In 1970, high-grade heroin and opium flooded Southeast Asia. Military physicians in Vietnam estimated that between 10 percent and 25 percent of enlisted Army men were addicted to narcotics. Deaths from overdosing soared. In May 1971, the crisis exploded on the front page of The New York Times: “G.I. Heroin Addiction Epidemic in Vietnam.” Spurred by fears that newly discharged veterans would ignite an outbreak of heroin use in American cities, President Richard Nixon commanded the military to begin drug testing. In June, the White House announced that no soldier would be allowed to board the plane home unless he passed a urine test. Those who failed could go to an Army-sponsored detoxification program before they were re-tested.
The plan worked. Most GIs stopped using narcotics as word of the new directive spread and the vast minority who were detained produced clean samples when given a second chance. More startlingly, only 12 percent of soldiers who were dependent on opiate narcotics in Vietnam became re-addicted to heroin at some point in the three years after their return to the states. “This surprising rate of recovery even when re-exposed to narcotic drugs,” said the epidemiologist who collected the data, “ran counter to the conventional wisdom that heroin is a drug which causes addicts to suffer intolerable craving that rapidly leads to re-addiction if re-exposed to the drug.”
The story of returning Vietnam veterans overturned the conventional wisdom of “once an addict, always an addict.” The data were hailed as “revolutionary” and “path-breaking." Alas, the lesson became a casualty of generational amnesia. “Once an addict, always an addict” has merely been replaced by a newer and more sleekly scientific version of the same concept, namely, “addiction is a chronic and relapsing brain disease.”
Now comes an important and provocative book called Addiction: A Disorder of Choice by the psychologist Gene Heyman, a research psychologist at McLean Hospital and a lecturer at Harvard. Heyman mounts a devastating assault on the brain-based model of addiction. Not that he views addiction as independent of the brain—no serious person could even entertain such a claim. What he rejects, however, is the notion that excessive drug or alcohol consumption is an irresistible act wholly beyond the user’s control, as the term “addiction,” commonly understood, implies. If anything, Heyman writes, “[a]ddiction … helps us understand voluntary behavior.” How so? “[B]ecause,” he explains, “it is not possible to understand addiction without understanding how we make choices.”
