Brain Change in Addiction as Learning, Not Disease

Summary and Analysis

An article by one of the leaders in addiction theory and practice, Marc Lewis, summarizing and comparing the learning model of addiction to the brain disease model of addiction.

Lewis has been at the forefront of debate concerning addiction and presents compelling arguments for a broader understanding of addiction.  

Excerpted from The New England Journal of Medicine

These aims and outcomes [connected with the Brain Disease Model of Addiction] are well intended, and they have been beneficial in some contexts, but the narrow focus of the disease model on the neurobiologic substrates of addiction has diverted attention (and research funding) from other models. Alternatives to the brain disease model often highlight the social and environmental factors that contribute to addiction, as well as the learning processes that translate these factors into negative outcomes. For example, it has been shown repeatedly that adverse experiences in childhood and adolescence in-crease the probability of later addiction. Also, exposure to physical, economic, or psychological trauma greatly increases susceptibility to addiction. Learning models propose that addiction, though obviously disadvantageous, is a natural, context-sensitive response to challenging environmental contingencies, not a dis-ease. Yet the brain disease model construes addictive learning in terms of pathologic brain changes triggered mainly by substance abuse. Learning models also favor individual solutions for overcoming addiction, facilitated by cognitive modifications and personal agency.