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The Paradox of Addiction Neuroscience

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Abstract

Neuroscience has substantially advanced the understanding of how changes in brain biochemistry contribute to mechanisms of tolerance and physical dependence via exposure to addictive drugs. Many scientists and mental health advocates scaffold this emerging knowledge by adding the imprimatur of disease, arguing that conceptualizing addiction as a “brain disease” will reduce stigma amongst the folk. Promoting a brain disease concept is grounded in beneficent and utilitarian thinking: the language makes room for individuals living with addiction to receive the same level of compassion and access to healthcare services as individuals living with other medical diseases, and promotes enlightened social and legal policies. However such claims may yield unintended consequences by fostering discrimination commonly associated with pathology. Specifically, the language of neuroscience used to describe addiction may reduce attitudes such as blame and responsibility while inadvertently identifying addicted persons as neurobiological others. In this paper, we examine the merits and limitations of adopting the language of neuroscience to describe addiction. We argue that the reframing of addiction in the language of neuroscience provides benefits such as the creation of empowered biosocial communities, but also creates a new set of risks, as descriptive neuroscience concepts are inseparable from historical attitudes and intuitions towards addiction and addicted persons. In particular, placing emphasis on the diseased brain may foster unintended harm by paradoxically increasing social distance towards the vulnerable group the term is intended to benefit.

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Notes

  1. There is currently no universally agreed upon definition for addiction, and some have argued that the term is “conceptually chaotic”. See, for example, Shaffer [1].

  2. We believe that it is important for neuroethics to probe the ways in which the general public, i.e. the folk, understand neurobiological concepts as they apply to their lived experiences. We suggest that this is a worthy endeavor in so far as it allows for the development of empirically grounded normative claims, which can then be used to at least partially democratize policy decisions regarding the introduction of new technologies in the neurosciences. Our advocacy of the value of investigating folk psychology is not intended to diminish arguments that it represents an inadequate theory of understanding psychological predicates (see, for example, P.M Churchland [3] and P.S. Churchland [4]) but rather to highlight the fact that folk psychological concepts exist in the real world and that as neuroethicists, understanding those concepts is informative.

  3. In this paper we only speak to addiction as it applies to substance use, however we accept that addiction is not restricted to psychoactive substances and may include behaviours such as gambling, shopping, sex, and so forth.

  4. It is perhaps worthwhile to distinguish illness from disease from disorder—and mental disorder in particular—although what constitutes each of these terms is still yet to be universally agreed upon. At this time, a provisional definition is that a disease may refer to objective pathological changes within the body that are expressed through diverse physical indicators and symptoms. Illness, on the other hand, may refer to the individual’s subjective interpretation and response to these changes and symptoms. For mental disorder, we will borrow the definition from Jerome Wakefield [18] who argues that “a disorder exists when the failure of a person’s internal mechanisms to perform their functions as designed by nature impinges harmfully on the person’s well-being as defined by social values and meanings” [18: 373].

  5. There are many potential drawbacks to a brain disease view, and to include them all would be to go beyond the limits of this manuscript. One concern, for example, is what Hall [53] has referred to as a disproportionate focus on “great and desperate cures”, namely, that a brain disease view may be used to justify the use of more coercive interventions to ‘cure’ addiction.

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Acknowledgements

We’d like to thank Grant Gillett for sharing his insights on this topic with us. Supported by CIHR CNE #85117.

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Correspondence to Peter B. Reiner.

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Buchman, D.Z., Illes, J. & Reiner, P.B. The Paradox of Addiction Neuroscience. Neuroethics 4, 65–77 (2011). https://doi.org/10.1007/s12152-010-9079-z

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