The National Clearinghouse for Alcohol and Drug Information, an agency within the U.S. Department of Health and Human Services, is a prodigious producer of posters, all free for the asking. My favourite, dating from 1992, features "African-American kids doing a variety of fun and interesting activities." One plays a cello, another is taking pictures, while a third, dressed in white and resting a racquet on her shoulder, has taken up tennis. No matter what the activity, whether cerebral or simply athletic, all have found "better things to do than drugs."
- Addiction: A Disorder of Choice, by Gene M. Heyman, Harvard University Press, 200 pages, $32.50
The targets of this particular campaign were other "youth in low-income urban environments," and the message to them was as much an inspiration as it was a reproach: If the kids in the poster could stay off drugs by finding better ways to spend their time, so could kids looking at the poster.
This is, in many ways, the entire point of Gene Heyman's provocative and engaging new book. Addiction is a choice, one that competes with a myriad of other choices in our lives, and just as the road into it is about making the wrong choices, the road out of it is about making the right choices. Addicts are grasshoppers, always opting for the pleasure closest at hand, and the rest of us (by inference) are ants, opting for pleasures the rewards of which lie in the future. The difference is between short-term thinking and long-term thinking, or what experimental psychologists like Heyman call local choice and global choice.
I am simplifying what is a complex and internally logical argument, one in which the syllogisms lurk just below the surface of the text. What Heyman is offering, in effect, is a global theory of addiction, with elegant and seemingly irrefutable answers for all the great imponderables in the field: why people start abusing substances, why most of them stop by the age of 30 and why a smaller percentage end up relapsing.
This is a house with many rooms, but the edifice ultimately rests on just one pillar: how you define "choice." Heyman's basic point is that people are perfectly capable of making bad choices. We all know this on an intuitive level, but to say that addiction is a choice is to say that it is not a disease. And that is exactly what Heyman is saying. Addiction may not be an "optimal pattern of behaviour," but still less is it a disease. It is something altogether different: a voluntary disorder that in many instances is "self-correcting." As for the cravings addicts experience, "an urge is not an obligation."
Heyman bases his assertions on how people and animals make choices in experimental settings. And here the overwhelming favourite is the so-called local option, which is to say that we prefer a bird in the hand to two in the bush. Apply the same principle to intoxicating substances, and you have people choosing the immediate gratification a drug offers over the delayed but more sustainable gratifications other activities offer. Apply it to consumer spending, and you end up with shopping sprees and the ugly excesses of modern life: with McMansions and Hummers and 100 pairs of shoes.
For Heyman's theory to work, you must first accept that the pathways into and out of addiction are ultimately binary, that they can be reduced to a model that applies in all cases. I wonder. Lady Henry Somerset, the president of the British Women's Temperance Association and a great fan of John Stuart Mill, was famous for giving ambiguous answers to yes-or-no questions. Where most people's mottoes are upbeat and to the point, hers rested on a double negative: "We must never believe we cannot hold two inconsistent views." My guess is that addiction is one of those grey areas, which is to say that it may be a "choice" for some people and a "disease" for others.
The missing variable in this equation is the social one. It is all well and fine to say that people make choices, but do they always have them? Did the addicts on Vancouver's Downtown Eastside start with as many choices as William Burroughs or F. Scott Fitzgerald? Bill Wilson, the legendary co-founder of Alcoholics Anonymous, had a great deal going for him before he descended into alcoholism - looks, charisma, well-connected friends - and these same factors contributed, if only indirectly, to his recovery.
My point is a simple one: To tell people that they have "better things to do than drugs," society must first pony up for those things.
How you will react to this book depends very much on what you think about free will and personal responsibility. There is, however, one point on which all readers will agree: Heyman's challenge to the disease concept of addiction is both coherent and provocative. The result is a readable book that will have you thinking about the choices people make and the choices societies make for them.
Jessica Warner is a senior scientist at the Centre for Addiction and Mental Health and a faculty member of the Institute for the History and Philosophy of Science and Technology. Her most recent book is The Day George Bush Stopped Drinking: Why Abstinence Matters to the Religious Right.