Literature

This is the respond of my professor:

(My grade on these Assignment was 0)

Crucero, A literature review is a thematic synthesis of the literature. As such, for this assignment, the narrative themes for synthesis needed to follow the grading criteria (rubric):

IT problem analysis, trends, prior research, future research, contention in the literature, and gaps associated with your research interest.

Further, Tunitin reported a similarity score of 91%, suggesting that virtually all work submitted is non-original and taken from other sources without revision and/or citation, which is plagiarsm. This practice must be avoided (review Walden's academic integrity policy). No credit earned. Suggest resubmission for partial credit. Dr. Lonny

Week 3 Assignment 1: Application; Synthesizing Literature

Review of Gene Heyman’s Addition Disorder of choice

A disorder of choice, Gene Heyman surveys historical, anthropological, survey, clinical, and laboratory-based to build an argument about the role of basic choice processes in the phenomena that comprise drug addiction. 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. A disorder of choice Gene Heyman makes a case for drug addiction to be a result of natural processes involving voluntary behavior, specifically choice.

Main Body

Over the course of seven chapters Heyman makes his case by describing the history of drug abuse and addiction, societal responses to it, case histories from addicts, the epidemiology of drug addiction, “rational” and “irrational” choice, brain–behavior relationships, and approaches to treatment of drug addiction. These descriptions provide the bases for the focal points made, which are that normal, apparently rational choice processes can lead to poor long-term outcomes and that an understanding of such processes offers a viable approach to the prevention and treatment of drug addiction. In this review, I endeavor to describe briefly and evaluate some of the key points made by Heyman about how normal choice processes play a role in drug addiction and to highlight his arguments countering the “addiction is a brain disease” view. The first of the seven chapters provides an overview of the history of drug use and abuse, as well as information about its current prevalence. Although alcohol abuse has been documented from time to time for centuries, abuse of other drugs is a relatively recent phenomenon. Heyman notes that the first “epidemic”in the United States occurred in the late19 century, before legal prohibitions were established. Interestingly, incidence rates from that period, before legal sanctions, were similar to current ones. However, abuse also extended to those of lower socioeconomic status, largely in the form of opium smoking in “opium dens.” Heyman makes the case that public concern raised by drug abuse among the lower classes set the wheels in motion for governmental responses.

As Heyman outlines, the current costs of drug abuse are enormous, including costs of enforcement and lost productivity, as well as incarceration, which has increased 10-fold since 1980. Importantly, he reminds us that drug abuse is a behavioral, 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). Without explicitly noting the irony, he points out that since the official adoption of the viewpoint that drug abuse is a disease, and the expenditure of very large sums of research money by NIDA and NIAAA, prevalence rates of drug use and dependence have either increased or remained.

Chapter 2 presents epidemiological findings about the development and characteristics of drug addiction. First, data are presented confirming the now well-known fact that drug use usually does not advance to drug abuse. For most drugs of abuse only about 2–3% move from occasional use to drug dependence. Heyman notes appropriately, however, that 3% yields a very large absolute number of individuals.

In Chapter 3, Heyman summarizes a few case histories as reported by current and former drug addicts. Although these accounts are highly anecdotal in character and therefore suspect with respect to generality, Heyman makes use of them later in his arguments about the usual courses of drug abuse. There is no clear way to determine in what sense any of the cases is typical, but they at least serve one useful function. Therefore, these cases lay some introductory groundwork about whether drug addicts can quit, a focal topic of Chapter 4, which carries the title, “Once and addict, always an addict?”

The opening parts of Chapter 4 serve to document the prevalence of the current received view that drug addiction is for life, and Heyman summarizes research supporting that contention, noting that relapse from treatment for abuse of any drug generally occurs with a high frequency. Commonly, relapse rates may exceed 50% within 6 months of completion of initially successful treatment (McClellan, McKay, Forman, Cacciola, & Kemp, 2005). Here Heyman's argument picks up momentum. Heyman addresses the issue of whether those entering treatment are somehow different from those who do not, and finds support that, in fact, they are different. Heyman concludes Chapter 4 by offering a hypothesis about why most, not otherwise psychiatrically disabled, drug addicts eventually cease their addiction. His view is based to a considerable extent on the case histories presented in Chapter 3, and it is that, “…whether addicts keep using drugs or quit depends to a great extent on their alternatives.” (p.84). That is, the change from abuse to recovery is based on choice alternatives. That, of course, begs the question of how choice can lead to the problem in the first place if choice is, in fact, the avenue to recovery. That question is addressed in Chapters 6 and 7.

In Chapter 5, Heyman addresses the disease model more fully by examining the arguments and data supportive of that perspective. First, those in support of drug abuse as a disease point to the demonstrated role of genetic factors in addiction. Heyman acknowledges genetic contributions, but points out that genetic influence is not a sound basis for concluding that drug abuse is a disease process. He notes, for example, that there is a genetic association for religious choice between identical twins reared apart (Waller, Kojetin, Bouchard, Lykken, & Tellegen, 1990 From these results, the common conclusion is: “That addiction is tied to changes in brain structure and function is what makes it, fundamentally, a disease.” (Leshner, 1997, p. 45) Heyman also summarizes sound empirical evidence indicating that reports of craving and actual drug taking may be uncorrelated. He thereby sets up the case for Chapter 6, which is the lynchpin of the book.

In Chapter 6 Heyman argues for the possibility that normal choice processes are at the root of drug abuse. He argues that choice always involves the selection of the better current option, and that under certain circumstances drugs have advantages over other outcomes in that they provide immediate pleasure, their negative effects are delayed, they are not particularly subject to satiation, and they can undermine the value of other options. Specifically, there is no clear explanation of exactly what framing is and how it comes to be. Heyman notes that, “…global choice requires both reflection and forethought….” (p. 158). Heyman's view strongly encourages a basic research program especially directed toward how to generate global rather than local framing of choices—in my view, a major contribution of this book. Having made a case for drug abuse as operant choice gone awry, Heyman's last chapter focuses on treatment and prevention of drug abuse. He begins with another attack on one of the mainstays of the disease model, specifically the overly simplistic idea that dopamine activity in the brain provides an adequate explanation of drug abuse.

In this chapter Heyman also examines factors related to the incidence of drug abuse and finds several that support his view that drug abuse results from normal choice processes. In an additional salvo against the disease model, Heyman notes that marriage is not protective with respect to several other psychiatric maladies including schizophrenia, depression, and obsessive-compulsive disorder, among others (Robins & Regier, 1991.

Conclusion

To sum up, Heyman's book is provocative in two major ways. First, it develops a very compelling case that drug abuse should not be considered a disease. The several lines of evidence he presents accumulate and complement each other, building a virtually overwhelming argument in favor of his contention. Certainly, at the very least, research-funding and treatment agencies should not be “putting all their eggs” in the disease basket.

Second, Heyman presents a reasonable suggestion that drug abuse can be considered as illustrating choice patterns that are appropriate in the short term, appropriate in the sense that they are predictable from what is known about choice.

References

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