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.

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

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.

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?

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.

This guy is 100 percent correct.

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

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?

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?

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.

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.

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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…

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.

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.

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.

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.

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?

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”.

Heyman rocks!

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.

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.

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.

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.

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

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.

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.

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?

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.

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.

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?

“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.

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, 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.

“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!!

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.

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!

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.

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!

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.

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.

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

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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

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.”

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