, Volume 10, Issue 1, pp 103–110 | Cite as

Disease or Developmental Disorder: Competing Perspectives on the Neuroscience of Addiction

Original Paper


Lewis’ neurodevelopmental model provides a plausible alternative to the brain disease model of addiction (BDMA) that is a dominant perspective in the USA. We disagree with Lewis’ claim that the BDMA is unchallenged within the addiction field but we agree that it provides unduly pessimistic prospects of recovery. We question the strength of evidence for the BDMA provided by animal models and human neuroimaging studies. We endorse Lewis’ framing of addiction as a developmental process underpinned by reversible forms of neuroplasticity. His view is consistent with epidemiological evidence of addicted individuals ‘maturing out’ and recovering from addiction. We do however hold some reservations about Lewis’ model. We do not think that his analysis of the neurobiological evidence is clearly different from that of the BDMA or that his neurodevelopmental model provides a more rigorous interpretation of the evidence than the BDMA. We believe that our understanding of the neurobiology of drug use is too immature to warrant the major role given to it in the BDMA. Our social research finds very mixed support for the BDMA among addicted people and health professionals in Australia. Lewis’ account of addiction requires similar empirical evaluation of its real-world implications.


Addiction Brain disease Neuroplasticity Neurodevelopment Learning 



Adrian Carter received an Australian Research Council Discovery Early Career Researcher Award (No. DE140101097).


  1. 1.
    Fraser, S., D. Moore, and H. Keane. 2014. Habits: remaking addiction. Basingstoke: Springer.CrossRefGoogle Scholar
  2. 2.
    Keane, H. 2002. What’s wrong with addiction? Carlton: Melbourne University Press.Google Scholar
  3. 3.
    Heyman, G. 2009. Addiction: a disorder of choice. Cambridge: Harvard University Press.Google Scholar
  4. 4.
    Netherland, J. 2011. “We haven’t sliced open anyone's brain yet”: neuroscience, embodiment and the governance of addiction. In Sociological reflections on the neurosciences, ed. M. Pickersgill and I. Van Keulen, 153–177. Bingley: Emerald.CrossRefGoogle Scholar
  5. 5.
    Reinarman, C., and R. Granfield. 2014. Addiction is not just a brain disease. In Expanding addiction: critical essays, ed. C. Reinarman and R. Granfield, 1–24. New York: Routledge.Google Scholar
  6. 6.
    Satel, S., and S.O. Lilienfeld. 2014. Addiction and the brain-disease fallacy. Frontiers in Psychiatry 4: 141.CrossRefGoogle Scholar
  7. 7.
    Satel, S., and S.O. Lilienfeld. 2013. Brainwashed: the seductive appeal of mindless neuroscience. New York: Perseus Books Group.Google Scholar
  8. 8.
    Lewis, M. 2015. The biology of desire: why addiction is not a disease. New York: Scribe Publications.Google Scholar
  9. 9.
    Kalant, H. 2010. What neurobiology cannot tell us about addiction. Addiction 105: 780–789.CrossRefGoogle Scholar
  10. 10.
    Peele, S. 2010. Addiction in society: blinded by biochemistry. Available from: Accessed 13 August 2016 1 September.
  11. 11.
    Heim, D. 2014. Addiction: not just brain malfunction. Nature 507: 40.CrossRefGoogle Scholar
  12. 12.
    Vrecko, S. 2010. Birth of a brain disease: science, the state and addiction neuropolitics. History of the Human Sciences 23: 52–67.CrossRefGoogle Scholar
  13. 13.
    Wood, E., J.H. Samet, and N.D. Volkow. 2013. Physician education in addiction medicine. JAMA 310: 1673–1674.CrossRefGoogle Scholar
  14. 14.
    Volkow, N.D., G.F. Koob, and A.T. McLellan. 2016. Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine 374: 363–371.CrossRefGoogle Scholar
  15. 15.
    Volkow, N.D., and T.K. Li. 2005. The neuroscience of addiction. Nature Neuroscience 8: 1429–1430.CrossRefGoogle Scholar
  16. 16.
    Volkow, N.D., G.F. Koob, and A.T. McLellan. 2016. Supplementary appendix to ‘Neurobiologic advances from the brain disease model of addiction’. New England Journal of Medicine 374: 363–371.CrossRefGoogle Scholar
  17. 17.
    Volkow, N.D., and G. Koob. 2015. Brain disease model of addiction: why is it so controversial? Lancet Psychiatry 2: 677–679.CrossRefGoogle Scholar
  18. 18.
    Heilig, M. 2015. The thirteenth step: addiction in the age of brain science. New York: Columbia University Press.CrossRefGoogle Scholar
  19. 19.
    Koob, G.F., G.K. Lloyd, and B.J. Mason. 2009. Development of pharmacotherapies for drug addiction: a Rosetta stone approach. Nature Reviews Drug Discovery 8: 500–515.CrossRefGoogle Scholar
  20. 20.
    Leshner, A.I. 1997. Addiction is a brain disease, and it matters. Science 278: 45–47.CrossRefGoogle Scholar
  21. 21.
    Volkow, N.D., and T.K. Li. 2004. Drug addiction: the neurobiology of behaviour gone awry. Nature Reviews Neuroscience 5: 963–970.CrossRefGoogle Scholar
  22. 22.
    Dackis, C., and C. O'Brien. 2005. Neurobiology of addiction: treatment and public policy ramifications. Nature Neuroscience 8: 1431–1436.CrossRefGoogle Scholar
  23. 23.
    Levy, N. 2013. Addiction is not a brain disease (and it matters). Frontiers in Psychiatry 4: 24.Google Scholar
  24. 24.
    Koob, G.F., and M. Le Moal. 2006. Neurobiology of addiction. New York: Academic Press.Google Scholar
  25. 25.
    Heyman, G.M. 2013. Quitting drugs: quantitative and qualitative features. Annual Review of Clinical Psychology 9: 29–59.CrossRefGoogle Scholar
  26. 26.
    Ahmed, S.H. 2010. Validation crisis in animal models of drug addiction: beyond non-disordered drug use toward drug addiction. Neuroscience and Biobehavioral Reviews 35: 172–184.CrossRefGoogle Scholar
  27. 27.
    Kalant, H. 2015. Neurobiological research on addiction: what value has it added to the concept? International Journal of Alcohol and Drug Research 4: 53–59.CrossRefGoogle Scholar
  28. 28.
    Ioannidis, J.P. 2011. Excess significance bias in the literature on brain volume abnormalities. Archives of General Psychiatry 68: 773–780.CrossRefGoogle Scholar
  29. 29.
    Eklund, A., T.E. Nichols, and H. Knutsson. 2016. Cluster failure: why fMRI inferences for spatial extent have inflated false-positive rates. Proceedings of the National Academy of Sciences of the United States of America 113: 7900–7905.CrossRefGoogle Scholar
  30. 30.
    Lewis, M. 2017. Addiction and the brain: development, not disease. Neuroethics. doi: 10.1007/s12152-016-9293-4
  31. 31.
    Hyman, S., and E. Addiction. 2005. A disease of learning and memory. American Journal of Psychiatry 162: 1414–1422.CrossRefGoogle Scholar
  32. 32.
    Hyman, S.E., R.C. Malenka, and E.J. Nestler. 2006. Neural mechanisms of addiction: the role of reward-related learning and memory. Annual Review of Neuroscience 29: 565–598.CrossRefGoogle Scholar
  33. 33.
    Koob, G.F., and M.J. Kreek. 2007. Stress, dysregulation of drug reward pathways, and the transition to drug dependence. American Journal of Psychiatry 164: 1149–1159.CrossRefGoogle Scholar
  34. 34.
    Koob, G.F., and M. Le Moal. 2005. Plasticity of reward neurocircuitry and the ‘dark side’ of drug addiction. Nature Neuroscience 8: 1442–1444.CrossRefGoogle Scholar
  35. 35.
    Koob, G.F. 2006. The neurobiology of addiction: a neuroadaptational view relevant for diagnosis. Addiction 101(Suppl 1): 23–30.CrossRefGoogle Scholar
  36. 36.
    Bennett, M.R., and P.M.S. Hacker. 2003. Philosophical foundations of neuroscience. Malden: Blackwell.Google Scholar
  37. 37.
    Best, D., W. Dawson, G. De Leon, B. Kidd, T. McSweeney, M. Gilman, et al. 2010. Tackling addiction: pathways to recovery. London: Jessica Kingsley.Google Scholar
  38. 38.
    Volkow, N.D., and T.-K. Li. 2005. Drugs and alcohol: treating and preventing abuse, addiction and their medical consequences. Pharmacology and Therapeutics 108: 3–17.CrossRefGoogle Scholar
  39. 39.
    National Academies of Sciences Engineering and Medicine. 2016. Ending discrimination against people with mental and substance use disorders: the evidence for stigma change. Washington, DC: The National Academies Press.Google Scholar
  40. 40.
    Phelan, J.C., and B.G. Link. 2012. Genetics, addiction and stigma. In Genetic research on addiction: ethics, the law and public health, ed. A. Chapman, 174–194. New York: Cambridge University Press.CrossRefGoogle Scholar
  41. 41.
    Meurk, C., K. Morphett, A. Carter, M. Weier, J. Lucke, and W. Hall. 2016. Scepticism and hope in a complex predicament: people with addictions deliberate about neuroscience. International Journal of Drug Policy 32: 34–43.Google Scholar
  42. 42.
    Bell, S., A. Carter, R. Mathews, C. Gartner, J. Lucke, and W. Hall. 2014. Views of addiction neuroscientists and clinicians on the clinical impact of a brain disease model of addiction. Neuroethics 7(1): 19–27.Google Scholar
  43. 43.
    Barnett, A.I., and C.L. Fry. 2015. The clinical impact of the brain disease model of alcohol and drug addiction: exploring the attitudes of community-based AOD clinicians in Australia. Neuroethics 8(3): 271–282.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Centre for Youth Substance Abuse ResearchUniversity of QueenslandBrisbaneAustralia
  2. 2.University of Queensland Centre for Clinical ResearchUniversity of QueenslandBrisbaneAustralia
  3. 3.School of Psychological Sciences and Monash Institute of Cognitive and Clinical NeurosciencesMonash UniversityClaytonAustralia
  4. 4.School of Psychological Sciences and Monash Institute of Cognitive and Clinical NeurosciencesMonash UniversityClaytonAustralia

Personalised recommendations