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

Abstract

Please cite this article as: Meurk, C., Morphett, K., Carter, A., Weier, M., Lucke, J., and Hall, W.,Scepticism and hope in a complex predicament: people with addictions deliberate about neuroscience, International Journal of Drug Policy (2016), http://dx.doi.org/10. 1016/j.drugpo.2016.03.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. AbstractBackground According to the 'brain disease model of addiction', addiction is a chronic condition the symptoms of which reflect persistent changes in neural functioning produced by long-term drug use. Scholars have argued both for and against the validity and usefulness of this way of conceptualising addiction, which has been variously described as emancipatory and detrimental to addicted persons. In this paper we explore how people with addictions make sense of the brain disease concept and the extent to which they find it useful. Methods: We conducted 44 semi-structured interviews with persons in treatment for drug and alcohol addiction recruited through a variety of channels. Transcripts were analysed by combining a health identity approach with thematic analysis. Results: We describe participants' understandings of how they became addicted and what role, if any, neurobiological conceptions play in their explanations. Our findings highlight the hopeful and sceptical viewpoints of addicted individuals on the value of addiction neuroscience ideas and neurotechnologies. Conclusions: These viewpoints shed some light on the diverse and divergent ways that people with addictions make sense of neurobiological ideas and technologies. It also describes when, and how, neurobiological explanations and the 'brain disease' model can be helpful to addicted persons. Some of the limitations of the brain disease model become apparent in the complex ways in which neurobiological explanations and labels are incorporated into lay understandings. In order to be more useful to addicted persons, neurobiological explanations should be provided as part of a more complex explanation of addiction and the brain than the BDMA offers, and should not be given a 'disease' label.

Smokers’ Understandings of Addiction to Nicotine and Tobacco: A Systematic Review and Interpretive Synthesis of Quantitative and Qualitative Research

“…This suggests that a biomedical understanding of addiction to smoking, where nicotine induces neurochemical changes to the brain which make it very difficult to stop, does not dominate lay beliefs about addiction to cigarettes. These findings are consistent with previous research on how addicted individuals understand the biological basis of their addiction 15,[82][83][84] . While the physical aspects of addiction are often acknowledged, smokers' explanations of addiction are much broader, referring to the role of peers, routine, emotions, habits, inner strength or weakness, and contextual cues.…”

Beneficial and detrimental effects of genetic explanations for addiction

“…For example, these conceptual frameworks may engender genetic essentialism —the misguided view that DNA contains the biological, largely immutable “essence” of a disorder, inevitably consigning people with certain genes to the fate of developing a particular health problem (Dar-Nimrod & Heine, 2011; Haslam, 2011). Although the essentialist view that addiction results deterministically from genes may deflect individual blame by countering the notion that people with addictions are simply choosing freely to engage in problematic behaviors, it may also promote the notion that people with genetically caused disorders lack agency or control over their behavior, and are thus helpless against their symptoms (Dar-Nimrod, Zuckerman, & Duberstein, 2013; Kong, Dunn, & Parker, 2017; Meurk et al, 2016). …”

The biomedicalisation of smoking cessation: a mixed methods study of lay perspectives on nicotine addiction

“…These findings support other empirical research on public understandings of neuroscience which has found that neuroscience information is interpreted through the lens of alreadyexisting cultural worldviews and explanations of behaviour (Bröer & Heerings, 2012;Meurk et al, 2016;O'Connor & Joffe, 2013;Pickersgill et al, 2011). An issue deserving further research attention is the way that people conceptualise the link between their brain and behaviour.…”

“…More specifically, it is hypothesised that it will lead addicted individuals to see their addiction as a medical problem requiring medical treatment. An increasing number of studies have investigated stakeholder knowledge and attitudes towards neurobiological technologies and their implications for various facets of human existence, including adolescence (Choudhury, McKinney, & Merten, 2012), mental illness (Borgelt, Buchman, & Illes, 2011;Bröer & Heerings, 2012;Pescosolido et al, 2010) and addiction Meurk et al, 2016;Netherland, 2011).…”