Instituto Daguerre | Profesorado de Ingles

LANGUAGE
PROJECT

IHONA WINIGER

Ihona Winiger

TABLE OF CONTENTS
HYPOTHESIS
.

INTRODUCTION

DEVELOPMENT

CONCLUSION

ANNEX

REFERENCES.

Ihona Winiger

Hypothesis

Drug addiction,
Is it a disease or is it
based on choice?

Ihona Winiger

INTRODUCTION
YOU NEVER KNOW HOW STRONG YOU ARE
UNTIL
BEING STRONG IS THE ONLY
CHOICE YOU HAVE.
According to JOIN TOGETHER STAFF, in the article Drug Abuse Kills 200,000 People
Each Year: Drug addiction is a problem that has been increasing immensely among our
society today. Moreover, heroin, cocaine and other drugs continue to kill around 200,000
people a year, shattering families and bringing misery to thousands of other people, insecurity
and the spread of HIV.

Drug addictions can only hinder or restrain us from accomplishing goals or dreams in life.
People sometimes feel they are too bright, too powerful, too much in control to become
addictive. Addiction can trap anyone. It can lead to harming ones body, causing problems in
family structure, and contribute to the delinquency in society. The sooner people seek help for
drug addiction problems, the more chances they have of gaining control of their life once
again. However, abstinence is the safest way to live a longer and healthier life. We are greatly
influenced by the people around us. There is direct and indirect pressure that might influence
a persons decision in using drugs. Direct pressure might be when a person is offered to try
drugs. Indirect pressure might be when a person is around people using drugs and sees that
there is nothing wrong with using drugs.
I have been touched by this issue personally. Should be noted that this did not happen to me,
but it has happened to someone from my family, my brother.
He was sent to a drug and psychiatric rehabilitation clinic after he admitted smoking
cannabis and having hallucinations. His doctor told me and my family that cannabis could
be a possible trigger for psychosis.

When I learnt that my brother was a drug addict, I thought that it was his entire fault. I could
not understand why doctors were saying that it was a disease.

Ihona Winiger
Nowadays, he is better. He is married and he has got two children. He is working again and I
think that he is happy.
After visiting my brother at the clinic for a year and listening not only my brothers
experiences but also his partners, I am sure that when drug use becomes more frequent, it is
considered drug abuse. Once an individuals drug abuse is can no longer be controlled, and
they are using the drug to get through everyday life, it becomes an addiction. A person on
drugs has an altered way of thinking, behaving, and perceiving.
People often disagree with the idea of calling addiction a disease in the same way we call
conditions like diabetes a disease. The behaviour of addicts is frustrating, ugly - even
criminal. How can driving drunk be a symptom of a disease?
In the laymans terms addicts make the choice to use drugs and that their inability to stop is
simply immature and irresponsible behaviour. Diabetics, for instance, do not have a choice
about whether or not to have a high blood sugar. These arguments make sense, and are often
embraced for their intuitive appeal alone.

DEVELOPMENT
Numerous studies have been done on the subject of drug addiction and its effect on the
human brain. Some researchers believe that drug addicts have no choice and cannot stop
without medical assistance while other researchers say that addiction is the conscious
decision of the person each and every time that they consume drugs. There are compelling
arguments for each side of this debate.
Gene Heyman, a lecturer on psychology at the Harvard Medical School and Extension School
instructor, wrote a controversial book, Addiction: A Disorder of Choice. The book has
influenced how many psychologists perceive and treat addiction.
Heyman uses the same definition of addiction as the American Psychiatric Association: The
persistence of drug use despite aversive consequences. Heyman believes in the choice model
of addiction. He points out that some psychiatric disorders can be influenced by outsides,
such as concern over legal consequences and respect from children and parents. Other
disorders, like schizophrenia, can't be influenced by opinions of others. The schizophrenic
may know that by hallucinating they will embarrass their children, but they will continue to
hallucinate. When looking at drug addicts, one of the main things that stopped addicts from
using was the concern over what their parents and children thought of them. There were costs
and benefits to their addiction.
Addiction: a Disorder of Choice makes the provocative argument that addiction is
voluntary rather than compulsory, that addicts respond to incentives just like most other
people, and that in fact most drug addicts stop using without the help of treatment.
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Ihona Winiger
Heymans book, which seems likely to generate controversy, argues that all choices,
including drug dependence, are influenced by preferences and goals. Addicts tend to quit
when adult responsibilities weigh more heavily, and the costs of addiction (financial, marital,
and otherwise) become greater than the benefits. Humans, in Heymans view, have an innate
tendency to over-consume the things they like best because of our great susceptibility to
short-term rewards - even if those rewards happen to be harmful in the long term.
Heyman in his book recounts studies in which cocaine abusers were given traditional
addiction counselling, and also offered vouchers which they could trade in for modest
rewards such as movie tickets or sports equipment if they proved through urine tests that
they were abstaining from drug use. In the early stages of the study, 70% of those in the
voucher program remained abstinent, while only 20% stayed abstinent in the control group
which didnt receive the incentive of the vouchers. This demonstrates that substance use is
not in fact compulsive or involuntary, but that it is a matter of choice, because these addicts
when presented with a clear and immediately rewarding alternative to substance use and
incentive not to use, chose it. Furthermore, follow up studies showed that this led to long
term changes. A full year after the program, the voucher group had double the success rate of
those who received only counselling (80% to 40%, respectively). The cocaine abusers in the
voucher group practiced replacing substance use with other activities, such as using the sports
equipment or movie passes they gained as a direct consequence of abstaining from drug use
thus they made it a habit to find other ways of amusing themselves, this probably led to brain
changes, and the new habits became the norm.
Addiction, Heyman notes, remains widely seen as a chronic, relapsing brain disease, yet
unlike most other supposed diseases you can be imprisoned for it (if youre caught with
illegal drugs). But medical treatment and punishment, the author says, do not exhaust the
possible responses to human problems. Finding suitable alternatives is one reason it matters
whether or not addiction is in fact an illness.
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. He
points to a variety of factors that keep most from becoming addicted, with a focus on the role
of choice governed by choice-by-choice contingencies versus choice governed by the
outcome of sequences of choices, a difference in an under-described activity called framing.
Importantly, he reminds us that drug abuse is a behavioural, 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).

Ihona Winiger
Heyman in order to explain why addiction is in fact voluntary points out that the American
Psychiatric Association and World Health Organization describe addiction as a form of
involuntary, compulsive drug use. The American National Institute of Drug Abuse describes
addiction as a chronic, relapsing disease. He tested these claims by asking whether addicts
typically remain long-term drug users, and what, if anything helps them to stop using drugs.
He also says that every national survey of psychiatric disorders has revealed that most addicts
were actually ex-addicts. The quit rate was about 75 percent. According to the age statistics,
most addicts had quit using drugs at clinically significant levels by about 30 to 35 years old.
The surveys also reveal that most addicts, typically over 70 percent, did not seek clinical
help. So, Heyman adds that they must have quit without professional assistance. In-depth
interviews showed that quitting was preceded by such factors as the drug users concern
about finances, desire for respect from family, keeping or getting a job, and worries about
health. In other words, the usual factors that influence everyday decisions helped addicts quit
drugs. But, he also says that those same factors do not eliminate the symptoms of
schizophrenia or Alzheimers disease. Accordingly, he calls these disorders diseases. He
does not mean to say that someone chooses to be an addict. Rather, Heyman assure that they
choose to have just one more drink or quit tomorrow. He holds the idea that a long enough
series of one-more-times makes an addict. Addicts tend to quit when the hassles of
maintaining their habit become too great (sometimes called hitting bottom).
Also, he says that if we recognize that addiction is voluntary then we have to conclude that
individuals are quite capable of voluntary self-destructive behaviour. This is hard to
understand, and it raises questions about the wisdom of forms of government and economic
institutions that assume human rationality - that individuals make choices which favour their
best long-term interests. Addiction tells us that humans can act persistently against their own
interests. Novelists and dramatists know this, but its an idea that doesnt easily fit the
modern scientific viewpoint.
Heyman agrees with the idea that addiction has a hereditary component. He says that we are
biological creatures, and even voluntary behaviour has biology, including a genetic
background. He says that the question is not whether addiction has a biological basis - it does
- but whether its biological basis prevents drug use from coming under the influence of costs
and benefits. As it turns out, incentives matter, he adds.
He strongly argues for the idea that all experience that changes behaviour does so by
changing the brain. The critical question is whether these changes are deleterious, and
whether they block the influence of the factors that support self-control. His hunch is that if
drug-induced brain changes do not block the influence of costs and benefits on drug use, so,
for example internet-induced brain changes do not make turning off your computer
impossible.

Ihona Winiger
On the other hand, Dr. Nora D. Volkow, M.D.-Director of the National Institute on Drug
Abuse, maintains that Drug addiction is a brain disease that can be treated. She points out
that addiction is a disease that affects both brain and behaviour.
As opposed to doctor Heyman, Dr. Volkow claims that addiction is defined as a chronic,
relapsing brain disease that is characterized by compulsive drug seeking and use, despite
harmful consequences. It is considered a brain disease because drugs change the brainthey
change its structure and how it works. These brain changes can be long lasting, and can lead
to the harmful behaviours seen in people who abuse drugs.
Dr. Volkow holds the idea that addiction is similar to other diseases, such as heart disease.
Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful
consequences, are preventable, treatable, and if left untreated, can last a lifetime.
See annex no puedo copier la imagen

At first, people may perceive what seem to be positive effects with drug use. They also may
believe that they can control their use; however, drugs can quickly take over their lives.
Dr. Volkow exemplifies the previous idea, Consider how a social drinker can become
intoxicated, put himself behind a wheel and quickly turn a pleasurable activity into a tragedy
for him and others. Over time, if drug use continues, pleasurable activities become less
pleasurable, and drug abuse becomes necessary for abusers to simply feel normal. Drug
abusers reach a point where they seek and take drugs, despite the tremendous problems
caused for themselves and their loved ones. Some individuals may start to feel the need to
take higher or more frequent doses, even in the early stages of their drug use.
Dr. Volkow takes the view that the initial decision to take drugs is mostly voluntary.
However, when drug abuse takes over, a persons ability to exert self -control can become
seriously impaired. Brain imaging studies from drug-addicted individuals show physical
changes in areas of the brain that are critical to judgment, decision-making, learning and
memory, and behaviour control. Scientists believe that these changes alter the way the brain
works, and may help explain the compulsive and destructive behaviours of addiction.
For this medical group opinion, as with any other disease, vulnerability to addiction differs
from person to person. In general, the more risk factors an individual has, the greater the
chance that taking drugs will lead to abuse and addiction. Protective factors reduce a
persons risk of developing addiction.
From Dr. Volkow point of view no single factor determines whether a person will become
addicted to drugs. The overall risk for addiction is impacted by the biological makeup of the
individual, it can even be influenced by gender or ethnicity, his or her developmental stage,
and the surrounding social environment (e.g., conditions at home, at school, and in the
neighbourhood).
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Ihona Winiger
Scientists estimate that genetic factors account for between 40 and 60 percent of a persons
vulnerability to addiction, including the effects of environment on gene expression and
function. Adolescents and individuals with mental disorders are at greater risk of drug abuse
and addiction than the general population.
Drugs are chemicals. They work in the brain by tapping into the brains communication
system and interfering with the way nerve cells normally send, receive, and process
information. Some drugs, such as marijuana and heroin, can activate neurons because their
chemical structure mimics that of a natural neurotransmitter. This similarity in structure
fools receptors and allows the drugs to lock onto and activate the nerve cells. Although
these drugs mimic brain chemicals, they dont activate nerve cells in the same way as a
natural neurotransmitter, and they lead to abnormal messages being transmitted through the
network.
Other drugs, such as amphetamine or cocaine, can cause the nerve cells to release abnormally
large amounts of natural neurotransmitters or prevent the normal recycling of these brain
chemicals. This disruption produces a greatly amplified message, ultimately disrupting
communication channels. The difference in effect can be described as the difference between
someone whispering into your ear and someone shouting into a microphone.
Dr. Volkow agrees with my brothers doctor when she says that drug abuse and mental
disorders often co-exist. In some cases, mental diseases may precede addiction; in other
cases, drug abuse may trigger or exacerbate mental disorders, particularly in individuals with
specific vulnerabilities.
According to Dr. Volkow Addiction need not be a life sentence. Like other chronic diseases,
addiction can be managed successfully. Treatment enables people to counteract addictions
powerful disruptive effects on brain and behaviour and regain control of their lives. Also, she
adds that behavioural treatments help engage people in drug abuse treatment, modifying their
attitudes and behaviours related to drug abuse and increasing their life skills to handle
stressful circumstances and environmental cues that may trigger intense craving for drugs
and prompt another cycle of compulsive abuse. Moreover, behavioural therapies can enhance
the effectiveness of medications and help people remain in treatment longer.
Dr. Volkow also differs with Dr. Heyman when she claims that when some drugs of
abuse are taken, they can release 2 to 10 times the amount of dopamine that natural
rewards do. In some cases, this occurs almost immediately (as when drugs are smoked
or injected), and the effects can last much longer than those produced by natural
rewards. The resulting effects on the brains pleasure circuit dwarfs those produced by
naturally rewarding behaviors such as eating and sex. The effect of such a powerful
reward strongly motivates people to take drugs again and again. This is why scientists
sometimes say that drug abuse is something we learn to do very, very well.

Ihona Winiger
See annex

Numerous studies have been done on the subject of drug addiction and its effect on the
human brain. Some researchers believe that drug addicts have no choice and cannot
stop without medical assistance while other researchers say that addiction is the
conscious decision of the person each and every time that they consume drugs. There
are compelling arguments for each side of this debate, however, after reading numerous
reports for each side I have come to believe that drug addiction is a conscious choice
and the addict uses this as an excuse to society instead of taking the responsibility for
their actions upon themselves where it belongs.

Looking at it from a scientific point of view, the discovery is extremely important.

ANNEX
How addiction changes your brain

Is Addiction a Choice? Faculty Insight with Gene Heyman)

http://www.youtube.com/watch?v=jh0ZAUxuQSo#t=391

Ihona Winiger

Is addiction a choice? Faculty member Gene Heyman thinks so. Heyman discusses his controversial
book, "Addiction: A Disorder of Choice," with interviewer Jenny Attiyeh of ThoughtCast. Heyman is a
lecturer on psychology at Harvard Medical School and Harvard Extension School.

An

Interview with Nora D. Volkow, M.D.

http://www.hbo.com/addiction/thefilm/supplemental/624_nora_volkow.html
Director of the National Institute on Drug Abuse, Dr. Nora Volkow addresses a wide range of issues in
this program such as: addiction as a brain disease; the stigma associated with addiction; the

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Ihona Winiger
adolescent addict; relapse; and the effectiveness of combining behavioural therapies with medication.
While Volkow argues that addiction is a chronic, relapsing disease of the brain, she also stresses the
brain's enormous capacity to recover with the right comprehensive treatments.

Source: From the laboratories of Drs. N. Volkow and H. Schelbert.

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Ihona Winiger

Nicotine is an addictive stimulant found in cigarettes and other forms of tobacco. Tobacco smoke
increases a users risk of cancer, emphysema, bronchial disorders, and cardiovascular disease. The
mortality rate associated with tobacco addiction is staggering. Tobacco use killed approximately 100
million people during the 20th century and, if current smoking trends continue, the cumulative death
toll for this century has been projected to reach 1 billion.

Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca
plant native to South America. It produces short-term euphoria, energy, and
talkativeness in addition to potentially dangerous physical effects like raising heart
rate and blood pressure.
Alcohol consumption can damage the brain and most body organs. Areas of the brain that are
especially vulnerable to alcohol-related damage are the cerebral cortex (largely responsible for our
higher brain functions, including problemsolving and decisionmaking), the hippocampus (important for
memory and learning), and the cerebellum (important for movement coordination).

Marijuana is the most commonly abused illicit substance. This drug impairs short-term memory
and learning, the ability to focus attention, and coordination. It also increases heart rate, can harm the
lungs, and can increase the risk of psychosis in those with an underlying vulnerability.

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Ihona Winiger
Amphetamines, including methamphetamine, are powerful stimulants that can produce feelings of
euphoria and alertness. Methamphetamines effects are particularly long-lasting and harmful to the
brain. Amphetamines can cause high body temperature and can lead to serious heart problems and
seizures.

Ecstasy (MDMA) produces both stimulant and mind-altering effects. It can increase body
temperature, heart rate, blood pressure, and heart wall stress. Ecstasy may also be toxic to nerve
cells.

Prescription medications are increasingly being abused or used for nonmedical purposes. This
practice cannot only be addictive, but in some cases also lethal. Commonly abused classes of
prescription drugs include painkillers, sedatives, and stimulants. Among the most disturbing aspects
of this emerging trend is its prevalence among teenagers and young adults, and the common
misperception that because these medications are prescribed by physicians, they are safe even when
used illicitly.

Heroin is an opioid drug that is synthesized from morphine, a naturally occurring

substance extracted from the seed pod of the Asian opium poppy plant. Heroin
usually appears as a white or brown powder or as a black sticky substance, known
as black tar heroin.
Steroids, which can also be prescribed for certain medical conditions, are abused to increase muscle
mass and to improve athletic performance or physical appearance. Serious consequences of abuse
can include severe acne, heart disease, liver problems, stroke, infectious diseases, depression, and
suicide.

REFERENCES
1. Heyman G.M. Addiction: A disorder of choice. Cambridge, MA: Harvard University
Press; 2009.
2. Is Addiction a Choice? Faculty Insight with Gene Heyman
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Ihona Winiger
1. http://www.youtube.com/watch?v=jh0ZAUxuQSo#t=391
3. How addiction changes your brain
1. http://www.youtube.com/watch?v=5f1nmqiHIII

4. National Institute of drug abuse of the USA

http://www.drugabuse.gov/

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