Excerpted from The Psychologist
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.