Evaluating the Brain Disease Model of Addiction

This ground-breaking book advances the fundamental debate about the nature of addiction. As well as presenting the case for seeing addiction as a brain disease, it brings together all the most cogent and penetrating critiques of the brain disease model of addiction (BDMA) and the main grounds for being skeptical of BDMA claims. The idea that addiction is a brain disease dominates thinking and practice worldwide. However, the editors of this book argue that our understanding of addiction is undergoing a revolutionary change, from being considered a brain disease to a disorder of voluntary behavior. The resolution of this controversy will determine the future of scientific progress in understanding addiction, together with necessary advances in treatment, prevention, and societal responses to addictive disorders. This volume brings together the various strands of the contemporary debate about whether or not addiction is best regarded as a brain disease. Contributors offer arguments for and against, and reasons for uncertainty; they also propose novel alternatives to both brain disease and moral models of addiction. In addition to reprints of classic articles from the addiction research literature, each section contains original chapters written by authorities on their chosen topic. The editors have assembled a stellar cast of chapter authors from a wide range of disciplines – neuroscience, philosophy, psychiatry, psychology, cognitive science, sociology, and law – including some of the most brilliant and influential voices in the field of addiction studies today. The result is a landmark volume in the study of addiction which will be essential reading for advanced students and researchers in addiction as well as professionals such as medical practitioners, psychiatrists, psychologists of all varieties, and social workers.

Table of Contents:
General introduction; SECTION I FOR THE BRAIN DISEASE MODEL OF ADDICTION 1. Introduction to Section I; 2. Addiction is a brain disease, and it matters; 3. Neurobiologic advances from the brain disease model of addiction; 4. Time to connect: bringing social context into addiction neuroscience; 5. Drug addiction: updating actions to habits to compulsions ten years on; 6. Is addiction a brain disease? The incentive-sensitization view; 7. Addiction is a brain disease (but does it matter?); SECTION II AGAINST THE BRAIN DISEASE MODEL OF ADDICTION 8. Introduction to Section II; 9. Giving the neurobiology of addiction no more than its due; 10. The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises?; 11. Brain disease model of addiction: why is it so controversial?; 12. Brain disease model of addiction: misplaced priorities?; 13. Addiction and the brain-disease fallacy; 14. Recovery is possible: overcoming ‘addiction’ and its rescue hypotheses; 15. Superpower rivalry, the American Grand Narrative, and the BDMA; 16. My brain disease made me do it: bioethical implications of the Brain Disease Model of Addiction; 17. Addiction is a human problem, but brain disease models divert attention and resources away from human-level solutions; 18. Before ‘rock bottom’? Problem framing effects on stigma and change among harmful drinkers; 19. Brain change in addiction: disease or learning? Implications for science, policy, and care; 20. Brains or persons? Is it coherent to ascribe psychological powers to brains?; 21. The persistence of addiction is better explained by socioeconomic deprivation-related factors powerfully motivating goal-directed drug choice than by automaticity, habit or compulsion theories favored by the brain disease model; 22. Addiction and criminal responsibility: the law’s rejection of the disease model; 23. One cheer for the brain-disease interpretation of addiction; SECTION III UNSURE ABOUT THE BRAIN DISEASE MODEL OF ADDICTION 24. Introduction to Section III; 25. In search of addiction in the brains of laboratory animals; 26. Addiction treatment providers’ engagements with the Brain Disease Model of Addiction; 27. Balancing the ethical and methodological pros and cons of the BDMA; 28. The making of the epistemic project of addiction in the brain; 29. Addiction and the meaning of disease; 30. The pitfalls of recycling substance-use disorder criteria to diagnose behavioral addictions; SECTION IV ALTERNATIVES TO THE BRAIN DISEASE MODEL OF ADDICTION 31. Introduction to Section IV; 32. Addiction is socially engineered exploitation of natural biological vulnerability; 33. Toward an ecological understanding of addiction; 34. Addiction biases choice in the mind, brain, and behavior systems: beyond the brain disease model; 35. Multiple enactments of the brain disease model: which model, when, for whom, and at what cost?; 36. The social perspective and the BDMA’s entry into the non-medical stronghold in Sweden and other Nordic countries; 37. Beyond the medical model: addiction as a response to trauma and stress; 38. Psychotherapeutic strategies to enhance motivation and cognitive control; 39. Addiction is not (only) in the brain: molar behavioral economic models of etiology and cessation of harmful substance use; 40. Understanding substance use disorders among veterans: virtues of the Multitudinous Self Model; 41. How an addiction ontology can unify competing conceptualizations of addiction; 42. Looping processes in the development of and desistance from addictive behaviors; 43. Recovery and identity: a socially focused challenge to brain disease models; 44. Replacing the BDMA: a paradigm shift in the field of addiction; Concluding comments