Addiction Is A Brain Disease
Is Gambling Addiction A Brain Disease
Is Gambling Addiction A Disease

AJOB Neurosci. Author manuscript; available in PMC 2014 Jul 8.

Published in final edited form as:

Published online 2013 Jul 8. doi: 10.1080/21507740.2013.796328

Compulsive gambling is a disorder that affects millions in the U.S. Get the facts on gambling addiction causes, risk factors, symptoms, signs, diagnosis, treatment, negative effects, complications, and support. Mar 03, 2014 Addiction as a “Brain Disease” So, what exactly makes addiction a brain disease? “That addiction is tied to changes in brain structure and function is what makes it, fundamentally, a brain disease,” Leshner wrote in a now-landmark article in Science in 1997. But that can’t be right. Addiction as a brain disease is similarly construed as a sort of “secular possession”. Rather than a malady of the weak-willed, addiction reframed as a pathology of the weak-brained (or weak-gened) bears just as much potential for wielding stigma and creating marginalized populations. The brain of gambling addicts We need to understand brain function to address a gambler’s behavior and plan for recovery. Let’s take a brief look at what goes on in the brain, from the inside out, before taking a brief look at treatments that can be helpful in dealing with the immediate and long-term remediation of the effects of gambling.

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Abstract

To deepen understanding of efforts to consider addiction a “brain disease,” we review critical appraisals of the disease model in conjunction with responses from in-depth semistructured stakeholder interviews with (1) patients in treatment for addiction and (2) addiction scientists. Sixty-three patients (from five alcohol and/or nicotine treatment centers in the Midwest) and 20 addiction scientists (representing genetic, molecular, behavioral, and epidemiologic research) were asked to describe their understanding of addiction, including whether they considered addiction to be a disease. To examine the NIDA brain disease paradigm, our approach includes a review of current criticism from the literature, enhanced by the voices of key stakeholders. Many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma. We conclude that it is not necessary, and may be harmful, to frame addiction as a disease.

Over the last decade, the National Institute on Drug Abuse (NIDA) has proclaimed addiction to be a chronic, relapsing brain disease caused by prolonged substance use (Leshner 2001; ). In the official publication “Drugs, Brains, and Behavior: The Science of Addiction,” NIDA director Nora Volkow writes, “Today, thanks to science, our views and our responses to drug abuse have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of drug addiction, enabling us to respond effectively to the problem” (Volkow 2007). However, many social scientists have criticized the recent neurocentric discourse as “reductively inattentive to individual values and social context” (Courtwright 2010).

Historians and those who have long studied addiction without functional magnetic resonance imaging, gene sequencing, or other biomedical technology have understandably questioned the claim that describing addiction as a chronic, relapsing brain disease paradigm is “revolutionary” (Acker 2005; Andrews 1941; Courtwright 2010; Goodman 1965; Gough 1884; Kolb 1962; Krivanek 1988; Morse 2006; Reinarman 2005). The idea of addiction as a disease and/or a brain disease is not revolutionary; nevertheless, it is an accomplishment celebrated and complicated by numerous competing interests. Furthermore, the efficacy of NIDA’s brain disease paradigm remains to be seen, with an estimated 23 million Americans aged 12 years and older in need of substance abuse treatment and more than $180 billion per year consumed in addiction-related expenditures in the United States (Executive Office of the President 2004).

Addiction Is A Brain Disease

Historian Nancy Campbell, who studies the history of scientific research on drug addiction, asserts that the brain-disease model of addiction is an attempt to create “a unified framework for a problem-based field in conceptual disarray” (Campbell 2007). The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), classifies addiction according to behavioral criteria, not biological criteria. Meanwhile, addiction scientists continue to evidence a biological understanding of addiction in search of a molecular etiology. Because diseases are both socially constructed and characterized by biological features, the disease distinction may place addiction status somewhere in a middle ground, as Campbell suggests. However, whether addiction is or is not glossed as a disease bears significant weight because of the way definitions perform “cultural work” (Acker 2010). Portraying addiction as a disease can never be neutral; thus, its effect on patients and scientists alike warrants consideration.

The popularity of neuroscience in the 1990s (proclaimed by the National Institutes of Health [NIH] and George H. W. Bush as “The Decade of the Brain”; Bush 1990) led to a vernacular shift built upon language and imagery used by brain scientists. Self-help titles appeared like “How to keep from sabotaging your brain chemistry” (Ruden 2000). Jocund new terms for addicts, such as the Economist’s “dopamine head” (Economist 1993), were born. On the Oprah Winfrey Show, researcher Anna Rose Childress described addicts as “living subcortical lives” (Campbell 2010), suggesting that addicts are precariously controlled by their more primitive, reptilian midbrains. Attending to this vernacular shift, scholar Nicolas Rose has argued that society increasingly privileges a “molecular style of thought” in which personal identity and human behavior are understood as inextricably intertwined with one’s “neurochemical self” (Rose 2004).¹ Addiction is one of myriad problems attributed to neural defect, often bereft of social context.

This article reviews several contemporary criticisms of the disease model of addiction from the literature, points further enhanced in interviews with key stakeholders. Our team interviewed 63 patients from five alcohol and/or nicotine treatment centers in Minnesota, as well as 20 addiction scientists from a variety of research fields (genetic, molecular, behavioral, epidemiologic). We asked all participants to describe their understanding of addiction, including whether they considered addiction to be a disease. Interview transcripts were coded and analyzed by the team of authors, and further discussion of methods and dominant themes arising from our qualitative analysis appears elsewhere.(Dingel et al. 2012; )

We focus on the voices of interviewed stakeholders—patients and scientists—to demonstrate how the discourse around addiction remains contentious and complex. In the first section, we contrast the utility of the disease construct with its potential to further stigmatize addicts. We then follow with a discussion on how well the NIDA brain disease paradigm fits criteria for disease classification. We then consider institutional incentives reinforcing the disease model among researchers and explore how translational science goals are shaped by the reductive, neurocentrist disease paradigm. We conclude with an analysis of disease metaphors to suggest that “disease” is an unnecessary and commonly negative frame that distracts from the positive and hopeful messages that can accompany a biological understanding of addiction.

CRITICISM OF THE “ADDICTION AS DISEASE” FRAMEWORK

Addiction as Secular Possession

Those who favor the addiction-as-disease framework often believe that the objective, biological gaze debunks the moralized argument that addiction is a problem for weak-willed people (). In the same vein, opponents of the disease framework often claim that the biological understanding will remove the onus of personal responsibility and moral culpability, that patients will use their “disease” as a “crutch” (Dingel et al. 2012; Rosenberg 1992), The majority of our interviewed patients found the disease model useful. Many believed that a disease diagnosis diminishes moral judgment while reinforcing the imperative that the sick persons take responsibility for their condition and seek treatment. Paige,² in treatment for alcoholism, said:

I think understanding that it

Gambling Is A Brain Disease