Calling it “Brain Disease” Makes Addiction Harder to Treat


From The Boston Globe: Conceptualizing addiction as a biological brain disease is often ineffective, as the biological model overlooks the important psychological and social factors that shape individuals’ choices to use substances or enter into treatment.

“No matter how wealthy they might be, people discover that opioids are an excellent short-term balm for existential maladies like self-loathing, emptiness, erosion of purpose, and isolation. Years of heavy use condition people to desire drugs at the first stab of distress. After so much time spent damaging themselves, their families, and their futures, a new layer of anguish has formed over the original bedrock of misery, urging onward the cycle of misery-and-relief. Surely, people don’t chose to be addicts, but that is not what they are choosing: what they want is relief.

That people use drugs for reasons — a notion the brain disease model can’t accommodate — helps explain why people are so ambivalent about giving up opioids, why they drop out of treatment at high rates, and why many don’t even take advantage of treatment when it is offered. The link between psychic pain and addiction explains why some people are more vulnerable to abusing opioid prescriptions than others, contrary to the popular trope that we are all at risk.”

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    • Actually, that would not be sufficient to diagnose a brain disease. It would diagnose a brain INJURY, but the “disease model” suggests that addicts are somehow different from “normal” people and that their addiction is a result of these biological differences. So in order to demonstrate a “brain disease,” they’d have to show that “normal” people can somehow be distinguished from “potential addicts” BEFORE exposure to the drugs, and that “normal” people do not develop the same brain injuries upon use. My guess is that most anyone using these drugs would accumulate the same incremental brain damage, and that addicts and non-addicts are not distinguishable before this damage occurs. I would surmise that the main difference between addicts and non-addicts is that the addicts gain something from the drug use that seems important to them, whether physiological, psychological or social, and that non-addicts are not seeking that same kind of relief or experience.

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  1. This reminds me of my neighbor recently who stood in front of me holding a cigarette in one hand and a beer in the other defiantly declaring how “all the scientists and all the psychiatrists know that addiction is a disease”. I just thought, whatever relieves the cognitive dissonance you have about your bad habits and gets you through the day lady, more power to ya. I don’t see the point in arguing with addicts that they have the power to change their behavior. It’s a pointless folly.

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