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Instituto Daguerre | Profesorado de Ingles



Ihona Winiger





Ihona Winiger

Ihona Winiger


Drug addiction,
Is it a disease or is it
based on choice?

Ihona Winiger

According to JOIN TOGETHER STAFF, in the article Drug Abuse kills 200,000. People
each year: Drug addiction is a problem that has been increasing immensely among our
society today. Moreover, heroin, cocaine and other drugs1 continue to kill around 200,000
people a year, shattering families and bringing misery to thousands of other people, insecurity
and the spread of HIV.
I think that drug addiction can only hinder or restrain us from accomplishing goals or dreams
in life. People sometimes feel they are too bright, too powerful, too much in control to
become addictive. Addiction can trap anyone. It can lead to harming ones body, causing
problems in family structure, and contribute to delinquency in society. The sooner people
seek help for drug addiction problems, the more chances they have of gaining control of their
life once again. However, abstinence is the safest way to live a longer and healthier life. We
are greatly influenced by the people around us. There is direct and indirect pressure that
might influence a persons decision in using drugs. Direct pressure occurs when a person is
offered to try drugs. Indirect pressure occurs when a person is around people using drugs and
sees that there is nothing wrong with using drugs.

1 See annex /glossary


Ihona Winiger
I have been touched by this issue personally. Should be noted that this did not happen to me,
but it has happened to someone from my family, my brother.
He was sent to a drug and psychiatric rehabilitation clinic after he admitted smoking
cannabis and having hallucinations. His doctor told me that cannabis could be a possible
trigger for psychosis.

When I learnt that my brother was a drug addict, I thought that it was his entire fault. I could
not understand why doctors were saying that it was a disease.
Nowadays, he is better. He got married and he has got two children. He is working again and
I think that he is happy.
After visiting my brother at the clinic for a year and listening not only to my brothers
experiences but also his partners, I am sure that when drug use becomes more frequent, it is
considered drug abuse. Once an individuals drug abuse can no longer be controlled and they
are using the drug to get through everyday life it becomes an addiction. A person on drugs has
an altered way of thinking, behaving, and perceiving.
People often disagree with the idea of calling addiction a disease in the same way we call
conditions like diabetes a disease. The behaviour of addicts is frustrating, ugly, and even
criminal. How can driving drunk be a symptom of a disease?
In the laymans terms addicts make the choice to use drugs and that their inability to stop is
simply immature and irresponsible behaviour. Diabetics, for instance, do not have a choice
about whether or not to have a high blood sugar. These arguments make sense and are often
embraced for their intuitive appeal alone. Has this argument got a scientific explanation?

Ihona Winiger

Numerous studies have been done on the subject of drug addiction and its effect on the
human brain. Some researchers believe that drug addicts have no choice and cannot stop
without medical assistance while other researchers say that addiction is the conscious
decision of the person each and every time that they consume drugs. There are compelling
arguments for each side of this debate.
Gene Heyman, a lecturer on psychology at the Harvard Medical School and Extension School
instructor wrote a controversial book: Addiction: A Disorder of Choice. The book has
influenced how many psychologists perceive and treat addiction.
Heyman uses the same definition of addiction as the American Psychiatric Association: The
persistence of drug use despite aversive consequences. Heyman believes in the choice model
of addiction. He points out that some psychiatric disorders can be influenced by outsides,
such as concern over legal consequences and respect from children and parents. Other
disorders, like schizophrenia, cannot be influenced by opinions of others. The schizophrenic
may know that by hallucinating they will embarrass their children, but they will continue to
hallucinate. When looking at drug addicts, one of the main things that stopped addicts from
using was the concern over what their parents and children thought of them. There were costs
and benefits to their addiction.
Addiction: a Disorder of Choice makes the provocative argument that addiction is
voluntary rather than compulsory, that addicts respond to incentives just like most other
people, and that in fact most drug addicts stop using without the help of treatment.

Ihona Winiger
Heymans book argues that all choices including drug dependence are influenced by
preferences and goals. Addicts tend to quit when adult responsibilities weigh more heavily
and the costs of addiction (financial, marital and otherwise) become greater than the benefits.
Humans, in Heymans view, have an innate tendency to over-consume the things they like
best because of our great susceptibility to short-term rewards - even if those rewards happen
to be harmful in the long term.
Heyman, also, recounts studies in which cocaine abusers were given traditional addiction
counselling and also offered vouchers which they could trade in for modest rewards such as
movie tickets or sports equipment if they proved through urine tests that they were
abstaining from drug use. In the early stages of the study, 70% of those in the voucher
program remained abstinent, while only 20% stayed abstinent in the control group which
didnt receive the incentive of the vouchers. This demonstrates that substance use is not in
fact compulsive or involuntary, but that it is a matter of choice, because these addicts when
presented with a clear and immediately rewarding alternative to substance use and incentive
not to use, choose it. Furthermore, follow up studies showed that this led to long term
changes. A full year after the program, the voucher group had double the success rate of
those who received only counselling (80% to 40%, respectively). The cocaine abusers in the
voucher group practiced replacing substance use with other activities, such as using the sports
equipment or movie passes they gained as a direct consequence of abstaining from drug use,
thus they made it a habit to find other ways of amusing themselves, this probably led to brain
changes, and the new habits became the norm.
Addiction, Heyman notes, remains widely seen as a chronic, relapsing brain disease, yet
unlike most other supposed diseases you can be imprisoned for it (if youre caught with
illegal drugs). But medical treatment and punishment, the author says, do not exhaust the

Ihona Winiger
possible responses to human problems. Finding suitable alternatives is one reason it matters
whether or not addiction is in fact an illness.
In developing his argument, he points out that the best survey data available indicate that
most drug addicts quit their addiction, a fact inconsistent with a chronic-disease model. He
illustrates how basic, normal choice processes can lead to addiction, arguing that people do
not choose to be addicts, but that normal choice dynamics can lead them to that condition. He
points to a variety of factors that keep most from becoming addicted, with a focus on the role
of choice governed by choice-by-choice contingencies versus choice governed by the
outcome of sequences of choices, a difference in an under-described activity called framing.
Importantly, he reminds us that drug abuse is a behavioural or psychiatric disorder. He also
notes that drug abuse is the only psychiatric disorder that has two Federal research institutes
dedicated to it, namely the National Institute on Drug Abuse (NIDA) and the National
Institute on Alcoholism and Alcohol Abuse (NIAAA).
Heyman in order to explain why addiction is in fact voluntary points out that the American
Psychiatric Association and World Health Organization describe addiction as a form of
involuntary, compulsive drug use. The American National Institute of Drug Abuse describes
addiction as a chronic, relapsing disease. He tested these claims by asking whether addicts
typically remain long-term drug users, and what, if anything helps them to stop using drugs.
He also says that every national survey of psychiatric disorders has revealed that most addicts
were actually ex-addicts. The quit rate was about 75 percent. According to the age statistics,
most addicts had quit using drugs at clinically significant levels by about 30 to 35 years old.
The surveys also reveal that most addicts, typically over 70 percent, did not seek clinical
help. So, Heyman adds that they must have quit without professional assistance. In-depth

Ihona Winiger
interviews showed that quitting was preceded by such factors as the drug users concern
about finances, desire for respect from family, keeping or getting a job, and worries about
health. In other words, the usual factors that influence everyday decisions helped addicts quit
drugs. But, he also says that those same factors do not eliminate the symptoms of
schizophrenia or Alzheimers disease. Accordingly, he calls these disorders diseases. He
does not mean to say that someone chooses to be an addict. Rather, Heyman assure that they
choose to have just one more drink or quit tomorrow. He holds the idea that a long enough
series of one-more-times makes an addict. Addicts tend to quit when the hassles of
maintaining their habit become too great (sometimes called hitting bottom).
Also, Heyman says that if we recognize that addiction is voluntary then we have to conclude
that individuals are quite capable of voluntary self-destructive behaviour. This is hard to
understand and it raises questions about the wisdom of forms of government and economic
institutions that assume human rationality - that individuals make choices which favour their
best long-term interests. Addiction shows us that humans can act persistently against their
own interests. He adds that novelists and dramatists know this, but its an idea that doesnt
easily fit the modern scientific viewpoint.
Heyman agrees with the idea that addiction has a hereditary component. He says that we are
biological creatures, and even voluntary behaviour has biology, including a genetic
background. He says that the question is not whether addiction has a biological basis - it does
- but whether its biological basis prevents drug use from coming under the influence of costs
and benefits. As it turns out, incentives matter, he adds.
He strongly argues for the idea that all experience that changes behaviour does so by
changing the brain. The critical question is whether these changes are deleterious, and
whether they block the influence of the factors that support self-control. His hunch is that if

Ihona Winiger
drug-induced brain changes do not block the influence of costs and benefits on drug use, so,
for example internet-induced brain changes do not make turning off your computer
On the other hand, Dr. Nora D. Volkow, M.D.-Director of the National Institute on Drug
Abuse in the United States, maintains that Drug addiction is a brain disease that can be
treated. She points out that addiction is a disease that affects both brain and behaviour.
As opposed to doctor Heyman, Dr. Volkow claims that addiction is defined as a chronic,
relapsing brain disease that is characterized by compulsive drug seeking and use, despite
harmful consequences. It is considered a brain disease because drugs change the brainthey
change its structure and how it works. These brain changes can be long lasting, and can lead
to the harmful behaviours seen in people who abuse drugs.
Dr. Volkow holds the idea that addiction is similar to other diseases, such as heart disease.
Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful
consequences, are preventable, treatable, and if left untreated, can last a lifetime.2
At first, people may perceive what seem to be positive effects with drug use. They also may
believe that they can control their use; however, drugs can quickly take over their lives.
Dr. Volkow exemplifies the previous idea, Consider how a social drinker can become
intoxicated, put himself behind a wheel and quickly turn a pleasurable activity into a tragedy
for him and others. Over time, if drug use continues, pleasurable activities become less
pleasurable, and drug abuse becomes necessary for abusers to simply feel normal. Drug
abusers reach a point where they seek and take drugs, despite the tremendous problems

2 See annex 4

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caused for themselves and their loved ones. Some individuals may start to feel the need to
take higher or more frequent doses, even in the early stages of their drug use.
Dr. Volkow takes the view that the initial decision to take drugs is mostly voluntary.
However, when drug abuse takes over, a persons ability to exert self -control can become
seriously impaired. Brain imaging studies from drug-addicted individuals show physical
changes in areas of the brain that are critical to judgment, decision-making, learning and
memory, and behaviour control. Scientists believe that these changes alter the way the brain
works, and may help explain the compulsive and destructive behaviours of addiction.3
For this medical group opinion, as with any other disease, vulnerability to addiction differs
from person to person. In general, the more risk factors an individual has, the greater the
chance that taking drugs will lead to abuse and addiction. Protective factors reduce a
persons risk of developing addiction.

From Dr. Volkow point of view no single factor determines whether a person will become
addicted to drugs. The overall risk for addiction is impacted by the biological makeup of the
individual, it can even be influenced by gender or ethnicity, his or her developmental stage,
and the surrounding social environment (e.g., conditions at home, at school, and in the

Scientists estimate that genetic factors account for between 40 and 60 percent of a persons
vulnerability to addiction, including the effects of environment on gene expression and
function. Adolescents and individuals with mental disorders are at greater risk of drug abuse
and addiction than the general population.

3 See annex 5

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Dr Volkow defines drugs as chemicals. She says that drugs work in the brain by tapping into
the brains communication system and interfering with the way nerve cells normally send,
receive, and process information. Some drugs, such as marijuana and heroin, can activate
neurons because their chemical structure mimics that of a natural neurotransmitter. This
similarity in structure fools receptors and allows the drugs to lock onto and activate the
nerve cells. Although these drugs mimic brain chemicals, they dont activate nerve cells in
the same way as a natural neurotransmitter, and they lead to abnormal messages being
transmitted through the network.

Other drugs, such as amphetamine or cocaine, can cause the nerve cells to release abnormally
large amounts of natural neurotransmitters or prevent the normal recycling of these brain
chemicals. This disruption produces a greatly amplified message, ultimately disrupting
communication channels. The difference in effect can be described as the difference between
someone whispering into your ear and someone shouting into a microphone.

Dr. Volkow agrees with my brothers doctor when she says that drug abuse and mental
disorders often co-exist. In some cases, mental diseases may precede addiction; in other
cases, drug abuse may trigger or exacerbate mental disorders, particularly in individuals with
specific vulnerabilities.

According to Dr. Volkow Addiction need not be a life sentence. Like other chronic diseases,
addiction can be managed successfully. Treatment enables people to counteract addictions
powerful disruptive effects on brain and behaviour and regain control of their lives. Also, she
adds that behavioural treatments help engage people in drug abuse treatment, modifying their
attitudes and behaviours related to drug abuse and increasing their life skills to handle
stressful circumstances and environmental cues that may trigger intense craving for drugs and


Ihona Winiger
prompt another cycle of compulsive abuse. Moreover, behavioural therapies can enhance the
effectiveness of medications and help people remain in treatment longer.

Dr. Volkow also differs with Dr. Heyman when she claims that when some drugs of abuse are
taken, they can release 2 to 10 times the amount of dopamine that natural rewards do. In
some cases, this occurs almost immediately (as when drugs are smoked or injected), and the
effects can last much longer than those produced by natural rewards. The resulting effects on
the brains pleasure circuit dwarfs those produced by naturally rewarding behaviours such as
eating and sex. The effect of such a powerful reward strongly motivates people to take drugs
again and again. This is why scientists sometimes say that drug abuse is something we learn
to do very, very well.4

Numerous studies have been done on the subject of drug addiction and its effect on the
human brain. Some researchers, like Dr. Volkow, believe that drug addicts have no choice and
cannot stop without medical assistance while other researchers, like Hayman, say that
addiction is the conscious decision of the person each and every time that they consume
drugs. There are compelling arguments for each side of this debate, however, after reading
numerous scientific reports, watching videos, and talking with people who suffers from this
problem I have come to believe that drug addiction is at the beginning a conscious choice and
later on becomes a disease.
Haymans choice model sounds pretty rational, just a problem of behavioural economics,
we keep choosing what feels best. That also means that we can choose differently, providing
a gateway to recovery.

In my opinion what is wrong is that the choice model ignores

the brain. Moreover, I think that choices do not happen without a brain, it is the mechanism
of choice. The quality of a persons choices depends on the health of that mechanism.
However much we may wish that a persons choices were free in all instances, it is simply a
4 See annex 4

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fact that an addicted persons failures in the realm of choice are the product of a brain that has
become greatly compromised, it is readily apparent when we see the brain scan. Even if
taking a drug for the first time is a free choice, the progression of brain changes produce the
weakening of circuits in the prefrontal cortex and elsewhere which are necessary for exerting
self-control and resisting the temptations of drug use.
So I cannot

state that nobody chooses to be addicted or to be an addict is a choice

because it depends on each person. It depends on how ones brain is functioning. We have the
free choice to take them or not, but when we say yes to drugs we should think that we are
heading towards a problem. This choice can lead us to a disease.

1) Newspaper article:
Home / Join Together / Drug Abuse Kills 200,000 People Each Year: UN Report
Drug Abuse Kills 200,000 People Each Year: UN Report


Ihona Winiger
June 27th, 2012
Drug abuse kills about 200,000 people worldwide each year, according to a new United Nations (UN)
report. Global treatment for drug abuse would cost $250 billion per year if everyone who needed help
received proper care, according to the UN.

Fewer than one in five people who need treatment actually receive it, according to theAssociated
Press. Crimes committed by people who need money to finance their drug habit, as well as loss of
productivity, add tremendous costs for many countries, the report notes.
The UN estimates that about 230 million people, or 5 percent of the worlds population, used illegal
drugs at least once in 2010. In the United States, female drug use was two-thirds the male rate, while
in India and Indonesia, females constituted only one-tenth of those using illegal drugs.

The 2012 World Drug Report cited an increase in synthetic drug production worldwide, including
significant increases in the production and consumptions of psychoactive substances that are not
under international control. Overall, use of illegal drugs remained stable during the past five years, at
between 3.4 and 6.6 percent of the worlds adult population. Marijuana was the most widely used
Coca bush cultivation has decreased 33 percent over the past 12 years. Seizures of
methamphetamine more than doubled in 2010 compared with 2008. In Europe, seizures of Ecstasy
pills more than doubled.

Heroin, cocaine and other drugs continue to kill around 200,000 people a year, shattering families
and bringing misery to thousands of other people, insecurity and the spread of HIV, the Executive
Director of the UN Office on Drugs and Crime, Yury Fedotov, said in anews release. He added that
as developing countries emulate industrialized nations lifestyles, it is likely that drug consumption will

2) How addiction changes your brain

Is Addiction a Choice? Faculty Insight with Gene Heyman)


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Is addiction a choice? Faculty member Gene Heyman thinks so. Heyman discusses his controversial
book, "Addiction: A Disorder of Choice," with interviewer Jenny Attiyeh of ThoughtCast. Heyman is a
lecturer on psychology at Harvard Medical School and Harvard Extension School.

2) An

Interview with Nora D. Volkow, M.D.


Chapter 1 and 4


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Director of the National Institute on Drug Abuse, Dr. Nora Volkow addresses a wide range of issues in
this program such as: addiction as a brain disease; the stigma associated with addiction; the
adolescent addict; relapse; and the effectiveness of combining behavioural therapies with medication.
While Volkow argues that addiction is a chronic, relapsing disease of the brain, she also stresses the
brain's enormous capacity to recover with the right comprehensive treatments.

3) Addiction is similar to other

diseases, such as heart disease.

Source: From the laboratories of Drs. N. Volkow and H. Schelbert.

4) The brains of individuals who are addicted to drugs (or even food) differ dramatically
from those who are not addicted


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ADDICTION: /dk()n/


Ihona Winiger
The American Psychiatric Association: (CHOICE MODEL) The

persistence of drug use despite aversive consequences.

Disease model is defined as a chronic, relapsing brain disease that is

characterized by compulsive drug seeking and use, despite harmful consequences.

dictionary:a strong need that someone feels to regularly take an illegal or harmfuldrug
There is a growing problem of drug addiction in our cities.
-addiction to:

An addiction to nicotine

Nicotine is an addictive stimulant found in cigarettes and other forms of tobacco.

Tobacco smoke increases a users risk of cancer, emphysema, bronchial disorders, and
cardiovascular disease. The mortality rate associated with tobacco addiction is

Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca
plant native to South America. It produces short-term euphoria, energy, and
talkativeness in addition to potentially dangerous physical effects like raising heart rate
and blood pressure.

Alcohol consumption can damage the brain and most body organs. Areas of the brain
that are especially vulnerable to alcohol-related damage are the cerebral cortex (largely
responsible for our higher brain functions, including problem solving and decision
making), the hippocampus (important for memory and learning), and the cerebellum
(important for movement coordination).

Marijuana is the most commonly abused illicit substance. This drug impairs shortterm memory and learning, the ability to focus attention, and coordination. It also
increases heart rate, can harm the lungs, and can increase the risk of psychosis in those
with an underlying vulnerability.


Ihona Winiger

Amphetamines, including methamphetamine, are powerful stimulants that can

produce feelings of euphoria and alertness. Methamphetamines effects are particularly
long-lasting and harmful to the brain. Amphetamines can cause high body temperature
and can lead to serious heart problems and seizures.

Ecstasy (MDMA) produces both stimulant and mind-altering effects. It can increase
body temperature, heart rate, blood pressure, and heart wall stress. Ecstasy may also be
toxic to nerve cells.

Prescription medications are increasingly being abused or used for nonmedical

purposes. This practice cannot only be addictive, but in some cases also lethal.
Commonly abused classes of prescription drugs include painkillers, sedatives, and
stimulants. Among the most disturbing aspects of this emerging trend is its prevalence
among teenagers and young adults, and the common misperception that because these
medications are prescribed by physicians, they are safe even when used illicitly.

Heroin is an opioid drug that is synthesized from morphine, a naturally occurring

substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually
appears as a white or brown powder or as a black sticky substance, known as black
tar heroin.

Steroids, which can also be prescribed for certain medical conditions, are abused to
increase muscle mass and to improve athletic performance or physical appearance.
Serious consequences of abuse can include severe acne, heart disease, liver problems,
stroke, infectious diseases, depression, and suicide.

Voluntary: /vlnt()ri/a voluntary action is done because you choose to do it, and not
because you have to.
Compulsory: /kmplsri/ Adjective
Something that is compulsory must be done because of a rule or law.

Compulsive: /kmplsv/ Adjective

impossible to control and therefore sometimes harmful

A compulsive eating disorder.


Ihona Winiger
If something is compulsory, it is something that must be done because of
the law, or because someone orders you to do it.
That someone can be yourself. You can do something because you
yourself order to do it.
In contrast, we use compulsive to describe someone's behaviour. It means
that it is very hard for that person to stop doing something. For example,
someone may be a 'compulsive' eater, which means that he or she cannot
control their eating habits; they eat all the time, even when they are not
hungry. In general, we use compulsive with behaviour that we think is
negative, or which is the result of psychological problems. So, there are
'compulsive' eaters, 'compulsive' gamblers and 'compulsive' liars.
Aversion /v(r)()n/a strong feeling that you dislike someone or something

Readily /redli/ means easily. Some computer instructions cannot be readily understood.
Exert: /z(r)t/to use influence, authority, or power in order to affect or achievesomething.
The inadequate degree of control exerted by some parents over their children
Hassles : /hs()l/ a situation that causes problems for you or that annoys you very much.
Relapse: /rlps/ to become ill again after you had been getting better
Impaired:/mpe(r)d/ If

your body's ability to do something is impaired, you are not fully ableto do it
Disease: /dziz/
An abnormal condition of an organism which interrupts the normal bodily functions that
often leads to feeling of pain and weakness, and usually associated with symptoms and signs.
A pathologic condition in which the normal functioning of an organism or body is impaired
or disrupted resulting in extreme pain, dysfunction, distress, or death.

Ihona Winiger

1. Heyman G.M. Addiction: A disorder of choice. Cambridge, MA: Harvard University
Press; 2009.
2. Is Addiction a Choice? Faculty Insight with Gene Heyman
1. http://www.youtube.com/watch?v=jh0ZAUxuQSo#t=391
3. How addiction changes your brain
1. http://www.youtube.com/watch?v=5f1nmqiHIII

4. National Institute of drug abuse of the USA