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Addiction Is Not a Brain Disease

[IMG] The idea that drugs and biology are to blame for addiction has done more harm than good. It’s also a theory that has been buoyed by...
By Emilita, Feb 25, 2017 | | |
  1. Emilita
    The idea that addiction is a brain disease is an appealing narrative: drugs hijack the brain’s natural pleasure-seeking system, leading to changes in the nervous system that present as tolerance, physical dependence, and cravings. It’s also a theory that has been buoyed by doctors, politicians, and media pundits alike, all of whom have claimed addiction is not a moral failing but a product of biology. But there’s one problem: It’s not true, a new paper in Nature Human Behavior argues.

    “Some people think that [the addiction-as-disease narrative] is more compassionate,” says Carl Hart, chair of the psychology department at Columbia University, who has spent decades studying how drugs affect the brain and behavior. Unfortunately, Hart writes, there’s not much to support the theory that addiction is a disease of the brain, and it has done more harm than good.

    The problem, as Hart explains, is that, if addiction arises from the effects of drugs on the brain, there are two paths to a solution: eliminate the drug from society (via restrictive policies and law enforcement) or look for a fix within the brain. But there are several problems with these approaches:

    1. Relying on law enforcement to remove drugs from communities has led to rampant discrimination. Viewing drug use as a chronic medical condition has not prevented drug use from being a criminal justice problem. Roughly 20 percent of the people in our nation’s prisons and jails were locked up for non-violent drug offenses. And black Americans are significantly more likely than whites to be incarcerated for drug offenses, despite equivalent or sometimes lower rates of drug use.

    2. The drugs themselves are probably not to blame. Indeed, drugs have the same neurochemical effects on the brain of every user, but only a small subset of people actually become addicted. And despite decades of research with increasingly powerful brain imaging technologies, there is still no scan that can discriminate between addicted and casual drug users, or make predictions about who will go on to abuse drugs. “To date,” Hart writes, “there has been no identified biological substrate to differentiate non-addicted persons from addicted individuals.”

    Rather than a disease, addiction is more likely a learned behavior. As Maia Szalavitz previously wrote in Pacific Standard:

    [A]ddiction isn’t simply a response to a drug or an experience — it is a learned pattern of behavior that involves the use of soothing or pleasant activities for a purpose like coping with stress. This is why simple exposure to a drug cannot cause addiction: The exposure must occur in a context where the person finds the experience pleasant and/or useful and must be deliberately repeated until the brain shifts its processing of the experience from deliberate and intentional to automatic and habitual.

    The theory of addiction as a brain disease ignores that context—the psychosocial factors that contribute to drug abuse: namely, a lack of opportunities for employment and education, poverty, and co-occurring psychiatric illnesses like depression, anxiety, or schizophrenia. There are plenty of reasons people abuse drugs, and thus prevention techniques need to be tailored. “Prevention may look different if you are targeting someone from rural Appalachia versus someone who is fairly well off and they are urban,” Hart says. Yet researchers continue to look for a one-size-fits-all cause or cure for addiction—perhaps because federal agencies and funding organizations are more likely to fund brain-related research than society-based solutions.

    “We need to make sure people have jobs, we need to make sure people have opportunities, we need to make sure that they don’t have other psychiatric illnesses,” Hart says. “It requires a commitment and that commitment is not as sexy as telling you that there’s something deep in your ventral forebrain that’s causing you to overindulge in drug use.”

    Original Source

    Written by: Kate Wheeling, Feb 18, 2017, Pacific standard

Recent User Reviews

  1. perro-salchicha614
    "Article needs link"
    3/5, 3 out of 5, reviewed Feb 25, 2017
    The article needs a link to the paper that's mentioned in the first paragraph.
    1. Emilita
      It wasn't provided in the original news article and l wanted to exactly replicate the way the story was displayed to open up a discussion (since they reference it but don't provide it).


  1. aemetha
    And yet, addiction is no more un-provable than the psychiatric illnesses also noted in the article in brain scans. We can see that changes occur in the brain in all of those instances, we don't fully understand the implications of them and that is why they are difficult to treat at this time. All psychiatric illnesses are affected by psychosocial issues, but that does not make them no longer diseases. There is a well established link between environmental causes and diseases, and the psychosocial environment while are human construct is still an environmental influence that can influence us through our interactions. Sometimes those interactions lead to mental disorders. Addiction and mental illness do co-occur with great frequency, but this article makes it seem as though you can only treat one or the other. That's not the case, and the recommended treatment is to treat both mental disorder and addiction both together as primary conditions in an integrated treatment plan. I don't understand why they think calling it a disease because it fits the model of a disease means a one size fits all response. No other mental disorder is treated with a one size fits all response in best practice. Patients are treated as individuals and treatments are tailored to their needs. Addiction cannot be called just a learned behaviour because it's observably much more difficult to break than other learned behaviours. You don't see many people still reflexively trying to suck their thumb after 20 years, but a former smoker reaches for their cigarettes constantly.
    1. GoGoDevilBunny
      Wouldn't there be more addicts if it was environmental. People who grew up and live in the same area would all be addicts. AAnd wouldnt there be more clusters of addicts in certain areas? I think addiction is mostly BC of genetics and upbringing
    2. GoGoDevilBunny
      I believe in treating dual diagnoses patients and I feel that the treatment plans are iindividualized. Addicts should do therapy and maybe 12 step programs but a lot also need psychiatric help BC of the comorbidity. And that's where itd be individualized. Each addict may need different medications. Also in all for iop programs for addicts and group and individual therapy. I posted that link to the university of Utah and the addiction studies, check out the mouse party its kind of cool lol.
    3. aemetha
      Sorry, environment means different things in different contexts. Most of the time when we read about the environment people are talking about the natural world, but it also means the immediate surroundings and conditions we live in, and that may include social and psychological influences, hence the term psychosocial environment.
  2. GoGoDevilBunny
    I'm going to disagree and im sure my addictions counselor would too, I believe it is hereditary however if one never takes the drug to begin with then theyre in the clear. Its when one with a family history of addiction takes a drug for the first time that it clicks on a switch an it becomes very difficult in time to control. Check out the university of Utah's genetic page. Everyday they learn more about different genes that correlate with addiction. I believe I remember my counselor saying there's a higher percent for one to have an addiction then there are a lot of diseases. Its complicated BC if you do have said gene or genes that doesn't mean you'll be an addict but there is a higher chance.
    1. GoGoDevilBunny
      Oh an its also possible for one to become an addict even if it doesn't run in their family. Neuroscientists don't fully understand addiction but they've done enough research to prove that it is a disease of the brain.
  3. Omphum
    Interesting read. I actually agree for the most part.

    I have my own theories about addiction and external environmental factors. I think it has more to do with learned behaviors during childhood, and alternatively, rebelling against learned behaviors during adolescence and young adulthood in an attempt to experience some form of adventure. Thousands of years ago we used to explore, discover things, and traverse the wild. Nowadays, especially in cities and suburbs, there is very little to explore--except our minds.

    For what it's worth, take my theory with a grain of salt. The tiniest particle you can imagine. It's likely that humankind knows virtually nothing about the nature of reality and/or it's inner workings, let alone how consciousness works. I'm just a creature on a space rock.
  4. gonzochef
    I want to believe that it is not a disease, because I am egotistical and want there to be a light at the end of the tunnel, and I have enough brain diseases already... I agree with Aemetha, however, about how social and environmental factors are not exclusive from disease. PTSD is a disease directly associated with exposure to certain stressful environments. And the idea that all addicts need or will profit from Intensive Out Patient therapy (IOP) is ridiculous. Similarly, not all addicts require medication to recover. Some addicts are normal people without environmentally caused diseases that just like to get high too much.
      perro-salchicha614 likes this.
    1. aemetha
      @gonzochef I addressed some of the points in this article more fully here: https://drugs-forum.com/ams/addiction-is-not-a-disease-a-rebuttal.27086/ but one of the things that has always bothered me about these articles is that they assert diseases are incurable. That's not the case, we cure diseases every day. I'm with you, I want, and believe that addiction is not incurable until I see proof otherwise, lots of people recover, so if it gets better how can it not be getting closer to cured? :)
      perro-salchicha614 likes this.
  5. xanderall143
    Very Insightful-
    I think every brain is different regardless of studies.
    All studies are very vague and not particular to one experience.
    I believe it is a mental condition. Not sure I would call it a disease though..
    This can be debated back and forth for days..
  6. xmascardfromroch
    Great article. The debate continues.

    I've always wondered why the boys I'd hang out with would never get addicted to heroin when they use (literally, some never touched it again, some could manage a few times a year) while I went full speed and haven dependent after one use to aid some ugly depression that erupted violently.

    I mean everybody knows drug laws have a history of relating to "the dangerous classes" that were -coincidentally- minorities in the United States at the time, so it's easy to see why the thing they were using became criminalized, but I'm not trying to sound like Noam Chomsky here. If you have eyes, you can see the massive disproportion that relates to drug crimes and race, going back to the late 1800s. It's beyond obvious, and is immensely sad to conclude that this is the reality of the USA's many upsetting blunders. I guess what is the bigger point is the underlining brain disease that make people feel they need to escape from reality. In that sense, drugs are a proxy to mental illness, if not one specifically themselves...
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