Strengths and Limitations of the Brain Disease Model of Addiction
Of all the theories of addiction that researchers have proposed, the biomedical model of addiction seems to get the most attention. This model says that addiction is a brain disease. Its defining feature is that a drug hijacks the brain, leaving the person no choice but to continue using the drug. Most followers of the brain disease model accept that a person’s psychology and environment play some role, but the real issue is the negative effect of the drug on the physical brain. Those who believe in the disease model believe that it provides the best chance we have to significantly advance our understanding, treatment, and prevention of addiction.
Many addiction experts question whether the model will help us. A common complaint is that focusing on brain chemicals ignores people’s motivations to use drugs. Some complain that the disease model is too mechanical, or too neat and tidy, to offer a sound explanation. Others point out that telling individuals with chronic drug problems that they are “powerless” over using has led to fewer people overcoming addiction on their own (e.g. reduced rates of spontaneous recovery).
In this blog, we examine a few key features of the brain disease model to discover its strengths and limitations.
Strengths of the Brain Disease Model
Supporters of the model argue that because addiction is really about drugs mucking up certain parts of the brain—and there may be genetic predisposition—then addiction cannot be a moral issue. In a very real sense, those suffering from addiction are not responsible for drug use. They see “compulsion” as the defining feature of addiction, meaning the drug user has lost voluntary control over drug use. The popular idea that addicts are irresponsible or sinful just doesn’t make sense. So, according to this model, we have to offer them health care, not a jail cell.
Stigmatizing addiction as a moral issue is not only scientifically wrong, but it also wastes a lot of tax dollars. Research has shown that stigma is a barrier to asking for help. For example, many experts believe that the addiction rate for women is at least as high as for men, but there is such a stigma attached to addiction that many women prefer to suffer alone rather than ask for help.
Finally, if it is a brain disease, then it is logical that insurance companies pay for treatment, just as they would for heart problems or schizophrenia. So, as we can see, the disease model does have some benefits.
Intoxication and Consciousness
Studies of the brain have made human consciousness a hot topic. We all know that human beings are conscious of themselves and the world. We are conscious that we will die. We are conscious that we like the colour red, but not yellow. We want certain things and want to avoid other things. We are conscious that society expects certain things from us. We are conscious of our pasts and that we have a future yet to be lived.
We all know we are conscious, but it’s extremely difficult to pin down what this consciousness is all about. Here’s the most difficult question: How do all those chemicals floating about in the brain give rise to our personal experiences of life? Experts call this “the hard problem” and it’s difficult to find two experts who agree on how this is achieved.
Consciousness is an important issue in drug use. Those suffering from addictions tell us that intoxication alters their experience of life. Some people look to alcohol intoxication to put them in a better mood. Those addicted to marijuana tell us that time slows down and jokes are much funnier. Those using hallucinogens often say they are more creative when solving problems or creating art. Ecstasy users tell us that they experience more positive connections with others. In other words, intoxication alters consciousness in a way that is attractive to the drug user.
A problem with the brain disease model is that it does not address this altered state of consciousness. Disciples dismiss consciousness as an important element in drug use. That seems rather odd because those with addictions tell us that the purpose of using drugs is to achieve an altered state.
Brain Disease or Plasticity?
The brain disease model argues that changes in the brain from drug use are pathological and indicative of a brain disease. But many brain scientists have rejected this idea, based on studies of how the brain changes with regular drug use.
These scientists point out that the brain has internal mechanisms that allow it to change according to what is happening to it. We call this neuroplasticity. In other words, the brain is plastic and it changes, grows new connections, loses others, and creates greater sensitivity and tolerance. Neuroplasticity is not, however, like brain cancer or stroke. It doesn’t cause massive brain cell death. Rather, neuroplasticity is what evolution gave us, presumably because it has some survival value.
Marc Lewis is among many of these brain scientists who see addiction in terms of neuroplasticity. Lewis has argued that “the disease model has outlived its usefulness” and that “treatment approaches based on the disease model are too often ineffective.”
This is not to say the disease model is invalid—only that many experts on the brain do not agree that the effect of drugs creates a disease.
Brain Disease Model Can’t Make Sense of Contrary Research
The brain disease model is far too limited to make sense of research that indicates addiction cannot be reduced to the effects of a drug on the brain.
A growing number of studies say that addiction is based on environment. We can pin the origins of this new way of thinking about addiction to 1958, when Dwight Heath published his study of a group of people in Bolivia who regularly drank a lot of alcohol (and it was potent, 180-proof) and yet had no alcoholism.
According to the brain disease model, the alcohol hijacks the brain leading to compulsive use. But if these Bolivians drank so much alcohol, why was there no alcoholism?
Similarly, if the brain disease model were accurate, it should not really be possible to use ecstasy, cocaine, crystal meth, heroin, or other drugs recreationally. Brain scientist Carl Hart tells us that this is what he learned in school. Drugs hijack the brain, rendering the drug user impotent to stop using. After Hart started researching drug use, however, he found plenty of evidence that people were not at the mercy of drugs. In fact, he pointed to research that indicated lots of people use “hard” drugs recreationally without becoming addicted.
A problems with reducing addiction solely to a brain disease is that there’s not much we can do to help those suffering from chronic drug use.
We can hope for more and better medications. The current ones are mainly for detoxifying safely and reducing drug cravings. But even our options for cravings are limited. For example, we have anti-craving medications for opiate users, but not for simulant users.
Non-drug interventions are very limited. There’s no point providing family therapy, if you believe that addiction is a brain disease. And what’s the point of therapy that provides insight? We’re pretty much left with some coping skills to try to prevent relapse.
If addiction is a brain disease, then the best outcome is abstinence, because the problem is the effect of the drug on the brain. Many medical doctors suggest patients attend a 12-step program, not because of all that spiritual stuff, but merely because it promotes abstinence.
These interventions may be useful, but they’re not sufficient. We know, for example, that many in recovery relapse with no substantial cravings. We also know that relapse prevention programs don’t work all that well.
The Problem of Compulsion
The brain disease model argues that addiction is a “compulsion” to use drugs. Compulsion means that people will use the drug even if they don’t want to and even if they derive no pleasure from it. Many believe that the act of using drugs may even be outside of conscious awareness.
But is drug use really about compulsion? Although the brain disease model is quite firm on this point, many addiction experts don’t buy the argument.
It’s interesting that philosophers who examine addiction dismiss compulsion on grounds of logic. The most obvious point they raise is that if compulsion were accurate, then how would anyone ever recover?
We’ve already pointed out that some brain scientists argue that the real issue of drugs in the brain is not a disease, but neuroplasticity, the idea that the brain adapts to drug use. According to these brain scientists, drug use is learned behavior, not a compulsion.
Another problem of arguing that addiction is compulsion is that scientists are basically forced to decide on what a “normal” brain is. A person using a drug for the first time does not use compulsively. But after a number of episodes, the drug “hijacks” the brain, and the person uses drugs compulsively. So what is this magical line that gets crossed in the brain between not being addicted and being addicted? Because the brain is so spectacularly complicated, a lot of experts believe that it is impossible to define this point.