Addiction: Why is it a disorder of choice and decision?

The financial and social costs of addiction are staggeringly high; countless clinical reports and memoirs document the personal pain and chaos caused by addicted family members. In response, many addiction professionals and much of the public conclude that addiction is a disease. No one, the argument goes, would cause so much harm to themselves and others voluntarily. Yet research tells a different story. Clinical, historical, and biographical evidence reveals that economic conditions, legal sanctions, and the opinions of others, particularly family members and loved ones, influence the course of drug use in addicts. In contrast these same factors have little influence on the symptoms of the diseases addiction is said to be like, such as Alzheimer's, heart disease, and cancer. In support of these points, NIH epidemiological research shows that addiction has the highest remission rate of any psychiatric disorder, that most of those addicted to illegal drugs quit by age 30, and they typically quit without professional assistance. Of course, not all addicts quit by age 30, and dependence on legal drugs has a longer time course. However, analysis reveals that these are not qualitatively different outcomes, so that the choice framework fits both legal and illegal drugs and those who quit and those who don't quit. Nevertheless addiction is a disorder, which implies that its cost outweigh its benefits, which, in turn, appears to contradict choice accounts. However, research-based choice principles, such as hyperbolic discounting and melioration, predict semi-stable choice sequences that are optimal in the short run but suboptimal in the long run. That is, choice theory predicts a pattern of drug binging, remission, relapse, and eventual resolution. These finding do not make addiction any less of a problem, but they point to the most effective way to deal with addiction. The immediate implication is to reward abstinence and penalize drug use. Although this is a simplistic formula, it has been put to effective use in a wide range of settings.