What We're Not Talking about When We Talk about Addiction

Abstract

The landscape of addiction is dominated by two rival models: a moral model and a model that characterizes addiction as a neurobiological disease of compulsion. Against both, I offer a scientifically and clinically informed alternative. Addiction is a highly heterogenous condition that is ill‐characterized as involving compulsive use. On the whole, drug consumption in addiction remains goal directed: people take drugs because drugs have tremendous value. This view has potential implications for the claim that addiction is, in all cases, a brain disease. But more importantly, it has implications for clinical and policy interventions. To help someone overcome addiction, you need to understand and address why they persist in using drugs despite negative consequences. If they are not compelled, then the explanation must advert to the value of drugs for them as an individual. What blocks us from acknowledging this reality is not science but fear: that it will ignite moralism about drugs and condemnation of drug users. The solution is not to cleave to the concept of compulsion but to fight moralism directly.

The etiologic, theory-based, ontogenetic hierarchical framework of alcohol use disorder: A translational systematic review of reviews.

“…Interestingly, despite its relevance, compulsion is not consistently included in modern conceptualizations of addiction (e.g., AARDoC/ANA). Compulsion has also been criticized by some authors (e.g., Pickard, 2020) as problematic in that it largely ignores evidence in support of the impact of environmental and context-specific contingencies on choice and research suggesting that the choice to use is actually voluntary and value-based and, therefore, not compulsive. However, given compulsion-related shifts in neurocircuitry are well-established in the literature, we advocate for its inclusion within the ETOH Framework at this point in time.…”

Cannabis und Coronavirus SARS-CoV-2 – Eine Online-Kurzbefragung während der Kontaktbeschränkungen in der frühen Phase der Pandemie

“…Es ist einerseits davon auszugehen, dass es in Einzelfällen zu (gegebenenfalls zeitverzögerten) cannabisassoziierten gesundheitlichen Auswirkungen kommen kann [11], sich aber andererseits auch deutlich gezeigt hat, dass hierfür aus therapeutischer Sicht externe Aspekte [12] berücksichtigt werden müssen, da die Konsumveränderungen hauptsächlich pandemiebedingt waren, ebenso wie sich ein in einigen Fällen starker positiver Wertbezug dem eigenen Konsum gegenüber gezeigt hatte [13]. Es ist mithin davon auszugehen, dass Konsumsteigerungen als Versuche der persönlichen Krisenbewältigung nicht pauschal negativ betrachtet werden können.…”

The necessary paradigm shift in the study of addiction: Inconsistencies and fallacies of the brain disease model of addiction

“…The key is to recognize that people use drugs because they derive great benefits from doing so (e.g., reduced discomfort, increased physical capabilities, coping with stress, role-taking, etc.) and that it is that short-term expected value that leads to choosing repeated use (Pickard, 2020). In other words, people do not take drugs because their brain malfunctions, but because it provides them with benefits that they do not know how to obtain otherwise, and only when the harms outweigh the benefits does the person decide to change behavior, as explained by the theory of behavioral economics (Vuchinich, & Heather, 2003).…”