Talking Point: The brain disease model of addiction
The brain disease model of addiction: Is it supported by the evidence and has it delivered on its promises?
It has been almost two decades since Alan Leshner, then Director of the US National Institute on Drug Abuse (NIDA), published his seminal paper in Science declaring that “addiction is a brain disease, and it matters”. According to Leshner, and the current NIDA director, Nora Volkow, neuroscience will revolutionise our ability to treat and possibly prevent addiction.
They argue that recognition of addiction as a brain disease will also increase access to medical treatment, reduce stigma and discrimination associated with addiction, and minimise our reliance on punitive responses to deal with drug-using individuals.
However, neuroscience also raises numerous social and ethical challenges: If addicted individuals are suffering from a brain disease that drives them to drug use, should we mandate treatment? Do changes in the brain justify the use of invasive or risky neurobiological interventions, such as deep brain stimulation, to “cure” addiction?
How will “brain disease” explanations of addiction affect an individual’s belief in their ability to stop using drugs or seek treatment? This presentation examines the evidence supporting the claim that addiction is a “brain disease” and assesses whether it has delivered on its promises. It also considers some of the additional social, ethical and policy challenges that it raises.
Dr Adrian Carter, Senior Research Fellow, Monash University
Dr Adrian Carter is a Senior Research Fellow and Head of the Neuroethics and Policy Group at the School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University.
His research examines the impact that neuroscience has on understanding and treatment of addiction and other compulsive behaviours. This includes the impact of neuroscience on: our notions of agency, identity and moral responsibility; the use of coercion and the capacity for voluntary control of addictive or compulsive behaviours; and the use of emerging technologies, such as deep brain stimulation and brain imaging, to treat addiction.
He has published two books, including Addiction Neuroethics: The Promises and Perils of Addiction Neuroscience (Cambridge University Press, 2012). Dr Carter has been an advisor to the World Health Organization, European Monitoring Centre for Drugs and Drug Addiction, Australian Ministerial Council on Drugs Strategy and United Nations Office on Drugs and Crime.