The eighth installment of the Points Interview is a timely one, in light of guest blogger Eoin Cannon’s recent post discussing a classroom visit by Gene Heyman. Today, we are pleased to have Gene discussing his recent book, Addiction: A Disorder of Choice (Harvard University Press, 2009). Since it first appeared, the book’s provocative reconsideration of the nature of addiction and the disease paradigm has generated considerable interest (readers wanting to get a flavor of the varied responses are invited to examine this essay in The New Republic and this interesting exchange in Times Higher Education) in both academic and policy circles.
Describe your book in terms your mother (or the average mother-in-the-street) could understand.
While writing the book, I had several goals in mind as well as several audiences, including mothers. What I hoped the reader would come away with was an understanding of the nature of addiction–and an understanding of what addiction told us about ourselves, particularly how we make choices. I included key research findings so that readers could see for themselves how addicts behave and the nature of the support for the book’s conclusions. For example, although psychiatric texts, clinicians, researchers and the National Institute on Drug Abuse bulletins routinely refer to addiction as a “chronic relapsing disease,” the epidemiological chapter reveals that addiction is the psychiatric disorder with the highest remission rate. Most individuals who meet the official criteria for addiction are ex-addicts by age thirty. Every major, scientific epidemiological survey has obtained this result, yet it has gone unmentioned, even by experts. Thus, the book reveals “new” but well established research that is fundamental to the understanding addiction.
The last section of the book introduces an account of voluntary behavior that encompasses the key facts of addiction as well as general features of everyday choice. The analysis leads to several surprising results. First, the principles that govern everyday choices can produce a pattern of self-destructive choices, such as addiction. In other words, the analysis shows that you do not need to invoke compulsion or disease to get addiction. Second, the analysis predicts that we will typically over-consume any good that we prefer, regardless of its nature. Moralists and scolds from the Greeks to present day have been chastising their fellow citizens for being gluttonous and greedy. What, basic principles of choice reveal is that this problem is inherent to human nature; it is no accident that two of our “seven deadly sins” involve taking more than you need.
What do you think a bunch of drug and alcohol historians might find particularly interesting about your book?
I hope they find my approach as well as the historical events I focus on interesting. The emergence of opium smoking in China in the 17th century and the demographic characteristics of American drug users prior to the first national ban on recreational drug use in 1914 reveal features of addiction that cannot be observed in laboratory studies or even the clinic. Interestingly, when heroin was legal, it attracted a similar demographic as it does today: young, male, school dropouts. In contrast, laudanum drinking appealed to all sorts, including middle-aged matrons. The stories reveal the influence of pharmacology on history, as well as the influence of social forces on drug use.
Now that the hard part is over, what is the thing YOU find most interesting about your book?
For me the most interesting aspect of drug use is what it reveals about human nature. There appears to be a universal desire to alter our consciousness—escape from ourselves–and to make choices that we later regret yet then repeat. This is at the heart of addiction and also at the heart of imaginative literature.
Every research project leaves some stones unturned. What stone from Addiction: A Disorder of Choice are you most curious to see turned over soon?
One of the many stones I left buried is an exploration of the nature of intoxication. It is one of the primary motives behind drug use, yet little studied or understood.
BONUS QUESTION: Let’s give up on the idea that Ken Burns does a film based on the book. In an audiobook format, who should provide the voice for Addiction: A Disorder of Choice?
I think Sylvia Poggioli, NPR’s European correspondent, and Robin Williams, should trade off, doing alternate chapters. Poggioli has a gorgeous voice and unbeatable accent; Robin Williams has scores of funny voices that would liven up the statistics.