Rethinking Addiction

Summary and Analysis

This article addresses the claim that science has demonstrated that addiction is a disease of the brain. It identifies the significant opposition that exists to that claim amongst "scientists, academics and professionals interested in addiction" and provides references to source material that lays out the opposition. 

The article cites numerous types of studies that underscore factors involved in addiction other than a putative brain disease. For example, it references a 2009 book by Gene Heyman and colleagues that examined large-scale longitudinal surveys and found that between 76 and 83 per cent of "respondents who had ever met DSM criteria for substance dependence" were in remission which "was achieved without benefit of treatment." 

That finding, the article notes, is incompatible "with the notion of a compulsive, chronic disease."

The article also identifies problems inherent in the brain disease model of addiction and its impact on further study and resolution of addiction problems. 

It was written by Nick Heather, Emeritus Professor of Alcohol and Other Drug Studies in the Department of Psychology at Northumbria University. 

Excerpted from The Psychologist

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This might come as a surprise to those who regard it as settled that addiction is ‘a chronic relapsing brain disease’, but this is not the unanimous view of scientists, academics and professionals interested in addiction. There is a dissatisfaction with the ‘official’ portrayal of addiction and a desire for a more realistic, genuinely scientific account of this ubiquitous human problem.

Two polarised views of addiction, and the seemingly endless dispute between them, go way back. The ‘moral’ view, emerging from pre-industrial times, is that what we would now call addictive behaviour represents a free choice, similar to all the other apparently autonomous choices people make every day and are fully responsible for. Although most clearly associated with a pre-scientific mode of thinking, the moral view of addiction also finds expression in the work of scientists, an influential example being the The Myth of Addiction by my friend John B. Davies (who died while this article was in press – see obituary). At the opposite extreme is the disease view, beginning in the early 19th century and culminating in its latest manifestation, the brain disease model of addiction. This conceptualises addictive behaviour as completely involuntary and against the will of the person: addicts do not ‘use’ because they choose to, but because they are compelled to. This characterisation of addiction is now so common among scientists and professionals that to challenge it seems heretical. But, as we shall see, there is a mountain of evidence against the view that addictive behaviour is compulsive in any straightforward sense.