What Is Wrong with the Brains of Addicts?

Abstract

In his target article and recent interesting book about addiction and the brain, Marc Lewis claims that the prevalent medical view of addiction as a brain disease or a disorder, is mistaken. In this commentary we critically examine his arguments for this claim. We find these arguments to rest on some problematical and largely undefended assumptions about notions of disease, disorder and the demarcation between them and good health. Even if addiction does seem to differ from some typical brain diseases, we believe contrary to Lewis, that there are still good reasons to maintain its classification as a mental or behavioral disorder.

Introduction: Testing and Refining Marc Lewis’s Critique of the Brain Disease Model of Addiction

“…Satel and Lillienfeld [ 4 ] point out that before we can decide whether addiction is a brain disease, we must first decide whether it constitutes a disease in the first place. They note that there is very little consensus in psychiatry, and in other domains of medicine, about what constitutes a disease, and they doubt that this issue can be solved scientifically, as Lewis tries, by reinterpreting neuroscientific data (this objection is shared by Wakefield [ 5 ], as well as Henden & Gjelsvik [ 6 ]). Satel and Lillienfeld think that engaging in this classification debate is potentially fruitless and that the rational response is to develop an understanding of addiction that underscores the way a range of complex behaviours can be analysed in different dimensions ‘…ranging from molecular function and structure and brain physiology to psychology, psychosocial environment, and social and cultural relations.’ The issue of the status of addiction thus cannot avoid questions of normativity that feature in those domains.…”

“…Henden & Gjelsvik take a similar position [ 6 ]. Based on the idea of neuroplasticity, Lewis rejects the neuronormativity that underlines the BDMA.…”