Is addiction a brain disease? It’s an interesting question. Researchers asked over 1,200 members of the public in Australia what their views were. Their paper, published in Drug & Alcohol Review, starts by laying out the challenges of finding consensus:
In the USA, directors of the National Institute on Drug Abuse have argued that addiction is a ‘chronic relapsing brain disease’ and that ‘attending to the brain’ should be a core part of dealing with addiction. However, the advantages of labelling addiction as a (brain) disease have been hotly contested by philosophers, sociologists, scientists and clinicians who have expressed concern about the social, cultural and political implications of a ‘brain disease’ model.
In the study, most of those responding thought that addiction was a disease, but fewer agreed that it was a brain disease. Women and older people were more likely to agree. A significantly higher percentage (67%) agreed that alcoholism was a disease compared to heroin addiction (53%). In the end, people were quite nuanced in their views, acknowledging biological components, but seeing other relevant factors in the mix. The authors looked at influences, including AA, and make the point that the brain disease model of addiction is more accepted in the US than it is elsewhere. They conclude:
The patterns of response suggest that members of the public acknowledge that the causes of addiction are multiple and complex and are ambivalent towards reductionist labels for addiction. Framing addiction as a syndrome may resonate more with the Australian public than disease concepts as it allows multiple causes of addiction to be acknowledged.
Advantages & Disadvantages
I was interested in a response to a tweet I made highlighting the Thomas McLellan article on stigma. The tweeter responded: ‘this article is [worryingly] also about asserting and promoting the “brain disease of addiction.” I ought to have asked what vexed the tweeter about this particular model – in other words, what harm does he think it causes? I guess disempowerment and dependence on services. ‘It’s not my fault; I can’t do anything about it.” But that attitude gets short shrift in most residential treatment settings and no doubt elsewhere. I took a look at some of these issues a couple of weeks ago.
If the disease model has disadvantages in some people’s minds it also has perceived benefits. Dirk Hansen points out in his blog on the subject that “the anti-disease model authors seem not to care that addicted individuals are often immensely helped by, and hugely grateful for, disease conceptions of their disorder… In fact, it often helps addicts establish a healthier internal mental climate, in which they can more reasonably contemplate treatment.”
Does it matter?
I think it does matter because of the implications. It certainly matters to a lot of recovering people. There must be common ground here and it seems to me that we can use the genetic and neurobiological science to our advantage regardless of which models of addiction we sign up to.
Is the debate even worth having? I think so. Bill white has a perspective on this and thinks any model of addiction makes a significant influence.
The debate over the disease concept of addiction is not a meaningless intellectual exercise. Any framework for understanding AOD problems will exert a profound influence on the lives of individuals, families, social institutions, and communities.
And this is evolving all the time:
No addiction model has ever fully replaced its competitors; radically different conceptualizations of AOD problems have always co-existed, and our citizenry has always been ambivalent about whichever model claimed temporary prominence.
And he leaves us with a challenge:
The future of the disease concept will hinge on the ability of the addiction field to redefine this concept in light of accumulated scientific research and accumulated clinical and recovery experience.
Meurk, C., Partridge, B., Carter, A., Hall, W., Morphett, K., & Lucke, J. (2014). Public attitudes in Australia towards the claim that addiction is a (brain) disease Drug and Alcohol Review, 33 (3), 272-279 DOI: 10.1111/dar.12115