IN 1942, doctors sitting on the Research Council on Problems of Alcohol found themselves powerless to resolve America’s confusions about alcoholism. The repeal of Prohibition laws had taken chronic drunkenness off the police blotter, but physicians were unable to claim it as their territory. Instead they were losing out to the temperance-minded clergy and other public scolds who had inspired the introduction of Prohibition…

Continue reading this review at New Scientist (Jul 27 2009)

by Gene M. Heyman

Harvard University Press

IN 1942, doctors sitting on the Research Council on Problems of Alcohol found themselves powerless to resolve America’s confusions about alcoholism. The repeal of Prohibition laws had taken chronic drunkenness off the police blotter, but physicians were unable to claim it as their territory. Instead they were losing out to the temperance-minded clergy and other public scolds who had inspired the introduction of Prohibition.

So the doctors turned to a higher power: Dwight Anderson, head of the National Association of Publicity Directors. Anderson’s diagnosis was simple. People, he wrote, wouldn’t entrust their drinking problems to the medical profession until doctors persuaded them that alcoholism was a disease. Establish in the public mind that “the alcoholic is a sick man who is exceptionally reactive to alcohol”, that he is “not responsible for his condition”, Anderson said, and “the ‘yes’ response [to doctors] becomes automatic, uncritical, and on the emotional level”.

Nearly 70 years later, researchers have yet to find a pathogen which proves that addiction is a chronic disease like diabetes or asthma. As Anderson predicted, advertising has trumped science; the “yes response” has become automatic.

Researchers have not yet found a pathogen which proves that addiction is a chronic disease
Now Harvard psychologist Gene Heyman is the latest in a line of critics to challenge the science behind the disease hypothesis. He objects particularly to the assumption that the neurological changes in addicts’ brains are causes, rather than symptoms, of addiction. Citing both addicts’ accounts and epidemiological studies he shows that addiction remits at nearly double the rate of any other psychiatric illness, and that many addicts give up their habits by age 30 without treatment simply because heavy drug use interferes with their lives. These findings and others, he writes, “suggest that addiction is not a chronic disorder, but a limited and… perhaps, a self-correcting disorder”.

While Heyman tacitly objects to Anderson’s goal of relieving addicts of responsibility, the book is nearly free of moralising, at least about individual conduct. Drawing from behavioural economics, Heyman shows how the failure to sacrifice short-term gains (getting high) for long-term gains (sobriety-aided productivity) is endemic to a consumer culture, and how important a person’s social context is to reining in the penchant for pleasure. This, he argues, explains the effectiveness of Alcoholics Anonymous: it re-socialises addicts, giving them a reason to make the harder choice. Heyman implies that social institutions, particularly those that can guide by example and incentive rather than by precept, are crucial to preventing and “treating” addiction.

Heyman may accept the Protestant work ethic uncritically, but his approach is refreshing, avoiding false dilemmas about free will and biological determinism. The book suffers, however, from its detached, graphs-and-charts approach. Even the first-person stories seem desiccated compared with what any doctor, friend or relative has heard from a struggling addict.

This is not only a problem of audience appeal – Heyman’s turgid style will lose most non-academic readers immediately – but of argument. Heyman assumes that rationality will carry the day. But as Anderson knew, when it comes to a problem like addiction, which, in a society founded on free will, is mysterious, frightening and even subversive, rhetoric is more persuasive than reason.

Gary Greenberg is a psychotherapist and the author of The Noble Lie (Wiley, 2008)—>