Addiction: An Emergent Consequence of Elementary Choice Principles

ABSTRACT

Clinicians, researchers and the informed public have come to view addiction as a brain disease. However, in nature even extreme events often reflect normal processes, for instance the principles of plate tectonics explain earthquakes as well as the gradual changes in the face of the earth. In the same way, excessive drug use is predicted by general principles of choice. One of the implications of this result is that drugs do not turn addicts into compulsive drug users; they retain the capacity to say ‘no’. In support of the logical implications of the choice theory approach to addiction, research reveals that most addicts quit using drugs by about age 30, that most quit without professional help, that the correlates of quitting are the correlates of decision making, and, according to the most recent epidemiological evidence, the probability of quitting remains constant over time and independent of the onset of dependence. This last result implies that, after an initial period of heavy drug use, remission is independent of any further exposure to drugs. In short, there is much empirical support for the claim that addiction emerges as a function of the rules of everyday choice.

Notes

¹For example, Mukherjee, Emperor of All Maladies.

²For example, Kalivas and O'Brien, ‘Drug Addiction’; Spanagel and Heilig, ‘Addiction and its Brain Science’.

³Agency and Addiction Conference, University of Oslo, November 10–11, 2011.

⁴O'Brien and McLellan, ‘Myths’; McLellan et al., ‘Drug Dependence’.

⁵For example, Anthony and Helzer, ‘Syndromes of Drug Abuse’; Stinson et al., ‘Comorbidity’.

⁶For example, Ainslie and Monterosso, ‘Hyperbolic Discounting’; Becker and Murphy, ‘Theory of Rational Addiction’.

⁷Herrnstein and Prelec, ‘Theory of Addiction’.

⁸American Psychiatric Association, Diagnostic and Statistical Manual.

⁹For examples, see Heyman, Addiction.

¹⁰In both graphs, the curves representing the value of the drug reflect the idea that the costs of drug use increase according to the frequency of use raised to a power of 2.0, whereas the benefits increase linearly as a function of use: V = −AX² + BX + C, where X is the number of drug choice in the last 10 opportunities. The constants were then adjusted so that the function would approximate 0.0 when 10 of the last 10 decisions were to use the drug.

¹¹Herrnstein et al., ‘Utility Maximization and Melioration’; Vaughan, ‘Melioration, Matching, and Maximization’.

¹²For example, Davison and McCarthy, Matching Law; Herrnstein, ‘On the Law of Effect’, Matching Law; Williams, ‘Reinforcement, Choice’.

¹³For example, Heyman and Tanz, ‘How to Teach a Pigeon’; Kudadjie-Gyamfi and Rachlin, ‘Temporal Patterning’.

¹⁴Heyman, Addiction.

¹⁵Ibid.

¹⁶For example, McLellan et al., ‘Drug Dependence’; O'Brien and McLellan, ‘Myths’.

¹⁷For example, Goldstein et al., ‘Neurocircuitry of Impaired Insight’; Leshner, ‘Addiction is a Brain Disease’.

¹⁸For example, Kalivas, ‘Glutamate Homeostasis Hypothesis’.

¹⁹For example, McLellan et al., ‘Drug Dependence’; O'Brien and McLellan, ‘Myths’.

²⁰For example, Quenqua, ‘Rethinking Addiction's Roots’.

²¹For example, Heyman, ‘Quitting Drugs’.

²²For example, Anthony and Helzer, ‘Syndromes of Drug Abuse’; Conway et al., ‘Lifetime Comorbidity’; Kessler et al., ‘Lifetime Prevalence’, ‘Prevalence, Severity, and Comorbidity’; Stinson et al., ‘Comorbidity’; Warner et al., ‘Prevalence and Correlates’.

²³For example, Heyman, Addiction, ‘Quitting Drugs’.

²⁴For example, Anthony and Helzer, ‘Syndromes of Drug Abuse’; Stinson et al., ‘Comorbidity’.

²⁵For example, Biernacki, Pathways from Heroin Addiction; Waldorf, ‘Natural Recovery’; Waldorf, Reinarman, and Murphy, Cocaine Changes.

²⁶Robinson et al., ‘Cocaine Self-Administration’.

²⁷Ibid., 264.

²⁸Lenoir et al., ‘Intense Sweetness’.

²⁹For example, Robinson and Berridge, ‘Addiction’; Hyman, Malenka, and Nestler, ‘Neural Mechanisms of Addiction’.

³⁰Lenoir et al., ‘Intense Sweetness’.

³¹Heyman, ‘Preference for Saccharin’.

³²For example, Robinson and Berridge, ‘Addiction’.

³³Lopez-Quintero et al., ‘Probability and Predictors’.

³⁴Heyman, ‘Quitting Drugs’; Lopez-Quintero et al., ‘Probability and Predictors’.

³⁵Grant and Dawson, ‘National Epidemiological Survey on Alcohol’.

³⁶Heyman, ‘Quitting Drugs’.

³⁷Carlos Blanco kindly made the data available, and versions of this graph without the fitted equations are in Lopez-Quintero et al., ‘Probability and Predictors’.