In this paper, published in the American Journal of Public Health, the authors take issue with what they describe as an “effort to redefine addiction as a chronic, relapsing brain disease (CRBD).” Taking issue with a brain-centric view of addiction, they note that “brains are housed inside of people” and that since substance use is “biological, social, and political,” our concepts and approaches to substance use must address the same aspects of life. They argue that, “By overlooking the sociopolitical dynamics and inequalities bound up with substance use, the CRBD model can paradoxically further marginalize people who use drugs.”

The authors go on to suggest that “the CRBD model is not the only or best way to fight stigma and provide treatment,” providing examples of alternatives from other countries.

As an international network of historians and social scientists who study approaches to the management of drugs across time and place, we have noticed the effort to redefine addiction as a chronic, relapsing brain disease (CRBD). The CRBD model is promoted as a route to destigmatize addiction and to empower individuals to access treatment that works within that model’s terms.1 CRBD usefully recognizes that brain-based neural adaptations place individual brains in chronic states of readiness to relapse. But brains are housed inside of people. Substance use is biological, social, and political; our concepts and approaches to complex questions surrounding substance use must be, too.2,3 By overlooking the sociopolitical dynamics and inequalities bound up with substance use, the CRBD model can paradoxically further marginalize people who use drugs by positing them as neurobiologically incapable of agency or choice. We are concerned that the CRBD model paints drug users as individuals whose exclusion from social, economic, and political participation is justified by their biological flaws and damaged brains.