Skip to main content

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

A Letter to this article was published on 01 April 2017

Abstract

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.

This is a preview of subscription content, access via your institution.

References

  1. Fraser, S., D. Moore, and H. Keane. 2014. Habits: remaking addiction. Basingstoke: Springer.

    Book  Google Scholar 

  2. Keane, H. 2002. What’s wrong with addiction? Carlton: Melbourne University Press.

    Google Scholar 

  3. Heyman, G. 2009. Addiction: a disorder of choice. Cambridge: Harvard University Press.

    Google Scholar 

  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.

    Chapter  Google Scholar 

  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. Satel, S., and S.O. Lilienfeld. 2014. Addiction and the brain-disease fallacy. Frontiers in Psychiatry 4: 141.

    Article  Google Scholar 

  7. Satel, S., and S.O. Lilienfeld. 2013. Brainwashed: the seductive appeal of mindless neuroscience. New York: Perseus Books Group.

    Google Scholar 

  8. Lewis, M. 2015. The biology of desire: why addiction is not a disease. New York: Scribe Publications.

    Google Scholar 

  9. Kalant, H. 2010. What neurobiology cannot tell us about addiction. Addiction 105: 780–789.

    Article  Google Scholar 

  10. Peele, S. 2010. Addiction in society: blinded by biochemistry. Available from: https://www.psychologytoday.com/articles/201009/addiction-in-society-blinded-biochemistry. Accessed 13 August 2016 1 September.

  11. Heim, D. 2014. Addiction: not just brain malfunction. Nature 507: 40.

    Article  Google Scholar 

  12. Vrecko, S. 2010. Birth of a brain disease: science, the state and addiction neuropolitics. History of the Human Sciences 23: 52–67.

    Article  Google Scholar 

  13. Wood, E., J.H. Samet, and N.D. Volkow. 2013. Physician education in addiction medicine. JAMA 310: 1673–1674.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  15. Volkow, N.D., and T.K. Li. 2005. The neuroscience of addiction. Nature Neuroscience 8: 1429–1430.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  17. Volkow, N.D., and G. Koob. 2015. Brain disease model of addiction: why is it so controversial? Lancet Psychiatry 2: 677–679.

    Article  Google Scholar 

  18. Heilig, M. 2015. The thirteenth step: addiction in the age of brain science. New York: Columbia University Press.

    Book  Google Scholar 

  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.

    Article  Google Scholar 

  20. Leshner, A.I. 1997. Addiction is a brain disease, and it matters. Science 278: 45–47.

    Article  Google Scholar 

  21. Volkow, N.D., and T.K. Li. 2004. Drug addiction: the neurobiology of behaviour gone awry. Nature Reviews Neuroscience 5: 963–970.

    Article  Google Scholar 

  22. Dackis, C., and C. O'Brien. 2005. Neurobiology of addiction: treatment and public policy ramifications. Nature Neuroscience 8: 1431–1436.

    Article  Google Scholar 

  23. Levy, N. 2013. Addiction is not a brain disease (and it matters). Frontiers in Psychiatry 4: 24.

    Google Scholar 

  24. Koob, G.F., and M. Le Moal. 2006. Neurobiology of addiction. New York: Academic Press.

    Google Scholar 

  25. Heyman, G.M. 2013. Quitting drugs: quantitative and qualitative features. Annual Review of Clinical Psychology 9: 29–59.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  28. Ioannidis, J.P. 2011. Excess significance bias in the literature on brain volume abnormalities. Archives of General Psychiatry 68: 773–780.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  30. Lewis, M. 2017. Addiction and the brain: development, not disease. Neuroethics. doi:10.1007/s12152-016-9293-4

  31. Hyman, S., and E. Addiction. 2005. A disease of learning and memory. American Journal of Psychiatry 162: 1414–1422.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  35. Koob, G.F. 2006. The neurobiology of addiction: a neuroadaptational view relevant for diagnosis. Addiction 101(Suppl 1): 23–30.

    Article  Google Scholar 

  36. Bennett, M.R., and P.M.S. Hacker. 2003. Philosophical foundations of neuroscience. Malden: Blackwell.

    Google Scholar 

  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. 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.

    Article  Google Scholar 

  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. 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.

    Chapter  Google Scholar 

  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.

  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.

  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.

Download references

Acknowledgements

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

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adrian Carter.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hall, W., Carter, A. & Barnett, A. Disease or Developmental Disorder: Competing Perspectives on the Neuroscience of Addiction. Neuroethics 10, 103–110 (2017). https://doi.org/10.1007/s12152-017-9303-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12152-017-9303-1

Keywords

  • Addiction
  • Brain disease
  • Neuroplasticity
  • Neurodevelopment
  • Learning