addicts were unconciously self-medicating to get to a normal dopamine level. I also learned that fish oil can help to increase dopamine levels. I have inceased my daialy intake to three caps and have notice very positive results. Ergo: addiction is a form of self-medication, not exactly a choice.

  • Maria Oropallo

    Wish I could get through to the call in line because I’d like hear discussed the relationship between choice and value. When discussing giving a user the “choice” the alternative has to be something the user “values”.

    In one case that I’m personally familiar with, the “choice” presented “be a good father” “be a good husband” was less valuable to the person. When given his freedom, the “value” of the “choice to use” dimished immediately.

  • Moises Lomas

    I think the terms are being confused and/or being defined in completely different ways. Becoming an addict means making CHOICES that lead you to that extreme. This can be influenced by an endless amount of variables (which can include a bilogical predisposition to a drug). In this manner addiction is a choice. However, if we say addiction is being physically and/or psychologically attached to a substance, then it is a disease. At this point the person has made choices that have lead to an addiction and a dependance of the substance (their brain and body needs it just to function on a daily basis – just think about people addicted to caffeine). However, the will to make choices is never taken away. Sure it’s difficult to make the choice to stop and it’s hard physically and psychologically, but it’s possible.

  • Roy Dempsey

    Dr. Heyman is obviously very well read. He likes to deabte, do meta nalysies of many previous studies, and cite all types of previous studies, many done decades or at least years ago. He seems himself almost manic, and not fully objective to me. I would like to ask Dr. Heyman whether he has ever used drugs or alcohol or been addicted himself; comparisons to him going to the gymn just do not cut it. I somehow doubt that he works with active addicts in person on a regular basis. Dr. Seppala clearly has been with hundreds if not thousands of actual sufferring addicted humans, and his insights somehow seem much more relevant than Dr. Heyman’s extensive readings. Knowing about Greek mythology and ancient’s use of opiates and citing these seems somehow detached and pathetic to me. I am a Scientist and a recovering polydrug addict, who is still on a methadone Clinic, and suffer from bi-polar illness. I do have choices, but the clinical nature of my dual disorders is unquestionable to me.

  • Eric M. Jones

    When I was a child, I saw a movie where survivors from a sinking ship died of thirst in the middle of the ocean. I was certain that they just had a failure of willpower, and that not drinking the seawater was a choice. One mouthful of seawater changed my mind 100%.

    This argument is of the same sort. I recommend looking at using nicotine as a model for discussion. Once you have the tobacco habit, you get very smart on the addiction subject.

  • Sandy

    Does emotional IQ factor into addiction? If so How?

  • Expanded Consciousness

    We look too much for “all or nothing” explanations, for things to be all involuntary or all voluntary. I think to say that someone is addicted to say that have a “strong inclination.” It is not necessary to say it is hopelessly hardwired or say it is a “choice,” which implies it is easily chosen or not chosen.

    Too simplistic. Throw out all these terms: “disease,” “disease model,” “choice” and deal with the complexity of strong conflicting desires.

    Tom’s hunch that there are semantic problems here is correct.

  • Lorna Hunter

    Two Points: 1-The author keeps comparing addiction’s treatment and usage to dieting. You can not compare a substance you are trying to totally remove from your life, and a substance which you must have to live.Food overuse is different from drug use. Apples to apples please. 2-The post referring to tough love, though a good method in breaking addictions, does not answer the question of what to do with the one friend who did not respond to that method. Once you discarded this person who or what takes over and what method is used. Or do you not care?

  • Henry

    I have been listening to the WBUR broadcast this morning with Gene Heymen. I am a 57-year old alcoholic with eight years of sobriety who went through a 28-day program at Father Martin’s Ashley and subsequently received Recovery Counselor training at Johns Hopkins. During the process I sought therapy from a highly informed psychiatrist at Columbia, whom Heyman ought to be talking to to obtain the correct facts.

    Heyman appears to have almost no experience at going to NA or AA meetings and totally misses the key points on alcohol/other drug problems. Recovery is not a matter of simply making good choices or putting people in situations where they can have good social relations, which are of course valuable, but the problems are far greater and fundamentally more complex. He does not understand “hitting bottom” and the complex nature of what encourages people not only to seek but to accept help.

    I would suggest that Heyman do the necessary homework that should be associated with his position at Harvard and not provide uninformed and self-serving opinions in a public forum that will ultimately take away from people seeking treatment. His denial of the classification of this as a disease overlooks the facts and the use of the disease model simply to get people to start a recovery program and to accept the fact that the problem is larger than themselves and not their “fault”.

    “Choice” grossly and irresponsibly oversimplifies the circumstances.

    I too am well-connected to Harvard and its medical school and will be contacting Jeff Flier, Dean of the Medical School, to make sure that Heyman is penalized and never promoted beyond being a Lecturer to the more significant post of Associate Professor. Harvard does not like its name used in this manner.

  • Amber

    This subject is extremely relevant to me. I grew up with a single alcoholic mother. My sister has died from a drug overdose and my brother is on his way to death from the same thing. I’d like to support BOTH sides of this argument by saying that .., because I’ve known since early childhood that I’m genetically predisposed to this, I have made the CHOICE to never so much try a cigarette…

  • Abby Murray

    Heyman just spoke about the emergence of opium addiction in China and wondered what it was about Chinese society in particular that fostered an epidemic of addiction which was absent in Indian society. What about the political interference of the British trading interests? From Britannica Concise Encyclopedia:

    “The Chinese, accustomed to tributary relationships with others, required that Westerners pay for Chinese goods with silver currency. To offset a growing negative flow of silver at home, the British created a market for opium in China and began importing it there illegally. As demand for opium grew, China tried to stop the practice, and hostilities broke out.”

    While there’s an element of choice in deciding to fight against addiction, there are many factors which makes groups of people more vulnerable to addiction in the first place.

  • Susan

    In a sense, what Dr. Heyman says is simply what’s obvious to those who know anything about addiction–that there is no effective clinical treatment, the most successful model is support groups such as AA that provide a social support network that creates conditions where it is easier to stop drinking/using.

    On the other hand, the disease concept–which says that it is not a moral failing, but a biologically based problem–is what enables people to seek help by telling them they can “recover” and live a normal life. Although Dr. Heyman wants to give addicts hope that recovery is not so hard or unusual as they have been led to believe, it could be that his argument is knocking out the very support (albeit slight-of-hand) that allows addicts to succeed in “choosing” recovery.

  • PW

    Henry,I guess you may be suffering from the twin “diseases” of meanness and silliness, so I’ll try not to think badly of you.

  • Gabrielle Gutierrez

    Addiction is not a matter of choice though certain choices may lead to an addiction. I had failed to quit smoking after many attempts because I was approaching it as a choice. I realized that my body made choices for me despite my attempts to override them. I was feeling defeated, but I was able to quit by acknowledging that choice had nothing to do with my addiction. I instead forced myself to quit. It was hard. I went through a process that was similar to grief. Some days I cried when I had a craving. I had to cut work days short sometimes because I couldn’t deal. I just had to keep telling myself that I have no choice; I just wasn’t allowed to smoke anymore.

  • millard-fillmore

    How about internet addiction? Seems to me that our society is increasingly addicted to the internet – there was an article in NYT 9I think) this past weekend on how people wake up and the first thing they do is not to make coffee, but to turn up their computers. Our activism is more and more limited to the internet instead of in the outside world.

  • jessica

    I have been in AA for 20 years and can assure you that addiction is very self-destructive. I do not know ANYONE in AA who would choose to be an alcoholic and the destructive life behind him/her.
    This guy is talking about changing circumstances. What about the great parent with kids he/she loves and a great lifestyle who dies from alcoholism or drug addiction? I know those people. Was that their ‘choice’.
    Worse, perhaps, is that the book is dangerous. Many people do not get sober because they feel that they are supposed to be able to do it on their own; their family thinks the same thing and brings shame on them. If our society thinks its only about the person’s choice, then we continue with a society with its head in the sand, people ashamed to get help for their drinking, and commercials that say absurd things like, ‘drink responsibly.’
    I know a lot of people who suffer from and have died from alcoholism and drug addiction and i know no one who wants to be an alcoholic or drug addict. Is that their choice?
    This guy is dangerously misleading.

  • Pete Hildebrandt

    This is a very complicated issue. Leaving it that addiction is a choice and not some of the many things put forth on this program seems at the least as far too simplistic. It may be on par with those who insist depression is a choice, such as those signs you sometimes see in front of churches: “You’re too blessed to be depressed!” You can have “the blues” and “snap out of it!” as those around you suggest. But longterm depression affects the brain in ways those who don’t have the disease can understand. I agree with the person here who suggested hearing a bit more on Dr. Heyman’s personal background. Does he have some baggage of his own with a family member who made the “choice” to not be addicted or did not overcome addiction because they did not choose. Or, perhaps he’s writing from far above all this; those in towers of ivory need to come down from their pedestals sometimes and smell the coffee or booze or cigarettes sometimes too. It’s a tough complicated world out there – forget the studies and try to look at what’s going on…

  • http://www.swzr.com Seth

    It seems rather clear to me that the term disease is severely misplaced when it’s applied to drug addiction.

    No one goes out jonesin’ for some cancer, aids, or actual diseases. Can I bum some cancer off you maaaaan?

    Granted people have genetic dispositions for lousy decision making, where they have certain deficiencies. Couple that with an individuals life experiences, their conditioning, and you’ll have variances that heavily influence the choices they make in their lives.

    Drug addiction is NOT a disease. People with cancer can’t just decide to stop having cancer. And to compare lab rats as having a parallel to human decision making capabilities is just stupid. Not all lab tests on animals will result in universal absolutes in regards to the human correlation of said test.

    Stop calling it a disease and treat the brains deficiency in the specific regions that aren’t properly developed along with the individuals education and lifestyle. Only then will they truly be able to break free of their desire for drugs.

  • Henry

    PW: at least I speak from knowledge and experience whether you like me or the truth or neither. Keep coming back… you might actually learn something.

  • Expanded Consciousness

    Addiction: A Disease

    Addiction: A Disorder of Choice

    How about Addiction: Incredibly Strong Desires And A Will To Fight Against Them

    Not an either/or.

  • Paula

    Addictions are in both sides of my birth family. Substances include alcohol, tobacco, food, legal drugs and possibly illegal drugs. My mother took her own life after years of addiction to alcohol and prescription drugs. She spent time at McLean Hospital back in the late 50′s. Nothing seemed to convince her that the struggle of quitting might be worth it. In other words, she made the choice to continue until the bitter end, despite the havoc and heartbreak her behavior caused for her family. Moises Lomas’ thoughts (above) sum up my thoughts on this issue. I don’t think the situation can be summed by mutually exclusive explanations. It’s not a binary “choice” versus “disease” problem. Even though I understand that my mother might have suffered from a disease, I also believe strongly enough in free will (“…the will to make choices is never taken away…” )so that I can place part of the responsibility on her failure to make different choices.
    Paula F.

  • Joe Gleason

    Interesting program. Like my father, I was seriously addicted to alcohol and nicotine. I healed the alcohol addiction with diet, and eventually quit nicotine as well. I recently quit alcohol altogether.
    A vital component of the addiction syndrome was (as usual) missed altogether on your program. Any alcoholic, as well as other addicts, have a serious overgrowth of Candida Albicans fungus. It is an “intelligent parasite”, in that it causes the craving as well as being fed by the substance(s) involved. Controlling it is a vital part of overcoming the habits.
    Candida is encouraged primarily by drugs (particularly pharmaceuticals), refined carbohydrates, and most other addictive substances. Electromagnetic field (EMF) exposure strongly encourages any fungal growth. The EMF soup modern humans live in is a major contributor to addiction and most other health challenges.
    I encourage you to interview someone really knowledgeable about such things, such as Jonathan V. Wright, M.D. at Tahoma Clinic in Washington State. Thanks for the great programs.

  • Hugh Briss

    As an alcoholic who suffers from manic depression I’m extremely angry at this man who selectively leaves out inconvenient facts which don’t support highly idiosyncratic, not to say TORTURED definitions of “choice” and “disease”. At LEAST 30% of people who live with mental illness also suffer from addiction: It’s called a dual-diagnosis Thank you to Henry above for his perceptive post. It is a comfort to me that he has connections at the Medical School and intends to use them.

  • Nicole Penna

    As a child of alcoholics without “substance” abuse and a person with depression, OCD, and an eating disorder I use therapy (including DBT) to treat and manage my diseases without drugs or medication. The implication by the author/speaker that my diseases (which he said were different and “actual diseases”) are not diseases based on the resaoning he gave for why addiction is not a disease is FRIGHTENING! As a person struggling with legitimate diseases that are barely acknowledged I feel like this is a sad step backwards in thinking. Especially from a person working for McLean.
    Addiction is the disease, not the substance. Cocaine, heroine, food, refined sugar, money, gambling…pick your vice, it’s the addiction not the vice.
    We put people in prison for their actions…remember, killing yourself is illegal too!

  • Expanded Consciousness

    I think that the definition of “disease” is the issue here. “Disease” is presented here as something involuntary, you cannot chose or not chose to have diabetes. Yet, this is not the only way we use or define the term “disease.” If I have the flu, then I have a disease process and no choice in having the flu or not. That doesn’t mean my whole will power has been obliterated. I can chose to go to work or stay home. To lay in bed and recover or to get up and sit and watch TV. So, one can have a disease and will power, simulaneously. The question is can the will power influence the disease directly. The will power cannot influence diabetes or the flu, since they are passively experienced. The will power can influence the action required to take a substance, be it a drug or a slice of chocolate cake if one is dieting. That gives hope.

    The semantic question is do you want the term “disease” to be exclusively applied to completely involuntary processes and nothing else? So, this is just a debate about the “medical model” and not really about, or exclusively about, addiction.

  • Pat

    I am sorry that I did not get to speak with this egotistic man today. I got through, but not in time to get in the queue. I am a recovering alcoholic who could not and would not stop until I hit rock bottom. Didn’t matter what I might lose. Through an awesome treatment facility I accepted my addicition once I came to realize have a disease. That was my glimmer of hope. When we were told we were not “bad people trying to become good”, we are “sick people trying to get better”. With rehab and the support of a 12-step program, we can stay sober one day at a time. To call us ex-addicts only shows how much this man does NOT know. We are recovering and will never be ex. Our brains ARE different; our green light stays on when “normal” people’s red light comes on.I am shocked that this book even got published. I wonder just how many of us recovering addicts were harmed by his interview today. Shame on you, NPR.
    By the way, mice, like humans, love sugar. That’s one of the foods we were not allowed to have in rehab because sugar triggers the alcoholic brain.

  • Mike

    are there not people out there that say depression is a choice as well as addiction? who tell people not to be depress and to stop it, but as most know its is a chemical conditions that affects peoples condition.

    So as for addictions maybe i missed it, but would not depression play a large role in addiction as well?

  • Pat

    To think that by shaming addicts you will help them? Most of us live in shame….self-wrought and reinforced by family, friends and society in general simply because they don’t know any better. So why would you think that adding more shame and guilt would give us hope, strength and any sense of empowerment?

  • Margaret Barrett

    Clearly the author hasn’t talked with real people but bases his conclusions on an examination of data. I’m a sober alcoholic and I can say for certain that if alcohol affected him the way it affects me, he would be an alcoholic. I firmly believe that there is a biological component to alcoholism. Is that a disease? Well it certain it goes beyond “bad choices”.

  • Sarah

    I see drugs as an all-encompassing term, for one can get addicted to anything. Internet addiction, television addiction, addiction to exercise, addiction to relationships, etc. etc.
    It’s hard for me to see how conscious choice can be involved in all these scenarios. Lots of people who are addicted to something may not have ever thought about the fact that they are addicted. How could it be a conscious choice in that case?

    Also, if a baby is born addicted to crack because its momma was addicted to crack, was that a choice on the baby’s part? I don’t think so.

  • Jerry

    Heyman rocks!

  • Ellen Dibble

    To make an issue of lifestyle choice versus disease only makes sense to me if the cost of care is involved, and with health care insurance majorly on the line now, the question would be: How should medicine treat addiction. Who should pay?
    People in the forum are talking about ADD pairing with addictions or other mental health issues. This squares, to my view, with what Heyman said at the beginning, if I recall, that if there are better choices, people choose them, and people with various disabilities/diseases (among others) lack the better choices, or lack them more.
    This also squares with the idea that 18th century China provided a class of people with the time and leisure to indulge (and as somebody here pointed out, from a reference source, the English, needing silver cash, were only too pleased to stoke the wave of Chinese addictions). It squares with the environmental effects, whether of a leisure social stratum (or discriminated-against, thus-disabled stratum) or personal disease.
    The Candida connection is useful. Candida is in sugar (anything sweet, preserved, fermented, like vinegar, wine, soy sauce, overripe fruit, bread, left-overs has Candida), which I just read “triggers the alcoholic brain.” Electromagnetic fields encourage fungal infections with Candida, I read. Real science should chomp on that info.
    Our modern diets, plus the impurity of our world, is twisting us away from health and toward addiction, it seems.

  • Hal

    No wonder McLean has been dropped off the suggested list by the better patient referring agencies. If Harvard allows this sort of poorly-informed drivel to be distributed across the media, its own credibility is also in serious question.

    I hope that Paul Levy, Gary Gottlieb and others within Partners Healthcare are aware of this situation and that something is done to institute some sort of quality control that screens out books and individuals that are out there purely for the purpose of making money off those people who are desperate to find help for themselves, a friend, spouse or other loved one. Shame on McLean and Harvard for allowing this.

    And I am a doctor at a major New York City hospital that otherwise had immense admiration for Partners/Harvard. We are supposed to be medical professionals not best-seller beneficiaries from shabby materials and misleading speculation dressed up as good statistical analysis.

  • Ellen Dibble

    The baby born addicted does not have choice, and so is not an addict until he/she does have choice. The poster who makes this point may think addicts were born addicted, and it just gets enabled at the age when it’s possible. I don’t know.
    I do know, or have been persuaded, that alcoholism is in our genes as a survival mechanism. Alcohol is an antibiotic, and when people did not live much past 40, then having a natural antibiotic was a fine prescription for survival. People so inclined would do very well. But it’s a genetic legacy tough to deprogram.
    I don’t understand the language of blame and empowerment that’s being cast towards people who are trying very hard to find ways to enable escapes from addiction. Don’t blame them and try to disempower them. They are trying to help. I don’t hear them blaming the addicts, just trying to understand. It is not just the problem of the addict; it is the problem of the justice system, the problem of the health care system, the problem of the whole society.

  • Jorge Carrillo

    Just because one can become addicted by making a (poor) choice does not mean it is not a disease. A person may acquire an STD by making a sexual choice but it’s still a disease. Same for addiction.

  • Henry

    In making two phone calls to Harvard/Harvard Med I have learned that Harvard “allowed” Heyman to leave and go to Boston College. So much for the “Harvard affiliation” other than using Harvard Press to turn out a money-making book and McLean who apparently is suitably embarressed after receipt of numerous phone calls about the book and the media coverage.

  • Jeff P.

    As an alcoholic and an addict in 12 step recovery, I’ve come to believe that, I suffer from a hopeless state of mind and body. As the decision making mechanism is increasingly impaired, my choices are increasingly dictated, & displaced, by involuntary, biological compulsions (cravings) & mental obsessions (persistent disturbing preoccupations with an often unreasonable ideas or feelings). This combination of conditions insures two things: 1) once I ingest drugs or alcohol, a biological craving is triggered that insures I will not stop, on my own volition, because this compulsion becomes a dominating physical imperative and 2) the mental obsession distorts my basic cognition, even at an unconscious level, distorting my perception & judgement; in practical terms, this obsession insures I will, as soon as (my distorted mind decides) it’s possible, ingest that first drug or drink, thereby triggering the compulsion to consume until my supply is depleted or something interferes. Nevertheless, the obsession remains. This cycle progresses and manifests as a disease process overtime.

    As I understand, these conditions of body and mind existed long before I began consuming drugs or alcohol. I can conclude this anecdotally, with or without professional psychiatric aide, by considering how 1) I physically responded to initial use and 2) the fear based source of my obsession for external solutions to internal, psychic, problems.

    In the beginning, environmental and social consequences were more operative for me and I could, to some degree, choose when to use; it wasn’t a choice in the truest sense of the word though: the question wasn’t if I would use, or not, it was WHEN; and, it was based on fear of negative consequences. Furthermore, the positive consequences of a life of abstinence were reduced to irrelevancy as my dependency increased, Better living through chemisty was my highest ambition; eventually, it would become my only ambition.

    Though arguably more complex than most, is this not, already, a disease process? In this state of mind and body, with willpower short circuited and the very mechanism for choosing corrupted, can the good Dr. truly conclude someone is still “empowered,” by choice? Only when the pain was overwhelming, when I hit bottom, when everything and everyone were gone, when all that was left was pain & I prayed daily to die, did I surrender. Even if the good Dr. considers this (AHA!) a choice, left to my own devices I will continue to use until I’m arrested, institutionalized or die. So, the choice of surrender, without (miraculous)intervention, is an absurdly moot point. Only a few sick and suffering addicts escape this fate. The vast majority DON’T. Alas, we can’t include THEM in the study.

  • Rose

    Is eating a matter of choice?? Obviously not or else we would not depend on food to survive. I have struggled with bulimia for 15 years and have wished that it could be a choice or I would not have subjected myself to the god awful self induced suffering I did. Addiction is not a choice it never has been. It is a survival mechanism used to address the spiritual and emotional pain that one is experiencing but unable to feel or acknowledge. Dr. Heyman has obviously never experienced first hand an addiction or else he would not be saying it was a choice. This is a load of crap and shame on NPR for having this show.

  • Rose

    Also the reason that everyone (supposedly) treats themselves is because of the price!!!! Treatment is only really an option when it is free or insurance will cover it. From my personal experience had I been allowed to finish treatment I believe I would not still be struggling with this disease instead insurance would not cover treatment and I been repeatedly hospitalized.
    Had they covered treatment the first time for the length that was recommended I would have been able to nip this in the bud.

  • Putney Swope

    Joining us in our studio is Gene Heyman, a research psychologist at McLean Hospital and a lecturer in psychology at the Harvard Medical School.

    If what Henry says is true,that Heyman is at Boston College then why is he saying he is a lecturer at Harvard. If this information is true I would say this program is now a sham.

    Plenty of people have already offered up enough proof that Gene Heyman might be BSing the medical world and doing more harm than good. Does anyone at NPR do any research anymore? First the birthers program and now this.

    Snake Oil anyone?

  • Preventive Medicine Associates

    Addiction is a silent killer. It is more than a disease – it is a phenomenon that is taking lives every hour by either overdose or by complications from all of the negative impacts of substances of abuse on the body. And to say that addiction is a choice, as Gene Heyman is theorizing, is naïve at best.

    It is too simplistic to say that people can merely wander into a life of addictions only to wander back into a life of sobriety when they so choose. Very few people consciously want to be addicted to a harmful substance or to infuse their bodies with deadly addictive chemicals.

    From my vantage point as an addiction treatment specialist, I believe there are several major factors that are making it more difficult for mainstream America to be fully aware of the nature and scope of addiction.

    Despite the fact that addiction has been around as long as pleasurable or mood altering substances have been in existence, there is still so much that is unknown about it and there is no cure—despite what some doctors, specialists, or rehabs may claim. It is like cancer, in that you are not cured but merely in remission.

    Addiction is a phenomenon, much like a spark of lightening in nature. We cannot control the consequences when addiction wraps its ugly hands around an individual, much like we can’t control when a bolt of lightening strikes. We can only take precautions to teach and prevent people from following a path of addictions. Education is so vital to preventing that first experimentation with an addictive substance.

    Another phenomenon undermining the rehabilitation process is what I call the “Diseasing of America.” It is the notion, often shared by enabling parents, that if Johnny or Jenny is depressed, or angry, or anxious, they must surely have fallen victim to a powerful addiction. And the person responsible for dealing with this is not the parent, but the doctor, or perhaps the teacher. Recently, a mother brought her 13 year old child into my office because she had been drinking at a friend’s house and staying out late. She was not an addict, but her mother wanted me to treat her, as if I could give her a drug that would make her more obedient.

    Sadly, there is no drug that can cure someone’s addiction. And there is certainly no “on” and “off” switch to simply kicking the habit, as Heyman is suggesting. Addiction is a severely complex and deadly phenomenon. Our most powerful tool against substance abuse is prevention through the education process.

    Dr. Punyamurtula S. Kishore
    President of Preventive Medicine Associates
    Founder of the National Library of Addictions

  • Henry

    Putney, I called a tenured full Professor at Harvard Medical School who is a long-term friend and former professional associate. It was from him that I received the information… and I looked at the Harvard and Boston College websites as well while we were talking to confirm what I heard.

    There are plenty of good, qualified writers out there for NPR to cameo. It was very poor judgement on their part to give him this publicity. The book will now be labeled as something along the lines of “endorsed/supported by NPR and Harvard” even though neither have technically provided such endorsement other than inadvertantly. But they know the power of their names and should be more careful.

  • Joe P

    I am a sober member of alcoholics anonymous, recovered from alcoholism. I am not cured, yet I have not had a drink in 520 days (since March 9, 2008).

    I have two points I feel compelled to share:

    Not understanding the difference between AA and treatment, between drug addiction and alcoholism, between addiction at large and alcoholism, helped to keep me drunk for quite some time. Addiction and alcoholism are not synonymous. Addiction, chemical, psychological or by and other name, is a behavior defined by the compulsive use of a substance. Alcoholism is a far more complex condition, which manifests itself drunk or sober. And yes, it is a disease. I have no qualms with the idea that addiction, in and of itself, can be classified and something other than a disease. But when alcoholism is lumped together with addiction and all other pathologies regarding substances or behaviors, I must protest.

    My second point is this, there may be persons who by all measure are addicted to alcohol or may be called alcoholic, who experience a situation or “rock-bottom” that is sufficient to cause them to quit, and they never drink again. They may have “an alcohol problem,” which is solved by the removal of alcohol. Then there are people of my type, people who baffled doctors and clergy and politicians for centuries, who are alcoholic by any measure, who experience a life situation or bottom that causes them to quit, but without a daily program of action that continually calls them to trust in a higher power, clean house and help others, they ALWAYS drink again. This type of alcoholic requires a psychic change in order to stay sober. For us, alcohol is not our problem, alcoholism is. The problem is not only that we get drunk and ruin our lives and our health and our relationships, but that we get sober and sobriety becomes unbearable. We become restless, irritable and discontent whether there are problems, or if there lacks even a cloud on the horizon. This happens in sobriety even long after the pangs of withdraw and addiction have been removed.

    I do not speak on behalf of AA, but I am a testiment to a program of action that works, so long as I work it.

    I appreciate this venue to share.

  • Henry

    Here are Heyman’s positions off his own resume from the Boston College website… less impressive than what NPR seems to have implied:

    Adjunct Associate Professor, Department of Psychology, Boston College, 2007-
    Adjunct Associate Professor, Heller School for Social Policy, Brandeis University, 2002-2007
    Visiting Professor, University of Sao Paolo, Brazil (Fall, 2001)
    Lecturer, Department of Psychiatry, Harvard Medical School, 1998-
    Research Psychologist, McLean Hospital, 1998-
    Associate Professor, Department of Psychology, Harvard University, 1992-1998
    Assistant Professor, Department of Psychology, Harvard University, 1989-1992
    Senior Research Biologist, Lederle Laboratories, 1983-1989
    Postdoctoral Fellow, Department of Pharmacological and Physiological Sciences, University of
    Chicago, 1981-1983
    Lecturer on Psychology and Social Relations, Harvard University, 1979-1981

  • Putney Swope

    Good work Henry and thanks for being so tenacious. You should work for BUR.

    My problem with this show is that it now seems to be more likely that Heyman was booked on the show due to a good publicists and the idea of the subject being “controversial”.

    Not one person has addressed the social economic conditions and how they relate to the ravages of addiction in African American and Latino inner city men and women. How this affects the outcomes with the war on drugs and the prison populations.

  • mark

    Most addicts are no longer addicts in their thirties? While AA/NA, (Narcotics Anonymous), has the same success rate as no treatment at all, I think Heyman has left people who have died of addiction out of his sample, at least judging from the stories of my fellow sober house colleagues: junkies tend to die sooner than the alkies, perhaps that is what he’s getting at. Not entirely useless, AA/NA has some dopey sayings like, “One Day at a Time.” Or one hour or one minute at a time if necessary. If one “chooses” to be sober one minute at a time, how is that not chronic?

  • Ellen Dibble

    If Henry is worrying about Harvard’s imprimature being somehow corrupted by association with a controversial position, or merely gilding the presentation of Heyman, he hasn’t with his research altered my original approach to the show. Heyman is at Boston College since 2007, Brandeis for five years before that, time teaching in Brazil, lecturer in psychiatry at Harvard Medical School 1998- (which means “and following”) and research at McLean Hospital 1998- (same thing, and following), associate professor 6 years at Harvard U, 1992-1998, in psychology; assistant professor, Harvard, psychology, 1989-1992. He did post-doc at U. Chicago, 1981-83 in PHARMACOLOGICAL AND PHYSIOLOGICAL SCIENCES; and before that lectured at Harvard in psychology and social relations 1979-81.
    This is hugely a history of a scholar’s involvement with Harvard. Anyone who knows about the in-fighting in academia can come up with plenty of hypotheticals as to why he is at Boston College now. Brandeis and the University of Chicago are names to fling around too.
    I believe there is a saying that by the time something is de rigueur at Harvard, it is pretty much gone to seed. Harvard tends to be a little like the Republican party at present, invested in the past, perhaps partly because of the huge money that gets into its endowment. So Henry has boosted my opinion of Gene Heyman: he escaped Harvard without caving to total traditionalism. (Oh, the Crimson Tide of Harvard will come after me now…)
    Now, I am wondering, what is Henry’s view of addiction? Or is he contesting Heyman’s positions simply on the grounds this man gave most of 3 decades at Harvard rather than having a current professorship there?

  • melissa

    I completely agree with Heyman. It’s ridiculous for people to cop out and call addiction a disease. They accept no responsibility by saying they were born with some defect that made it a foregone conclusion that they would have an espially intense, disease-induced reaction to drugs that makes them impossible to pass up.
    Naturally, some people are born with brains that make them prone to depression, etc and, therefore, more susceptable to the escape of drugs.
    This is something that I know about having had an unhappy childhood from which I sought comfort in the form of drugs and other self destructive behaviors. Finally realizing the life-long implications of what I was doing to myself, I quite. But I am not “in recovery” nor do I “have a disease.” I simply no longer abuse substances, although, like most people, I’ll go out and drink too much wine on the weekends and sneak the occassional cigarette.
    My heart goes out to addicts but they have to make the tough choice and quit. It is up to them. We should empower them and not set them up for a life long battle with a mysterious disease.

  • Cindy

    This is a very interesting discussion.
    I am a muscular therapist working with any number of complex pain problems created by musculoskeletal “chronic conditions”.
    Perhaps addictions in the brain are similar to these kinds of chronic conditions in the body.
    In my experience, it is possible to make choices (such as working in conditions that create poor posture and mechanical stress)that eventually culminate in a musculoskeltal change in the body that cannot ever be reversed. At this point a person has a “permanent condition” that can only be “managed” by diligent ongoing therapy and execise programs. Once a person goes off of these programs the pain returns. Maybe an addicted person has a preisposition for this…we will call it “condition” rather than “disease…and once triggered this becomes a permenent change that cannot be reveresed, only managed and controlled.
    Many of my clients “choose” not to sustain their exercise programs and live with the pain…many “choose” to work very hard to manage their problem, but neither choice makes the underlying condition go away.

  • Boris Garrimore

    To be fair, Henry and others, the author works at McLean hospital in the greater boston area, one with a long history of addiction treatment including exposing patients/clients to the Alcoholics anonymous program.. It’s safe to say that he is well aware of AA, and just doesn’t agree with one or more of its main tenets. And as one person says, it really is a moot point for the involved. This argument primarily affects those who would or would choose not be in a decision making automated

    And Joe P., to believe that Alcoholism holds a position of greater depth and complexity –

    “…Alcoholism is a far more complex condition, which manifests itself drunk or sober. And yes, it is a disease. I have no qualms with the idea that addiction, in and of itself, can be classified and something other than a disease. But when alcoholism is lumped together with addiction and all other pathologies regarding substances or behaviors, I must protest.”

    I know the feeling of not wanting to be lumped into a category, especially before getting into drugs. But alcohol’s chemical dependency bears no considerable difference over another substance, nor bears a wider gap in comparison of one to another. Just easier to buy, and less stigma.

  • Hugh Briss

    Melissa. By definition alcoholics have to control their drinking whether they are abstinent or not. It doesn’t occur to non-alcoholics to try or not try to control: they have a stop button. Will power doesn’t cut it. And abuse isn’t about quantity, but motivation. Plus you confuse your past self-medication with true addiction. A working knowledge of CBT, DBT and neurophysiology would not only enlighten your world view, but prevent you from making such callously insulting statements. It is a bit like PTSD. Once activated you can never really go back to the former latent state. Through suffering with the diseases of alcoholism and manic-depression I’ve learned tolerance of such ignorance. For an alcoholic there is no such thing as “too much” on the weekends. Get it? Do you have any idea how much stigma there still is around this? Welcome to our world.

  • Steve A

    Pat said:”So why would you think that adding more shame and guilt would give us hope, strength and any sense of empowerment?:

    Thank you Pat. I have been clean in NA for 24 years. Before I cleaned up I was filled with shame. I was a criminal just being high. I felt that there was no place in this world for me. When I found a group of people who told me that I was not responsible for my disease, but I was responsible for my recovery, I felt hope and acceptance for the first time in many years.

    I would not care about this discussion except that a suffering addict who feels like I did may have heard this discussion and felt that old familiar rejection again. To those people, to my people, I say if I can live clean, you can live clean and don’t let any of this straight people who don’t have a clue get you down. You come hang out with me and my friends. We will get through this thing together.

  • Adriana

    I can relate to this program because I was married to a man with a highly addictive personality, alcohol, drugs, food, gambling etc. I lived many years observing his pattern of behavior and onset and offset of his many addictions. Family relations affected and severed, constant problems with the law / encarcerations, and a near fatal accident. Consequences to his addiction did not stop him, a near fatal experience did not stop him, a broken marriage, limited access to his son, nothing has made him stop. What defines hitting rock bottom? I wonder if its the individual’s definition of rock bottom, perhaps to some death is rock bottom. In my view and living so close to an addict, I believe that choices do lead to addiction. So whether you want to reject the word choice, truth of the matter is that the first time anyone experimented with cocaine, heroin, nicotine, alcohol, etc made a choice to experiment with these. I can understand that after becoming dependant on any substance, that the circuitry in their brain is unable to make “right choices”.
    The person has the responsibility to seek treatment, control and treat their so called “disease”, like any diabetic, cancer patient. To decide not to do something is a choice. This is obvious by some of the testimonies from the above recovering addicts. Whether they hit rock bottom and/or nearly encountered death, had children etc. Even with years of abuse and damage to body/brain, there was still a choice to stop with or without support from family/AA/treatment centers. I do not believe this is a disease, it’s a matter of choice from the beginning.
    If it is not a matter of moral choice, why then does our society penalize addiction/drug use?

  • hugh Briss

    Adriana. If it is not a matter of moral choice, why then do most societies penalize rape victims? Is there free will or is everything pre-determined? I’ve always had a problem considering alcoholism a disease. Doesn’t quite fit: like homosexuals being considered a minority. Perhaps with knowledge of neuroplasticity, a more subtle and inclusive definition of dis-ease can be evolve. This guy seems like some kind of neo-behaviorist, and not very savvy about newer models based on neuroanatomy which though no longer cutting edge, sure beats out the cart horse of once fashionable Behaviorism. Do revisit Cindy’s post. It says something very subtle with great clarity. I don’t have the luxury of separating addiction from mental illness. One affects the other. Could both be brain diseases?

  • Joe P

    “I know the feeling of not wanting to be lumped into a category, especially before getting into drugs. But alcohol’s chemical dependency bears no considerable difference over another substance, nor bears a wider gap in comparison of one to another. Just easier to buy, and less stigma.” -Boris

    Boris, I apologize if my comment was mistaken for a claim of superiority or a differentiation based upon a desire to be disassociated with drug addicts. Quite the opposite is true. I spend 2-3 afternoons per week with drug addicts and alcoholics at a homeless shelter/treatment center in downtown Louisville. I look into their eyes and I see me. I come to share my experience, strength and hope as an alcoholic. And, of course, I do it for free.

    My point is that addiction is not synonymous with alcoholism. “Addiction,” generically, just means that I have a compulsion to use a substance of behavior. Alcoholism is a specific disease, which may manifest itself as addiction, but is still present even after the addiction manifestation of the disease is not present. I used to be addicted to alcohol, but I am not anymore. I do not drink it, I do not crave it, and I have no physical reactions to the presence of alcohol or thought of alcohol. The absence of alcohol accomplished that. But I am absolutely an alcoholic. The difference is like I said: without a continuous program of recovery, sobriety will ALWAYS become so unbearable that I must drink to find relief, to literally preserve my sanity. It is how I feel when I am SOBER that makes me an alcoholic rather than someone with only a drinking problem. The latter, addicted or not, is solved by the removal of alcohol. And yes, you an substitute any drug you like for “alcohol,” so long as we are talking about the disease condition and not the generic “addiction.”

    Now, if you are referring to the heroin or cocaine or sexual or eating equivalent to alcoholism, not the generic “addiction,” then I would like to mention this. OF COURSE they are similar. And I would say that they qualify as diseases. Are they “equal” in many respects? Sure. Are they both heartbreaking to watch? Yes. However, there is ABSOLUTELY a difference. The difference may not mean much to a non-afflicted drug-user or alcoholic, but to an alcoholic, it is a matter of life or death. I know that this sounds like I’m saying we’re special or unique, but I promise I’m not, not in the way you think. AA doesn’t work because it is exclusive to the steps. The principles of the steps came long before AA and are freely available to anyone. AA works because an alcoholic identifies with other alcoholics who have felt the way he feels and thought the way he thinks and has drank the way he drinks. OTHERWISE, an alcoholic would never take actions (the steps) that he does not believe in. Identification is the key, which works hand in hand with AA’s singleness of purpose, being to help the alcoholic who still suffers. I want the heroin addict to recover as much as his mother, but I guarantee you he isn’t going to identify if he’s never drank and I’ve never used heroin. It is a disservice to the addict, especially when there are other programs through which he can find a solution. Now if he is an alcoholic AND an addict, then he can absolutely recover in AA.

    Perhaps what we need is a specific word, beyond “heroin addiction” to describe the disease associated with that drug, etc as we have alcoholism to differentiate from “alcohol addiction.” The fact that all diseases and conditions get lumped into “alcoholism” and then becomes interchangeable with “addiction” creates too much confusion to sort diagnoses and, more importantly, programs of recovery. It may appear as mere semantics, but I’ve watched too many people die for lack of understanding of our first step to pretend that these specific words don’t count.

    I hope this is clear.

    Thanks.

  • Ellen Dibble

    Why penalize addiction/drug use? Good question.
    First, I have read that illegal drugs are illegal because they hurt you. They hurt you because they block the ability of the brain to conjure up its own chemicals of joy, satisfaction, peace. Instead the brain waits for the drugs to prompt it.
    Maybe that’s not true in all cases, but I do wonder why addictions are illegal if they hurt no one else. I have voted against criminalizing marijuana. Police say oh, it’s an entry drug; it leads to other, more dangerous “use.” Really?
    Does smoking nicotine lead to other more dangerous addictions? What about bulimia; is that an immoral addiction? What about my addiction to sudoku? Or to trying to pick up little pieces of my environment every morning, dents in the detritus of various clinging disorders of life? Is it immoral to have a gut feeling that this is what I have to do? To be wired in ways that could be improved upon?
    I can tell you first hand how others’ addictions affect me: if cocaine is smoked in my apartment building, I get itchy, I get sores, I get sore throats, I get swollen inside of the nose, I get headaches, swollen lymph nodes, stiff necks, frozen shoulder. Medical insights suggest I have repeating flu. (Except this all stops when cocaine is not around.)
    I have a terrible allergy to Candida and a very high body load of heavy metals, which may be to blame; another person would not get sick. But I end up having to get innocent users evicted.
    Now, this year, now that marijuana use is not illegal, the question is, which smoke is it, marijuana or cocaine? And can I vouch to my conclusion as persuasively as a trained Canine with its cop. No. Courts of law say no: Human noses don’t count.
    I guess I’ll have to keep moving from apartment to apartment, or live the morally questionable life of a spoilsport. People can drink a truckload of alcohol directly underneath my bed and I do not suffer. So I would say the addiction to alcohol is not illegal. It’s what you do while addicted that might be illegal. Immoral — I’d say it’s between you and your conscience (try to get people and churches not to go around shaming, though — I know), but education could sure help point the way ahead. Call it prevention?

  • mark

    AA says addiction is like an elevator going down. You can get off whenever you choose until you hit bottom always with knowledge that there are more than only one bottom, that is,until you die. How nice to be allowed to have choices to the very end; whether through overdose or suicide.

  • Henry

    Ellen- you espouse the views on Harvard that slide off the tongues of those who could not tolerate its admittedly byzantine system, which also could not be less like the Republican party. I live the “system” through my partner every day and have through several others during my adulthood and before. Your perspective is one those who lose and can’t get over their blunted egos and not one of those who succeed.

    As far as Heyman’s work goes it is appallingly ill-conceived and misleading bordering on dangerous. It is populist, trendy and catchy but not much more. He ought to do his homework with doctors, psychiatrists and clinicians and not with the herds of believing undergraduates at Harvard, Brandeis and BC who have been most of the soft-landings for his ideas and not qualified, informed and questioning graduate students and post-PhD’s. He could not survive the rigors of this latter audience.

    He shows absolutley no knowledge of how addictions work during their progression, early-mid recovery and sobriety maintenance, and his writings avoid the true complexities, implications and outcome in the same way that most third-rate psychologists view the world… which is through the template of arguments rather than solutions to life threatening problems… in large part because they lack the brains, guts and commitment to be involved and at risk like true medical professionals, whose platform they are pleased to occupy when it serves their own money-making purposes.

    Let’s just say that there are many much better writers/practitioners out there who NPR ought to be sponsoring on its visible public platform. If you know this arena then you will know who they are… and Heyman is not on the list.

  • Ellen Dibble

    Henry, I have not read Heyman’s work and only know what I heard on this program. So maybe you know all of that, as well as a lot about addiction treatment (which you are not pointing to or explaining, by the way). I do know more or less what this forum can achieve, and I’d say they did pretty well today. A lot of people who would not otherwise weigh in did pitch in, which would not have been the case if there was a more “establishment” feel to it. My blunted ego bows to your judgment; those we deem the winners of this world are always right.

  • SOTHIT

    The show on addiction w/Dr. Heyman was easily one of the most circular (logic) and unproductive OnPoint shows I’ve listened to yet. Dr. Heyman’s theory on addiction was full of inconsistencies and errors. This was apparent when Mr. Ashebrook or callers challenged Dr. Heyman and his replies were, “there are human variations.”

    Two contentions I have with Dr. Heyman’s theory are.

    1). According to this theory, crack/alcohol addicted babies choose to be addicts.

    2). We do not live in an indentured slave society, therefore, no one is forced to do anything, therefore, everything is a choice. Saying addiction is a choice is like saying someone with mesothelioma chose to have it cause they chose to live in an environment with asbestos.

    At first I was interested to hear current theories on addiction, but Dr. Heyman did little in advancing and enhancing addiction knowledge and educating the public tonight. Instead semantics over a poorly thoughtout theory detracted from the real important topic.

  • http://SIMPLEREALITY rOBERT dElUCA

    “ADDICTION ISN’T A CRIME”

    Addiction is more a mental disorder and should be taken care of through what ever health care works for the condition. This is the reality until the research isn’t slowed by the criminal nature to solving the drug use of adult americans!

    One thing for sure is simple possession and recreational drug use by adult Americans shouldn’t be a crime. I call it my personal choice and my body should be my domain.
    Alcohol is the same except it is far more insidious and damaging physically and society holds back from arresting people who use the drug alcohol responsibly!

    Freedom and responsibility of adult americans should be the same across the board. Alcohol is the example! Americans deserve to be left alone except when it threatens the space or safety of another individual

    Addiction,as far as individual perspective,is wide open, but arresting Americans for recreational substance “USE” not abuse!!! This is un-American and anti Democratic.. Big brother is getting real large and we are allowing it to happen!!

  • anne

    seems to be not just choices one makes, but choices one has made, or has been made for you.

    my brother boasts he has alcoholism in his genes because our uncle exhibited it, and therefore has no problem tossing back sixpacks of budweiser at a time.

    his eldest, my godson, just turned 13. next time he pulls that excuse out, i am going to point out to him he just gave HIS kid a greenlight for drinking, as it’s not in his power.

  • Richard Johnston

    Neither side of the argument is convincing. The “it is a choice” side relies on statistics, and the “it is genetic” side relies on anecdotal evidence.

  • Pat

    TO Steve A:
    Thanks for your support. And after attending a meeting earlier tonight where your thoughts were reinforced, I’m gradually losing steam. I will let this go for today, but i am still disappointed in NPR for allowing this very uninformed self proclaimed professional (not) to come on board and promote his book of hogwash!

  • Jess

    I wonder if both theories are correct – meaning it is all a matter of degrees. For example, I have scoliosis. It was discovered when I was 13, and was already 70 degrees (crazy I know!) and I was told I had to have a surgery within the month. I can’t even tell you how many people have told me they also have scoliosis, though you would never even know it. 3 degrees, 8 degrees – whatever. Their spines are straight and stable enough.

    I do think Gene is right that most people make choices, to ‘get their act together’ and become healthy. Like the average spine with the 1-15 degree variance. It’s a good enough spines, and it never ends up disabling them. For others, it’s just a dramatic degree – they are wired to their addiction, and can not dally in half measures. It’s all or nothing. When they (hopefully) go into recovery, they have to maintain and awareness of their more drastic degree of addiction, and take one day at a time.

    Kudos to all those who posted who are staying sober!

  • Joshua Berman

    I am a psychiatist and do research on brain mechanisms involved in addiction. To say that addiction is either a disease or a matter of choice is a gross oversimplification and in the end making such a determination isn’t very helfpul or informative.
    Heyman is engaging in a sort of black and white thinking here. Disease is not totally free of influence from voluntary decisions, nor are choices as free of both internal and external fixed components as we like to think they are. Oddly, Heyman does touch on this in some of what he says, but then persists in making the reductionistic statement that addiction is a choice.

    Over the course of addiction, the brain’s decision making machinery becomes more and more impaired by the molecular changes wrought by the drugs taken. What starts with poor choices becomes something like an aquired disease, and both the rate and certainty with which the initial poor choices will lead to the disease state are highly variable based both on genetic and environmental factors. Kind of like Type II diabetes, or coronary artery disease, which even in fairly vulnerable individuals can be delayed or prevented with the right lifestyle choices. To further complicate matters, the highly addictable person may suffer from neurophysiological traits which if not ultimately expressed as drug addiction, may often intead be expressed as other psychiatric ailments.

    The problem I have with arguemnts like the ones Dr. Heyman puts forth is that they seem more aimed at scoring moral/polemic/policy points than at illuminating a complicated subject. Dr. Heyman didn’t quite acknowledge the nuances of some of the animal experiments he discussed, and he also didn’t seem to deal with the mechanistic implications of the range of addictability seen in humans, or of the predictability of relapse in large populations (as opposed to individuals).

    One could make the argument that he is contributing to clinical care by underscoring the importance of choices people make, but every clinician I know already incorporates this into treatments that work within the disease model. I worry, too, that overemphasizing the idea that drug taking is solely a matter of choice may cause those with addictions to underestimate their vulnerability to relapse and the degree to which the effects of drug use on their brains necessitates extra vigilence to avoid triggers to use.

    For any disease influenced by incompletely penetrant environmental and genetic causes there exists the possibility that its expression and course will be influenced to varying degrees by the choices we make, and that social, personal, and emotional factors will influence how we make those choices.

  • abby schult

    I’ve been sober 29 years, one day at a time, and an alanon member for 9 years. As a practicing alcoholic and drug addict the first puff or sip took away my free will. It took years for me to realize that once I took that first drink, puff or snort, I no longer had a choice. The substance and the need for it took over; the substance became my will. Psychology never helped me. The only thing that worked was the AA program and the people in it. Isolation and denial are the hallmarks of this disease. You say that a disease must be involuntary and that if you get your will back that proves it was never a disease. I disagree. Diseases and healing are part of the process of recovery. Recovery means that I move from unawareness, denial, to awareness, honesty. For example, one of the hallmarks of the process of acceptance of one’s own death is admission that of myself I can do nothing. My death is inevitable. I reached this point in my alcoholism. We call it the jumping off place. When I got to that point I became like the dying (because I was dying) and was willing to listen. I began to go to meetings and listen. That was not my will, but my holding on to a life preserver. So when some of us can and do recover you implay that means we do not have a disease. People with other illnesses choose to do what they can to fight the illness. As a result, cancers go in remission after surgery, chemo and radiation – diabetics become willing to stick to their diet and recover. Does that mean that they did not nor do not have a disease? I think not.
    My Heyman, you collect facts and come up with a theory about whether or not alcoholism is a disease. If you did that about any other disease, you would be fired by your university or perhaps advised to do research to help people recover from cancer, high blood pressure or diabetes. This investigating you do is done mostly in isolation, I would imagine. Collecting and analyzing data. Or perhaps you direct a team of people – tell them what to do – remain in charge. Isolating and being in control are hallmarks of the disease of alcoholism. Why did you not choose to study the process of healing and recovery rather than sit in your ivory tower and investigate the definition of alcoholism as a disease. Like you, I had my ivory tower to collect data and speculate. My drink or drug was my ivory tower. Ivory towers are perfect places to isolate. In AA, we recover, not I. We get the facts by listening to each other. We are told to quit analyzing and listen. It is not my will and the recovery of that will, that gets and keeps me sober, but rather our will, the recovery of our higher powers’ will. As with any healing from disease, we align our will with a much larger will that belongs to us all. It is no longer us staying away from what will destroy us but realizing that the larger will of us all wants us sober and has promised to keep us sober if we follow that will. Check out spiritual solutions and definitions of willpower and illness and disease. You have a lot to learn. You got the attention you so obviously wanted with your ‘observations’. Everyone is intrigued when someone challenges the status quo, especially if it gives people a way to vent their resentments and hurts. But your observations don’t help. Rather they encourage people who want to blame and isolate – blame themselves or others for the disease of alcoholism and isolate rather than asking for help. Look into your own life Mr. Heyman, your own family…come to some open AA meetings. Sit in on Alanon and learn about this disease and its recovery.

  • Expanded Consciousness

    Humans have both biology and a conscious sense of will power. Nothing will change that. Live with both concepts versus always looking to reduce everything to one or the other.

  • PW

    We can disagree on the extent to which addiction is disease or not,but I don’t think we can avoid noticing that many addictions are putting big bucks in others’ pockets. Whether you manufacture/sell alcohol, drugs, ciggies, or “cures” for all of the above, you have a vested interest in keeping people hooked. That’s well illustrated in the blurb for a Wednesday discussion at WHYY’s (Phila. public radio) “Radio Times”:

    “While health professionals and the media focus on the obesity epidemic and diet fads, some overweight women are making peace with their bodies. They are blogging about fat acceptance and ‘health at any size’ on sites like Shapely Prose, Big Fat Deal, The Rotund, and fatshionista. This hour, a look at the fat acceptance movement …”

    Of course, “obesity” and “fatness” are two different problems but both are to a greater or less extent market-driven — no less than salons, fad diet books, and (of course) what is disconcertingly called “the health care industry” nowadays!

  • Bridget

    As a recovered addict, i agree fully with dr heyman. Although many addicts are no aware they have a choice, they do. You make a choice everytime you use. It’s not to say that there are not horrible withdrawl symptoms and both loss of physical and mental control. But every second of every day is filled with choices.
    The path to addiction is usually filled with trauma. Many people are hiding from themselves and their choices and have convinced themselves that they cant handle the world without drugs. It all goes to the wonderful subconcious and how it influences our everyday activity.
    What a great topic. Thank you!

  • Brian Thomas

    I fail to see how a mere book or research study can be termed “dangerous”. Shall we just stick our heads in the sand and accept the dogma of 12 step programs as unassailable? As a serious problem drinker from a long line of problem drinkers I find far more hope in the notion that alcoholism is not a disease than in the tenuous nature of “one day at a time”. What a horrible way to live, believing that your addictive voice can make you relapse at any time. That some mysterious combination of heredity, chemistry and brain conditioning is the reason you get in the car drunk and plow into a minivan full of kids. Yes, that is a choice drinkers make every day.

    It’s ok to quit with AA, Rational RecoveryR, hypnotherapy, nutrition therapy, etc. The range of human personality is immense. Dr. Heyman’s viewpoint is just as valid as AA or as Jack Trimpey’s, or as Stanton Peele’s. However you do it, you know you have the problem, and it really doesn’t matter WHY you have the problem. People drink or use because it makes them feel so good all over. Impugning Dr. Heyman’s professional credentials simply makes no sense.

  • http://www.polladium.com Tony S

    Poll: Should addiction be treated as a matter of choice, or disease?

    http://www.polladium.com/poll.php?poll_id=233&location_id=1

  • sothit

    Dr. Heyman pawns off his research and theory as novel and revealing (that addicts need to make better choices). No addiction specialist would argue with that and many current treatments include this. Dr. Heyman’s theory is not revealing or advancing.

    As many people stated in previous posts, people should not confuse generalities made by Dr. Heyman. He posits environment and free will critical in the treatment equation. This is not up germane, however turning addiction into nature versus nurture argument is wrong and advances addiction knowledge nowhere. For example, many neuroscientists have show in both humans and animals that environment affects biology (including but not limited to genes) and biology (including but not limited to genes) affects environment.

    Only subscribing to one cause (environment vs. biological) throws out more effective treatment options to the public. For example, medication has only been shown to successfully treat depression around 40% off all cases, but when compared to treatments with both medication and cognitive behavioral therapy, successful treatment of depression increases dramatically. Bottom line, when you become too biased towards specific etiologies, you ultimately reduce treatment dramatically.

    This OnPoint guest/show did nothing to advance addiction understanding or even provide a meaningful debate. Dr. Heyman only encouraged people to argue semantics.

  • surfpk

    To Borrow from Tricky Dick Nixon “In the Global Village(Modern Society)we are all philosophers now” :)

    The critics of this guest views need to look at there own conditioned choice set. He is saying that in a morally ambiguous set of circumstances we have to make complex choices endlessly. How we handle those choices is determined in both social and individual dynamics.

    The important point is that we have many chances to choose based on circumstance and the more OFTEN we choose the more varied our choices become. This means that BOTH sides of the addiction argument ie: will power or disease are strictly determinant which binary(yes or no) “are you with me or against me”, they are in fact THE SAME THING. This can lead in a direction of highly evolved choice not available to primitive existence (before modern society).

    His approach is actually highly inspired and hope a few people listening have been able to understand this.

    Freewill is complex which is why it is free. Organized religion is the ultimate support group setting up a Pavlovian response chamber where the social environment is managed. We are better than that.

    Surfpk

  • http://www.onpointradio.org/about-on-point/wen-stephenson/ Wen Stephenson

    We asked Gene Heyman if he wanted to follow up, and he sent this note:

    I would again like to thank On Point for the opportunity to describe some of the research and ideas that my new book summarizes. What I will add here are a few words about the book’s approach or method.

    It emphasizes research results. This is because I wanted readers to be able to decide for themselves whether addiction is a chronic condition and whether it should be called a disease. Instead of relying on interpretations of research findings, the book provides many of the basic research findings themselves. It includes the results of every major epidemiological survey of psychiatric disorders, a collection of autobiographical accounts of drug use, laboratory studies of drug effects, and historical trends in drug use and its understanding.

    Surprisingly, the clergy not physicians introduced the idea that addiction is a disease, and they did so in the early 17th century, before the emergence of science-based medicine. There is also a review of what researchers mean by the terms “disease” and “choice.” My initial impetus in studying addiction was to discover how voluntary drug use became involuntary drug use. The book describes some of the highlights of what I have learned.
    -Gene Heyman

  • Anthoni F.

    Mr. Heyman should brush up on his history. The opium epidemic in China followed a similar path to the smallpox epidemic the Native Americans faced when the Europeans arrived. Why did they get smallpox? Because they had never before been exposed to it. The same thing happened to the Chinese. They had not been exposed to opium before. If you look at this one case in history, on which there is plenty, you will find that the Chinese had no more time or wealth on their hands. The British were giving it to them to get them addicted and then jacking up the prices so that China would have to spend silver instead of hoarding all of it as they had been doing. The Chinese government was extremely unhappy with the epidemic because of this, and also because nobody was working anymore. The addicts then were ignoring their responsibilities because of the drugs. I am unsure how this new information relates, but at least it is correct information.

  • ralph m

    Idiot psychologists like Gene Heyman don’t seem to ever read any of research being done in neuroscience. Otherwise, they would realize that free will is limited by very physical factors of neurochemistry and brain function.

    Dr. Heyman’s belief that addiction is a matter of contra-causal free will cannot explain why I went through the binge drinking and drug-experimentation in my youth, and left it all behind later on when I was ready to settle down. I have never felt the same drive to get high that a lot of addicts feel, and I know too many people that were addicted right from the first time they had a drink, to believe that everyone has the same capacity to deal with addictive substances.

    The other danger of this thinking is that it provides the mainstream with another excuse to condemn those who are addiction-prone as being deliberately immoral people. Simple fact is that some people like myself are fortunate not to feel the same pull of addiction that others have to deal with. Certainly, it’s up to them to try to manage their addictions and be contributing members of society; but useless psychobabble about “making better choices” is stating the obvious. The implication that it is all a matter of choice, leaves behind the implication that some people are incapable of making right choices.

  • Dean

    Nice parting shot, “professor”.

  • jim

    75% of addicts at the age of 42 are ex-addicts. That’s because the ones who kept using are dead.

  • Ellen Dibble

    Ralph M says, “Idiot psychologists like Gene Heyman don’t seem to ever read any of research being done in neuroscience. Otherwise, they would realize that free will is limited by very physical factors of neurochemistry and brain function.”
    Good idea to post that after most people aren’t reading the comments. Wen Stephenson just posted an update from Heyman — he wanted to lay out the research, the history, so as to allow readers to think about what that reveals. If this does unlatch us from dogma for a bit, so be it.
    If Ralph knows some specific things about neurochemistry and addiction, I would have been interested. Ditto to an earlier poster who spoke of organized religion vis-a-vis free will. Specific examples?
    Nobody has mentioned the huge inclination people have to assume somebody is an addict/immoral when no such thing is going on. It is just so easy to see someone struggling a little harder than is comfortable to watch, and conclude, “Well, they must be sunk in some chemical swamp of their own making.”
    Then is it easy to continue; don’t say it to that person’s face; the idea simply becomes common “knowledge” by its subterranean uncontestable nature.
    It is people’s free will to believe what they want to believe, I suppose, rightly or wrongly. Or call it choice.

  • Putney Swope

    melissa I hate too say this but you sound like your in denial. If you had drug and alcohol problems and just stopped without getting any therapy then the odds are your going to slip into the using again.

    You admitted to using too mask feelings of a some kind of trauma in childhood. Then you said you used drugs and just stopped. Then you go on to say that you sometimes go out and drink to much wine, whatever that means. To simplify addiction into black and white terms is not healthy.

    People have different brain chemistry which can manifest itself into addictions. Bipolar is a disorder that comes to mind. Also there are people who make bad decisions and go from social drinking to being alcoholics. This is not uncommon in some college age people who start out binge drinking on weekends and end up in AA meetings 20 years later.

    To say it’s just a choice is to simple, too easy.

    I would like to here how Mr. Heyman’s take on the 14 year old kid from East Baltimore who is already an addict due too his parents being addicts or being surrounded by a culture of drugs, violence and hopelessness. Did this child become an addict due to choices or conditions? Or just out a desire to escape from a crappy life.

  • gene

    Regarding the caller with heroin addicted parents, I give her a lot of credit for overcoming what must’ve been an extremely dysfunctional childhood, however, I don’t think she can assume, just because a predisposition to addiction runs in her family … that she, in fact, inherited that predisposition, therefore overcame it.

  • Mark

    I really enjoyed listening to this show and completely welcome the debate.

    I am in my mid-30s and had to quit drinking 2 years ago when it had become a quart of whiskey a day problem, drinking in the mornings, constant excuses etc. Following a long weekend detoxing at Mcleans (yes, the place people are deriding on here) I have not had a drink since. Having progressively become alcohol dependent over a period of 15 years it was a shock to discover that apparently the only option available to me was to attend AA, trust a higher power and take one day at a time etc as I apparently have a terminal disease.

    I have scoured the internet, library, bookstores and audible.com etc. for all the information I could find about my condition and have been constantly frustrated by the dogma about how it’s a disease and if you don’t believe in then you’re in denial etc. I accept I can’t drink again in safety, I know where it took me and where it could take me again but I am also someone that wants and needs to know as much as I can about this condition rather than just blindly relying on AA and it’s spiritual program.

    I can’t wait to read Dr Heyman’s book as for me, as someone who has been severely alcohol dependent, it is important to know why I did it and how I can avoid it in the future. Knowledge is power and the fact he even states that AA is a good program (which I have found it to be with it’s support and companionship) means that we should surely welcome these books and studies.

    And, Henry, whoever you are, you clearly have a grudge or resentment against the author… it’s a little aggressive and unnecessary IMHO.

  • Philip Kaveny

    I have listened to this program twice and I would love to see further discussion of the issues raised.The idea of making the better choice has iluminated my life.My core belief is that good choices lead to other good choice, and that choice matters, and is not merely subjective.

  • http://canucwhatic.blogspot.com/ roth

    How can we conclude that addiction is a “choice” when neuroscience – although it has undergone revolutionary changes in the past 20 years – is still in the beginning stages of discovering how the brain works?

    Despite the revolutionary changes, methods of diagnosis and treatment for patients with mental disorders have remained relatively unchanged. Medicating and treating psychiatric disorders is still very much in the hit or miss and/or trial and error stage which conveys how little we really know.

    In general, we know the environment, both socially and physically, interact with genetic vulnerability and predispositions, thus powerfully effecting the development of mental disorders, however, we do not know to what degree each one plays, nor do we understand how that interaction effects the choices we make.

    Couldn’t it be that, like any disease, there is a spectrum ranging from mild to severe? That the 20%- 25% who failed to overcome their addiction are the ones we would label as diseased or severely diseased, whereas the ones who overcame their “addiction” either are not diseased or have a milder form.

    I find it hard to believe that anyone would make the choice to totally fail at life, in the most humiliating, degrading and painful way possible.

  • Nic Greene

    I firmly believe that we are able to modify our behavior but only with the aid of insight. The passivity inherent in classifying unwelcome actions as disease is unhelpful.

    Environmental factors and heredity all play a part in our behavior. We are feeling creatures before we are reasoning creatures and many of our patters of behavior come from early life. With insight we are able to both understand the root causes and to link with their emotion states.

    Studying brain chemistry to understand the problems of being human, is very cleaver, but flawed. We are creatures of emotion, but these emotions can become distorted, damaged and cross linked by the passage of experience and one way of coping with this pain and or confusion is by the adoption of addictive behavior.

    In conclusion I would agree with Gene Heyman and say that addiction is adaptive behavior that can be changed.

  • mark

    Well that’s all very nice but it has nothing to do with addiction. Call it what you will, disease or not, neither you nor Heyman has the insight nor empathy to add anything to clarity of discourse. It isn’t ALL dogma. For instance there are clearly defined signs of relapse. Relapse occurs mentally before it manifests in behaviors like neglect of hygiene, certain predictable personality changes, etc. Let’s just hope that this book sinks into obscurity as quickly as it deserves.

  • Nic Greene

    Addictive behavior is, I think, compulsive and cyclic, driven by conflicting and opposing needs. These complex, and often painful conflicts cannot be addressed unless they are brought to consciousness. People will go to great lengths to avoid psychic pain, palliatives in the form of drugs are just one avenue.

    As Heymen pointed out if the environment changes, by say taking a soldier our of active service and thus reducing the stress and conflict, so his behavior will change and there a less need for palliative action.

    Psychoanalysis lays bare the roots of our behavior and while it may not be very hot on empathy it’s very good at what it does, which is to analyse problems. Unfortunately it is slow, painful, expensive and not widely available.

  • Mark

    Psychoanalysis can do many things, but it can’t deal with addiction. The name of the game is brain chemistry not Freud. I should know, I’m Bi-Polar, and have performed my own brain “experiments”: Without medication I’m loony tunes and I and everyone in my life knows it. Mania has been as destructive as alcoholism and it is said that BOTH DISEASES ARE PROGRESSIVE OVER TIME. I don’t really believe this so I’m probably doomed to further relapse and recovery as part of the learning process. My environment HAS changed by my making the healthy choice of living in a Sober House for now, along with other alkies/junkies most of whom are on medication for Depression, Bi-Polar Disorder, OCD. But at the present stage of recovery I am unwilling to subject myself to the triggers lurking in a more conventional living arrangement. Healthy choices don’t affect addiction and any garden variety social worker in any half way house knows this fact which Heyman either denies or is unaware of.
    The next step will be in medication that deals as effectively with addiction as it currently does with brain dis-ease, and not in this muddying of the waters under the ruse of promoting free discourse. He just wants a tenured professorship somewhere—anywhere—probably a place that caters to conventional academic hacks.

  • john hurd

    with what the un-told cost of alcohol/drug addiction in this country who cares about anything except help.

  • Nic Greene

    Prevention costs less than treatment in the long run.

    As a society we need to better understand the interplay of inherited tendencies and environmental factors that contribute to addictive and other distorted behavior patterns. Yes, people need help but prevention is better. This will only come from education and people taking responsibility for their actions.

    Seeing addiction as a disease only helps those who promote the means for it’s treatment.

  • http://www.facebook.com/people/Wes-Pires/100000733163743 Wes Pires

    Punyamurtula Kishore MD aka Mad Dog Millionaire has been suspended from
    several Boston and greater Boston Hospitals for sexual misconduct with
    male patients . Check MA Medical reg. for order . Punyamurtula Kishore
    aka Mad Dog Millionaire has admitted himself to Mcleans hospital in
    Belmont , Massachusetts for sex addiction and erectile sexual
    dysfunction .

    If you want to live , donot seek help from Dr. Punyamurtula Kishore MD
    aka Mad Dog Millionaire . Dr Kishore is a Quack . Many of his patients
    relapse and die , His Treatment protocols give his patients a false
    sense of hope and he continues to get rich at the expense of death .
    Preventive Medicine Associates formerly Addiction Medicine Associates is
    a Death Camp

  • http://pulse.yahoo.com/_TJ42IRUG4COR7VCGV3N3R6SAX4 Anita Gbomene

    Punyamurtula Kishore MD aka Mad Dog Millionaire has been suspended from several Boston and greater Boston Hospitals for sexual misconduct with male patients . Check MA Medical reg. for order . Punyamurtula Kishore aka Mad Dog Millionaire has admitted himself to Mcleans hospital in Belmont , Massachusetts for sex addiction and erectile sexual dysfunction .

    If you want to live , donot seek help from Dr. Punyamurtula Kishore MD
    aka Mad Dog Millionaire . Dr Kishore is a Quack . Many of his patients
    relapse and die , His Treatment protocols give his patients a false
    sense of hope and he continues to get rich at the expense of death .
    Preventive Medicine Associates formerly Addiction Medicine Associates i is a Death Camp.

  • http://pulse.yahoo.com/_TJ42IRUG4COR7VCGV3N3R6SAX4 Anita Gbomene

    Punyamurtula Kishore MD aka Mad Dog Millionaire has been suspended from several Boston and greater Boston Hospitals for sexual misconduct with male patients . Check MA Medical reg. for order . Punyamurtula Kishore aka Mad Dog Millionaire has admitted himself to Mcleans hospital in Belmont , Massachusetts for sex addiction and erectile sexual dysfunction .

    If you want to live , donot seek help from Dr. Punyamurtula Kishore MD
    aka Mad Dog Millionaire . Dr Kishore is a Quack . Many of his patients
    relapse and die , His Treatment protocols give his patients a false
    sense of hope and he continues to get rich at the expense of death .
    Preventive Medicine Associates formerly Addiction Medicine Associates i is a Death Camp.

  • http://pulse.yahoo.com/_TJ42IRUG4COR7VCGV3N3R6SAX4 Anita Gbomene

    Punyamurtula Kishore MD aka Mad Dog Millionaire has been suspended from several Boston and greater Boston Hospitals for sexual misconduct with male patients . Check MA Medical reg. for order . Punyamurtula Kishore aka Mad Dog Millionaire has admitted himself to Mcleans hospital in Belmont , Massachusetts for sex addiction and erectile sexual dysfunction .

    If you want to live , donot seek help from Dr. Punyamurtula Kishore MD
    aka Mad Dog Millionaire . Dr Kishore is a Quack . Many of his patients
    relapse and die , His Treatment protocols give his patients a false
    sense of hope and he continues to get rich at the expense of death .
    Preventive Medicine Associates formerly Addiction Medicine Associates i is a Death Camp.

  • salzburg

    Want to see a show on “children with computer and video game addiction”. I’m a mother of a 12 year old and this is a real problem. I have a girlfriend with the same problem with her son. Our children have A.D.D. and this make the matter worse. Dr. Russell Barkley has talked about it, but in many cases selfhelp is all that is available to Mothers. Expensive therapies are not a reality.

  • http://pulse.yahoo.com/_W72ND2BPBHYYHYFPQIWJ4F6BXM Aneka

    Is Punyamurtula Kishore MD aka Mad Dog Millionaire going to Prison for Medical Insurance Fraud ?
    PUNYAMURTULA KISHORE MD AKA MAD DOG MILLIONAIRE IS A CROOK.
    A doctor whose drug treatment clinics on and off Cape have been closing on nearly a daily basis has been charged in Malden District Court today with accepting medical assistance bribes and kickbacks, a clerk said.The charge against Dr. Punyamurtula Kishore was brought by Attorney General Martha Coakley’s office, the clerk said. Kishore pleaded not guilty at his arraignment, but was held in lieu of $150,000 cash bail. If the doctor is able to make bail, he will be forced to surrender his passport and make weekly visits to the probation department, she said.Doctor’s alleged kickback scheme revealed Kishore has recently closed clinics in Sandwich, Wareham and, most recently, Vineyard Haven that are aimed at helping opiate addicts.

    The Wareham clinic closed last week and the Vineyard clinic closed Friday. A recording on the phone line directs patients to either seek help at the Martha’s Vineyard Hospital or by calling Kishore’s 800-number.Meanwhile, the remaining Cape clinics one in West Yarmouth and another in Falmouth, as well as a counseling center in Barnstable are closing, Dr. Wendel Price, the medical director of the West Yarmouth clinic, said.Yes , He is definetly going to prison , this man is a liar and a fraud . Many of his patients have relapsed and died . He billed medical Insurance companies for patients that he or his associates have never seen or examined , this also includes patients who have died . He paid kickback money to the owners of halfway houses and sober homes . There is also no National Library of Addictions except on paper .

    This FOOL thought he could get away with ripping off medicaid , medicare , masshealth and private insurance companies. This idiot will be convicted and sentence to state prison . After he is released if he survives in the Massachusetts state prison sysytem , he will be deported to India .Source(s):Former Employees of Preventive Medicine Associates formerly Addiction Medicine Associates

  • http://pulse.yahoo.com/_MH7ATSNYASMCJO3MWNJ4C4T2KY Olivia

    the American College of Addiction Medicine and the National Library of Addictions has never existed anywhere in Massachusetts or the United States . Punyamurtula Kishore aka MAD DOG Millionaire is a Fraud .According to the attorney general, Dr. Kishore paid $2,500 a month to the president of the Fresh Start Recovery Coalition, a Malden company that ran “sober houses” across the state. In return, the company’s president, Damion Smith, allegedly sent residents to Kishore for drug testing. The purported scheme involved $597,000 in claims billed to MassHealth, the state’s Medicaid program. The attorney general calls it fraud.
    Each drug screen cost $100 to 200. Carviello, who did the testing for Kishore, says the president of those halfway houses was “testing crazy — five or six times a week.”
    That was crazy, Carviello and her co-workers thought, because opiates remain in the body for three to four days. Even ordering three tests a week should have been too much.
    Kishore never received a state license from the Department of Public Health to run addiction treatment programs.
    “You’re not going to learn anything new on Tuesday that you didn’t know on Monday,” Carviello said, “unless they used that very night before. And if they did, there’s no sense testing on Wednesday because it’s still in your system.”
    Others, too, question the need for so many tests. Joanne Peterson runs Learn To Cope, a support group for families of drug addicts on the South Shore. She says she became suspicious the first time she heard Dr. Kishore pitching his treatment plans to parents.
    People would say … ‘What do we do? How do we afford it?’ ” Peterson said. “He was like, ‘Have them come see me, I can get anyone on MassHealth — anyone. Don’t worry about it.’ And I was like ‘Oh my God. Red flag.’ ”
    That was 2004.
    By June of this year, MassHealth began withholding reimbursements for Kishore’s chain of clinics — a criminal investigation had begun. At the Woburn office, supervisors told the staffers it was merely an audit when they asked for 500 charts and lab work. But when she got the list of the names her supervisors needed to provide the state, Carviello saw the light.
    “The top of the paper said ‘Subpoena,’ so, that wasn’t very bright,” Carviello said, laughing.
    The joke turned out to be on both the employees and the patients.
    Patients Without Clinics
    Starved of the state reimbursements, Kishore started closing clinics without notice over the summer. At those that remained open, he stopped paying his employees. When he was arrested last week, the last of his clinics shut down, as did the supply of the anti-addiction drug Vivitrol.
    So why, with a potential crisis on its hands and knowing Kishore’s clinics were collapsing, didn’t the state step in sooner to avert the coming crisis for addicts who were about to be cut off from treatment?
    That was the question posed Monday to the state secretary of Health and Human Services, Dr. JudyAnn Bigby.
    “I can’t comment because of the investigation of a fraud that’s going on and the other agencies that are involved in the investigation,” Bigby said.
    If Bigby was suggesting the attorney general’s office was tying her hands, a spokesman for the attorney general had another position.
    “We worked cooperatively with MassHealth,” the spokesman said, “to ensure they were aware of our investigation well in advance of last week’s legal action.”
    The state says it’s trying to find and coordinate alternative treatment for Kishore’s patients. And, WBUR has learned that Dr. Kishore never got a state license from the state Department of Public Health to run addiction treatment programs.
    Meanwhile, at Kishore’s businesses in Brookline Tuesday, eviction notices were posted on closed doors.
    His lawyer didn’t return phone calls requesting comment and at his home, no one answered. The dry cleaning sat out front in stenciled packaging that read “We love our customers.”

  • http://pulse.yahoo.com/_MH7ATSNYASMCJO3MWNJ4C4T2KY Olivia

    the American College of Addiction Medicine and the National Library of Addictions has never existed anywhere in Massachusetts or the United States . Punyamurtula Kishore aka MAD DOG Millionaire is a Fraud .According to the attorney general, Dr. Kishore paid $2,500 a month to the president of the Fresh Start Recovery Coalition, a Malden company that ran “sober houses” across the state. In return, the company’s president, Damion Smith, allegedly sent residents to Kishore for drug testing. The purported scheme involved $597,000 in claims billed to MassHealth, the state’s Medicaid program. The attorney general calls it fraud.
    Each drug screen cost $100 to 200. Carviello, who did the testing for Kishore, says the president of those halfway houses was “testing crazy — five or six times a week.”
    That was crazy, Carviello and her co-workers thought, because opiates remain in the body for three to four days. Even ordering three tests a week should have been too much.
    Kishore never received a state license from the Department of Public Health to run addiction treatment programs.
    “You’re not going to learn anything new on Tuesday that you didn’t know on Monday,” Carviello said, “unless they used that very night before. And if they did, there’s no sense testing on Wednesday because it’s still in your system.”
    Others, too, question the need for so many tests. Joanne Peterson runs Learn To Cope, a support group for families of drug addicts on the South Shore. She says she became suspicious the first time she heard Dr. Kishore pitching his treatment plans to parents.
    People would say … ‘What do we do? How do we afford it?’ ” Peterson said. “He was like, ‘Have them come see me, I can get anyone on MassHealth — anyone. Don’t worry about it.’ And I was like ‘Oh my God. Red flag.’ ”
    That was 2004.
    By June of this year, MassHealth began withholding reimbursements for Kishore’s chain of clinics — a criminal investigation had begun. At the Woburn office, supervisors told the staffers it was merely an audit when they asked for 500 charts and lab work. But when she got the list of the names her supervisors needed to provide the state, Carviello saw the light.
    “The top of the paper said ‘Subpoena,’ so, that wasn’t very bright,” Carviello said, laughing.
    The joke turned out to be on both the employees and the patients.
    Patients Without Clinics
    Starved of the state reimbursements, Kishore started closing clinics without notice over the summer. At those that remained open, he stopped paying his employees. When he was arrested last week, the last of his clinics shut down, as did the supply of the anti-addiction drug Vivitrol.
    So why, with a potential crisis on its hands and knowing Kishore’s clinics were collapsing, didn’t the state step in sooner to avert the coming crisis for addicts who were about to be cut off from treatment?
    That was the question posed Monday to the state secretary of Health and Human Services, Dr. JudyAnn Bigby.
    “I can’t comment because of the investigation of a fraud that’s going on and the other agencies that are involved in the investigation,” Bigby said.
    If Bigby was suggesting the attorney general’s office was tying her hands, a spokesman for the attorney general had another position.
    “We worked cooperatively with MassHealth,” the spokesman said, “to ensure they were aware of our investigation well in advance of last week’s legal action.”
    The state says it’s trying to find and coordinate alternative treatment for Kishore’s patients. And, WBUR has learned that Dr. Kishore never got a state license from the state Department of Public Health to run addiction treatment programs.
    Meanwhile, at Kishore’s businesses in Brookline Tuesday, eviction notices were posted on closed doors.
    His lawyer didn’t return phone calls requesting comment and at his home, no one answered. The dry cleaning sat out front in stenciled packaging that read “We love our customers.”

  • Olivia Sanchez

    Punyamurtula Kishore MD aka MAD Dog Millionaire is a fraud , The American College of Addiction Medicine and the National Library of Addiction has never existed except on paper. Punyamurtula Kishore has been indicted by 3 Grand Juries for Medical Insurance Fraud , bribery and giving out and receiving kickbacks.MAD DOG MILLIONAIRE aka PUNYAMURTULA KISHORE HAS BEEN INDICTED BY 3 DIFFERENT GRAND JURYS , SUFFOLK COUNTY, MIDDLESEX COUNTY AND BARNSTABLE COUNTY FOR MEDICAL INSURANCE FRAUD . CORRUPTION , LYING , CHEATING , and STEALING from Mass Health , Medicare , Medicaid and private insurance companies . Exploiting his emoloyees and patients. Billing insurance companies without examining or seeing the patients. 30 years of CORRUPTION , LIES, CHEATING AND STEALING is Punyamurtula Kishore MD aka Mad Dog Millionaire’s trademark . He was involved in Corruption when he was the Medical Director at the Massachusetts Dept. of Correction , Martha Eliot Health Ctr , Roxbury Comprehensive Health Ctr. and his possess Medical Practice , Preventive Medicine Associates.formerly Addiction Medicine Associates. He used two entities he created on paper that never existed called the National library of Addictions and the American College of Addiction Medicine to advocate his emergence in the field of addiction medicine. This unscrupulous MD used and exploited his patients and employees for financial wealth. The only thing that MAD DOG MILLIONAIRE aka Punyamurtula Kishore cared about was making money at the expense of someone elses misery.

    • http://twitter.com/constancek67 Constance Kilsurmart

      Punyamurtula Kishore MD aka Mad Dog Millionaire has been suspended effective immediately from several Boston and greater Boston Hospitals for sexual misconduct with male patients,check MA registry of Med. for order. On July 31, 2012 Mad Dog admitted himself to Mcleans Hospital in Belmont ,MA for sex addiction and erectile dysfunction. Upon discharge from Mcleans MAD DOG will be referred and admitted to a 45 day residential inpatient treatment program. Upon discharge from residential progrm , MAD DOG will be ordered by the court and his pretrial probation officer to attend SEX and Love Addictions Anonymous , one on one counseling pyschotherapy groups and comply with medication Tx plan.

  • Sanchez194741

    This Fool Punyamurtula Kishore MD aka MAD DOG was never licensed by Mass. Dept of Public Health to practice Addiction Medicine. Punyamurtula Kishore MD aka MAD Dog Millionaire is a fraud , Punyamurtula Kishore MD aka MAD Dog Millionaire is a fraud , The American College of Addiction Medicine and the National Library of Addiction has never existed except on paper. Punyamurtula Kishore has been indicted by 3 Grand Juries for Medical Insurance Fraud , bribery and giving out and receiving kickbacks.He was involved in Corruption when he was the Medical Director at the Massachusetts Dept. of Correction , Martha Eliot Health Ctr , Roxbury Comprehensive Health Ctr. and his possess Medical Practice , Preventive Medicine Associates.formerly Addiction Medicine Associates. He used two entities he created on paper that never existed called the National library of Addictions and the American College of Addiction Medicine to advocate his emergence in the field of addiction medicine. This unscrupulous MD used and exploited his patients and employees for financial wealth. The only thing that MAD DOG MILLIONAIRE aka Punyamurtula Kishore cared about was making money at the expense of someone elses misery.

    • http://twitter.com/constancek67 Constance Kilsurmart

      Punyamurtula Kishore Md aka Mad Dog Millionaire has been suspended from several
      Boston and greater Boston Hospitals for sexual misconduct with male patients
      Check Ma Medical reg. for order Punyamurtula Kishoreaka Mad Dog Millionaire has
      admitted himself to Mcleans hospital inBelmont Massachusetts for sex addiction
      and erectile dysfunction .
      Punyamurtula Kishore Md s license applicatoin to
      practice and intern as a Gynaecologist has been rejected by the Ma Board
      Registry of Medicine.

  • http://www.facebook.com/people/Aneka-Gbomene/100003126171042 Aneka Gbomene

    I was in a AA meeting once and the speaker mentioned Dr Kishore, and the entire room erupted into laughter. I saw him back in the late 90s and he was a quack then. He was FAR from free. He had been fined years ago because when you sat in his waiting room (an hour was considered quick) he’d bill the insurance co’s for that time. Then once you saw him he’d tell you what a great guy he was for working with addicts. Ive been clean for over 10 years now and those professionals who really helped me were ones that didnt need to continiously pat themselves on the back. Addicts are a nightmare to work with, and I commend all those that put up with it all to help those in need. But theres no way you’re ever going to convince me Kishore was one of those people. This Fool Punyamurtula Kishore MD aka MAD DOG was never licensed by Mass. Dept of Public Health to practice Addiction Medicine. Punyamurtula Kishore MD aka MAD Dog Millionaire is a fraud , The American College of Addiction Medicine and the National Library of Addiction has never existed except on paper. Punyamurtula Kishore has been indicted by 3 Grand Juries for Medical Insurance Fraud , bribery and giving out and receiving kickbacks. He was involved in Corruption when he was the Medical Director at the Massachusetts Dept. of Correction , Martha Eliot Health Ctr , Roxbury Comprehensive Health Ctr. and his possess Medical Practice , Preventive Medicine Associates.formerly Addiction Medicine Associates. He used two entities he created on paper that never existed called the National library of Addictions and the American College of Addiction Medicine to advocate his emergence in the field of addiction medicine. This unscrupulous MD used and exploited his patients and employees for financial wealth. The only thing that MAD DOG MILLIONAIRE aka Punyamurtula Kishore cared about was making money at the expense of someone elses misery

  • http://www.facebook.com/people/Aneka-Gbomene/100003126171042 Aneka Gbomene

    I was in a AA meeting once and the speaker mentioned Dr Kishore, and the entire
    room erupted into laughter. I saw him back in the late 90s and he was a quack
    then. He was FAR from free. He had been fined years ago because when you sat in
    his waiting room (an hour was considered quick) he’d bill the insurance co’s for
    that time. Then once you saw him he’d tell you what a great guy he was for
    working with addicts. Ive been clean for over 10 years now and those
    professionals who really helped me were ones that didnt need to continiously pat
    themselves on the back. Addicts are a nightmare to work with, and I commend all
    those that put up with it all to help those in need. But theres no way you’re
    ever going to convince me Kishore was one of those people.

    This Fool
    Punyamurtula Kishore MD aka MAD DOG was never licensed by Mass. Dept of Public
    Health to practice Addiction Medicine. Punyamurtula Kishore MD aka MAD Dog
    Millionaire is a fraud ,

    The American College of Addiction Medicine and
    the National Library of Addiction has never existed except on paper.
    Punyamurtula Kishore has been indicted by 3 Grand Juries for Medical Insurance
    Fraud , bribery and giving out and receiving kickbacks. He was involved in
    Corruption when he was the Medical Director at the Massachusetts Dept. of
    Correction , Martha Eliot Health Ctr , Roxbury Comprehensive Health Ctr. and his
    possess Medical Practice , Preventive Medicine Associates.formerly Addiction
    Medicine Associates. He used two entities he created on paper that never existed
    called the National library of Addictions and the American College of Addiction
    Medicine to advocate his emergence in the field of addiction medicine. This
    unscrupulous MD used and exploited his patients and employees for financial
    wealth. The only thing that MAD DOG MILLIONAIRE aka Punyamurtula Kishore cared
    about was making money at the expense

    • http://twitter.com/constancek67 Constance Kilsurmart

      Punyamurtula Kishore Md aka Mad Dog Millionaire has been suspended from several
      Boston and greater Boston Hospitals for sexual misconduct with male patients
      Check Ma Medical reg. for order Punyamurtula Kishoreaka Mad Dog Millionaire has
      admitted himself to Mcleans hospital inBelmont Massachusetts for sex addiction
      and erectile dysfunction .
      Punyamurtula Kishore Md s license applicatoin to
      practice and intern as a Gynaecologist has been rejected by the Ma Board
      Registry of Medicine.

  • http://pulse.yahoo.com/_W72ND2BPBHYYHYFPQIWJ4F6BXM Aneka

    MAD DOG Millionaire aka Punyamurtula Kishore MD 20 20 I was in a AA meeting once and the speaker mentioned Dr Kishore, and the entire room erupted into laughter. I saw him back in the late 90s and he was a quack then. He was FAR from free. He had been fined years ago because when you sat in his waiting room (an hour was considered quick) he’d bill the insurance co’s for that time. Then once you s…aw him he’d tell you what a great guy he was for working with addicts. Ive been clean for over 10 years now and those professionals who really helped me were ones that didnt need to continiously pat themselves on the back. Addicts are a nightmare to work with, and I commend all those that put up with it all to help those in need. But theres no way you’re ever going to convince me Kishore was one of those people. This Fool Punyamurtula Kishore MD aka MAD DOG was never licensed by Mass. Dept of Public Health to practice Addiction Medicine. Punyamurtula Kishore MD aka MAD Dog Millionaire is a fraud , The American College of Addiction Medicine and the National Library of Addiction has never existed except on paper. Punyamurtula Kishore has been indicted by 3 Grand Juries for Medical Insurance Fraud , bribery and giving out and receiving kickbacks. He was involved in Corruption when he was the Medical Director at the Massachusetts Dept. of Correction , Martha Eliot Health Ctr , Roxbury Comprehensive Health Ctr. and his possess Medical Practice , Preventive Medicine Associates.formerly Addiction Medicine Associates. He used two entities he created on paper that never existed called the National library of Addictions and the American College of Addiction Medicine to advocate his emergence in the field of addiction medicine. This unscrupulous MD used and exploited his patients and employees for financial wealth. The only thing that MAD DOG MILLIONAIRE aka Punyamurtula Kishore cared about was making money at the expense of someone elses misery

  • http://twitter.com/constancek67 Constance Kilsurmart

    Punyamurtula Kishore Md aka Mad Dog Millionaire has been suspended from several
    Boston and greater Boston Hospitals for sexual misconduct with male patients
    Check Ma Medical reg. for order Punyamurtula Kishoreaka Mad Dog Millionaire has
    admitted himself to Mcleans hospital inBelmont Massachusetts for sex addiction
    and erectile dysfunction .
    Punyamurtula Kishore Md s license applicatoin to
    practice and intern as a Gynaecologist has been rejected by the Ma Board
    Registry of Medicine.

  • http://twitter.com/constancek67 Constance Kilsurmart

    Punyamurtula Kishore MD aka Mad Dog Millionaire has been suspended effective immediately from several Boston and greater Boston Hospitals for sexual misconduct with male patients,check MA registry of Med. for order. On July 31, 2012 Mad Dog admitted himself to Mcleans Hospital in Belmont ,MA for sex addiction and erectile dysfunction. (his penis is hard all the time) Upon discharge from Mcleans MAD DOG will be referred and admitted to a 45 day residential inpatient treatment program. Upon discharge from residential progrm , MAD DOG will be ordered by the court and his pretrial probation officer to attend SEX and Love Addictions Anonymous , one on one counseling pyschotherapy groups and complete compliance with medication treatment plan. He must also register as a Level 1 sex offender.

  • http://twitter.com/constancek67 Constance Kilsurmart

    Punyamurtula Kishore MD aka Mad Dog Millionaire has been suspended effective immediately from several Boston and greater Boston Hospitals for sexual misconduct with male patients,check MA registry of Med. for order. On July 31, 2012 Mad Dog admitted himself to Mcleans Hospital in Belmont ,MA for sex addiction and erectile dysfunction. (his penis is hard all the time) Upon discharge from Mcleans MAD DOG will be referred and admitted to a 45 day residential inpatient treatment program. Upon discharge from residential progrm , MAD DOG will be ordered by the court and his pretrial probation officer to attend SEX and Love Addictions Anonymous , one on one counseling pyschotherapy groups and complete compliance with medication treatment plan. He must also register as a Level 1 sex offender.

  • http://twitter.com/constancek67 Constance Kilsurmart

    Punyamurtula Kishore MD aka Mad Dog Millionaire has been suspended effective immediately from several Boston and greater Boston Hospitals for sexual misconduct with male patients,check MA registry of Med. for order. On July 31, 2012 Mad Dog admitted himself to Mcleans Hospital in Belmont ,MA for sex addiction and erectile dysfunction.(HIS PENIS IS IS ALWAYS HARD) Upon discharge from Mcleans MAD DOG will be referred and admitted to a 45 day residential inpatient treatment program. Upon discharge from residential progrm , MAD DOG will be ordered by the court and his pretrial probation officer to attend SEX and Love Addictions Anonymous , 1 on 1 counseling, pyschotherapy groups and complete compliance with medication treatment plan. He must also register as a Level 1 sex offender

  • Pingback: Do Addicts Choose to be Addicts?

ONPOINT
TODAY
Aug 27, 2014
Russian President Vladimir Putin, left, shakes hands with Ukrainian President Petro Poroshenko, right, as Kazakh President Nursultan Nazarbayev, center, looks at them, prior to their talks after after posing for a photo in Minsk, Belarus, Tuesday, Aug. 26, 2014. (AP)

Vladimir Putin and Ukraine’s leader meet. We’ll look at Russia and the high voltage chess game over Ukraine. Plus, we look at potential US military strikes in Syria and Iraq.

Aug 27, 2014
The cast of the new ABC comedy, "Black-ish." (Courtesy ABC)

This week the Emmys celebrate the best in television. We’ll look at what’s ahead for the Fall TV season.

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Federal Reserve Chair Janet Yellen, right, speaks with Ady Barkan of the Center for Popular Democracy as she arrives for a dinner during the Jackson Hole Economic Policy Symposium at the Jackson Lake Lodge in Grand Teton National Park near Jackson, Wyo. Thursday, Aug. 21, 2014.  (AP)

Multi-millionaire Nick Hanauer says he and his fellow super-rich are killing the goose–the American middle class — that lays the golden eggs.

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