Young Economics.

Rational Choice and Addiction

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Here is an interesting interview with psychologist Gene Heyman, who argues that drug addiction is a matter of choice and not of illness.  His reading of the epidemiological literature on addiction suggests that there is a lot of economics underlying the issue.

I began looking at the epidemiological data. . . .  A huge percentage of people who had at some point met the criteria for lifetime substance dependence no longer did so by the time they were in their 30s. It varied from 60 to 80 per cent.

. . .

It’s this problem we have with the idea that individuals can voluntarily do themselves harm. It just doesn’t make sense to us. Why wouldn’t you stop?

. . .

60 to 70 per cent of the time, [addicts who end up in rehab clinics and get studied] have additional psychiatric disorders. And those disorders interfere with their capacity to engage in activities that would compete with the drugs—jobs, family, other activities. So the people the clinicians see, and the people the researchers study, are those who keep using drugs and don’t stop right into their 40s. That’s maybe 15 to 20 per cent of [addicts], and they have greatly skewed our picture of the natural history of addiction.

. . .

[W]hen people are choosing the drug, they’re thinking that moment, or that particular day, would be better if they did. A chronic smoker will think that the next three minutes would be better with a cigarette than without. But after a year of smoking 20 cigarettes per day, adding up to 60 minutes each day, you might think, ‘I’d rather have the 60 minutes of not smoking each day.’ Unfortunately, you don’t choose 60 minutes at a time. You decide one cigarette—or three minutes—at a time, and that’s what makes this so difficult.

If Heyman is right, the choice to use drugs is the same as any other choice in a rational choice framework; it depends on the benefits and costs, including opportunity cost, now and in the discounted future.  Is a high intertemporal discount rate a psychological illness?

Note that Heyman’s point is not that addicts are weak and pathetic people.  The point is simply that addiction does not seem to exist outside of the usual framework of cost-benefit decision-making.

At the heart of the notion of behavioural disease is the idea of compulsivity, by which people mean it’s beyond the influence of reward, punishment, expectations, cultural values, personal values. Alan Leshner [the former head of the National Institute on Drug Abuse] says drug use starts off as voluntary and becomes involuntary. But the epidemiological evidence suggests otherwise.

. . .

That you’re making these choices one day at a time. What you’re choosing is to take heroin that day. You’re not choosing to have a miserable life. Eventually, you become stuck, though, where you don’t know what else to do but choose heroin each day, even though you wish it didn’t lead to a miserable life. You know, I’ve always thought it strange that people would think we should not have sympathy for those kinds of situations.


Written by Alex

May 26, 2009 at 4:08 pm

Posted in Uncategorized

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