The Disease Model of Addiction.

The idea that addiction is caused by a brain disease is widely muted and has become part of popular culture. With little evidence support this hypothesis or idea, the” disease model” implies that there is a brain disorder called “addiction” which has somehow been caught or passed on genetically, to the person with the problem. Unfortunately, the disease model; as it has been come to be known, overlooks the fundamental human concept of choice; essentially, the idea that a person with an addiction is undertaking an active choice, therefore empowering themselves. Thankfully addicts can choose to recover and are not helpless to their addiction or victims of a brain disease.

Lessons from history about addiction

In the 1970s, high-grade opium and heroin were available to soldiers fighting in Vietnam.  It was approximated that 50% of all enlisted US soldiers serving in that war tried heroin or opium. Roughly 10 to 15% of them became, what could be called, addicted to that drug.

In May 1971 the New York Times ran the headline “GI heroin addiction epidemic in Vietnam” it was thought that the newly discharged veterans returning to the US would join the ranks of the hordes of “junkies” which lived in the inner cities of the US. The President at the time, Richard Nixon, ordered the military to begin drug testing veterans returning to the US. Not one veteran could sit on a plane returning home without passing a urine test. Any veteran found positive could if needed, attend an army sponsored rehabilitation programme: most of the soldiers past this test on the second try.

An interesting thing occurred when the soldiers returned to their civilian lives; they stopped using heroin; it lost its appeal. A drug that helps them in due hours of endless boredom and moments of terror lost its charm. Furthermore, drug culture, the financial price of heroin, and the stigma of arrest and criminal a record, may have been another driver to deterred veterans from using.

Dr Lee Robbins, a sociologist from the University of Washington, conducted a test program in 1972 to 1974.

Dr Robbins found that only 5% of men who have used heroin, in Vietnam, and had become addicted, returned to the drug within ten months after returning from the war zone.  Furthermore, only 12% had a minor relapse within three years. The startling result was counterintuitive to what, at the time, people thought exposed to a narcotic drug such as heroin, would have. In that period, it was thought that addicts would have an unbearable craving which would lead them continually reuse a strong narcotic such as heroin. Addiction specialists at the time heralded these results as groundbreaking, turning over the belief that a person was “once an addict always an addict”. (Satel & Lillienfeld, 2014).

Time to rethink addiction?

Unfortunately, this information laying in textbooks and research papers and was overlooked by the addiction industry. The cliché “once an addict always an addict” was later reinforced in the mid-1990s with a new idea that addiction is a chronic brain disease; this idea was promoted by Alan Leshner, the director of the National Institute of Drug abuse in the US. A person entering rehab would learn that they have a chronic brain disease called “ addiction” also medical schools would teach this model. In the US, the American Society of Addiction Medicine is quoted as saying that “ addiction is a primary, acute disease of the brain’s reward, impulse, memory and relative circuitry” (Medicine, 2011).

Forgotten history

Unfortunately, in so many ways whether US leads the UK follows. Indeed, various drug policy decisions advise to such as Bill Clinton, George W Bush and lately Barrack Obama, have all been briefed regarding the brain disease model, the brain disease model becomes a form of “dogma” and thus taken as truth rather than a form of truth.

Indeed, the brain does take a large part in the addiction process. The idea of a brain disease, by its very nature, implies a lack of control over will, personality and bodily functions certain some addictive behaviours do look like this, but the process is far more complicated. Dr Lance Dodes, in his book Breaking Addiction, makes this comment “the drive for addiction is normal” (Dodes, 2011, p. 40). Dr Dodes makes an interesting argument when he says that addictions are compulsions, Dr Dodes, in fact, says that addictions are a form of displacement behaviour. Fundamentally, when some people find it hard to deal with emotions and feelings, they are displaced to an addictive process. This certainly bears out the research from Vietnam, if you think of young soldiers away from home in an environment that can be incredibly boring one moment and the next moment incredibly stressful.

When one removes that stressful environment, such as returning home to the US that behaviour or compulsion becomes redundant. This view flies in the face of researchers whose dominant view is that addiction is caused by a chronic brain disease that alters the brain. Undoubtedly, taking any form of drug alters the brain. Nevertheless, any interaction alters the brain essentially, what researchers could be witnessing is the idea of neuro- plasticity: in which the brain is constantly changing and adapting to its environment and experience.

Nevertheless, understand the brain of any addict only gives the partial view of why they have become an addict in the first place.

If Dr Dodes hypothesis is right, then the conventional thinking regarding addiction and its treatment may have to be turned on its head. The idea carefully enshrined by 12 step programs that an addict is always an addict and is powerless to his or her substance or behaviour may have to be rethought. In fact, the addict or person caught up in the compulsion or compulsive behaviours is actively making the choice and thus empowering themselves.

Before closing this article, one cannot discount genetic factors, these today are not fully known but the process of addiction partly happens through the action of dopamine, this is one of the brain’s primary neurotransmitters. Normally dopamine surges in the so-called reward pathways or circuits when we embark on a pleasant experience such as eating, sex or other stimuli central to survival; fundamentally this is nature’s way of making us do the same thing again and again, thus ensuring the survival of our race.

The idea of “salience” is an idea offered by neuroscientists to describe the pull of the substance on the addicted person, this can be identified as a sense of desire or wanting or even needing in preference to liking. Neuroscientists have observed the concepts of salience, by tracing the interaction on the neural pathways as they emerge from the underside of the brain (an area called the ventral tegmentum); these neural pathways sweep out into other brain regions such as the  accumbens, hyper campus and the prefrontal cortex all of which are associated with judgement reward, motivation inhibition and planning.

The truth of the matter is that not every person who drinks or use drugs use them continuously over a 24-hour period, in reality, most people who have some form of an addiction get on with everyday life quite well. The polarity at the heart of any addiction is the fact that the capacity to choose not to use drugs coexists with the self-destructiveness of addiction.

Maybe it is time to rethink how we think about treatment of addiction? Rather than seeing this as an action of a weak-willed person turning this on its head and looking at as an action of a very strong willed person who is displacing to the only thing they know will work from at that moment.

We would be interested to hear your comments, please leave them in the comments box.

Reference

 

Dodes, L. (2011). Breaking Addiction: A 7 Step Handbook for Ending Any Addiction. New York: HarperCollins.

Medicine, A. S. O. A. (2011). Public policy statement: definition of addiction (Vol. 2016, pp. Policy statement): American Society of Addiction Medicine

 

Satel, S., & Lillienfeld, S. (2014). Addiction and the brain disease fallacy. [Addiction]. Frontiers in Psychiatry, 4(March 2014).