Addiction: Current Criticism of the Brain Disease Paradigm

Abstract

To deepen understanding of efforts to consider addiction a “brain disease,” we review critical appraisals of the disease model in conjunction with responses from in-depth semistructured stakeholder interviews with (1) patients in treatment for addiction and (2) addiction scientists. Sixty-three patients (from five alcohol and/or nicotine treatment centers in the Midwest) and 20 addiction scientists (representing genetic, molecular, behavioral, and epidemiologic research) were asked to describe their understanding of addiction, including whether they considered addiction to be a disease. To examine the NIDA brain disease paradigm, our approach includes a review of current criticism from the literature, enhanced by the voices of key stakeholders. Many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma. We conclude that it is not necessary, and may be harmful, to frame addiction as a disease.

Scepticism and hope in a complex predicament: People with addictions deliberate about neuroscience

“…Critics argue that the BDMA reduces drug dependent persons' feelings of control, undermines their selfefficacy, promotes fatalism and leads policy-makers to neglect the role of social factors in the development and treatment of addiction (Dingel, Karkazis, & Koenig, 2011;Kalant, 2009;Levy, 2013;Midanik, 2004). M a n u s c r i p t 3 A growing literature has begun to examine the extent to which neuroscientific explanations of addiction have influenced the views of addiction held by the general public, addiction clinicians and neuroscientists, and addicted persons Dingel, et al, 2011;Hammer, Dingel, Ostergren, Nowakowski, & Koenig, 2012;Hammer, et al, 2013;Meurk, Hall, Morphett, Carter, & Lucke, 2013;Meurk, Partridge, et al, 2014;Netherland, 2011). Although there are some who express concerns about the negative consequences of the BDMA (Hammer, et al, 2013), others suggest that the predicted positive and negative social impacts of the BDMA have been overstated (Courtwright, 2010).…”

“…M a n u s c r i p t 3 A growing literature has begun to examine the extent to which neuroscientific explanations of addiction have influenced the views of addiction held by the general public, addiction clinicians and neuroscientists, and addicted persons Dingel, et al, 2011;Hammer, Dingel, Ostergren, Nowakowski, & Koenig, 2012;Hammer, et al, 2013;Meurk, Hall, Morphett, Carter, & Lucke, 2013;Meurk, Partridge, et al, 2014;Netherland, 2011). Although there are some who express concerns about the negative consequences of the BDMA (Hammer, et al, 2013), others suggest that the predicted positive and negative social impacts of the BDMA have been overstated (Courtwright, 2010). Although some aspects of brain-based explanations of addiction are accepted by most people (Meurk, Hall, Morphett, Carter, & Lucke, 2013), these ideas tend to be incorporated into older ideas about addiction, often in idiosyncratic ways.…”

The “Brain Disease” Concept in Addiction: A Cause for Ambivalence, Not Concern

“…(O'Connor & Joffe, 2013, p10) 7 Our research to date indicates that the public, addicted individuals, and neuroscientists accept complex views of addiction that acknowledge the role of environmental factors and individual motivation as much as neurobiology. Like that of Hammer et al (2013), our research suggests that neurobiological framings of addiction may potentially be useful to addicted individuals. However, further social research into public understandings of addiction is needed in order to unravel complexities in language and develop ways of framing work on the neurobiology of addiction that will improve public discourse and better integrate lay beliefs about the importance of willpower, motivation and individual choice in overcoming addiction.…”

“…While we agree with a number of their arguments, our own empirical research suggests that their concerns about the harms of the brain disease language are overstated. Hammer et al (2013) argue that neurobiological explanations of addiction may be helpful in reducing addicted persons' self-blame and reinforcing their responsibility for obtaining treatment. They are careful to distinguish between the value of a "biological" explanation of addiction and the use of the label of "disease".…”

Is addiction a disease or choice? Disease model on trial

“…What are the reasons to hold to disease model? -Those who favor the addiction-asdisease framework often believe that the objective, biological gaze debunks the moralized argument that addiction is a problem for weakwilled people (11); -They believe that a disease diagnosis diminishes moral judgment while reinforcing the imperative that the sick persons take responsibility for their condition and seek treatment; -Addiction-as-disease is an important factor in scientists' efforts to obtain funding and build research teams (12). Among the main critiques toward disease models are: -Pharmaceuticals are considered to be the prime target and most logical outcome of translational neurogenetic addiction research.…”