A Continuum is a Continuum, and Swans are Not Geese. Reply to Fenton & Wiers
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LETTER
A Continuum is a Continuum, and Swans are Not Geese. Reply to Fenton & Wiers Marc Lewis
Received: 20 January 2017 / Accepted: 27 January 2017 / Published online: 5 May 2017 # Springer Science+Business Media Dordrecht 2017
Abstract I applaud Fenton and Wiers' attempt to find a demarcation point between cases of addiction that fall within the range of normal function and those that may count as disease. However, I argue that continua don't offer demarcation points, the mechanisms involved are not demonstrably different, and trying to pin down subjectivity doesn't help. Keywords Spectrum of intensity . Agreement with Berridge . Continua vs. categories . Natural kinds . Problems with subjectivity . Perceptual and cognitive preferences
This commentary [1] does a fine job of capturing the key points of my argument [2], in the target article and the book, that addiction cannot be logically defined as a disease. I commend Fenton and Wiers for their clear and balanced summary of my model, and I'm pleased that they seem to like it. We fully agree that a wide spectrum of individual differences in addictive behavior, the developmental processes by which addiction arises, and the multiple determinants of addiction don't fit well with a disease definition. More specifically, we agree that psychological variables like delay discounting, impulsivity, biased attention, motivational factors, and the development of automaticity all impact on addiction, M. Lewis (*) Developmental Psychology, University of Toronto, 27 King’s College Cir, Toronto, ON M5S, Canada e-mail: [email protected]
and I think we agree on many of the neurobiological substrates of these factors. This multicausal cluster of factors encourages us (the authors and me) to see addictive behaviors along a spectrum rather than as members of a distinct category such as disease. The authors and I also agree that the spectrum of addictive behaviors ranges in intensity from minor perturbations in day-to-day activities to severe and selfdestructive extremes that could foreshadow permanent disability or death. A key point of their commentary is, however, that at the severe end of the spectrum things get bad enough to warrant the disease label – "black swans" rather than "gray geese." A similar point is made very persuasively by Kent Berridge in his commentary [3], with respect to extreme deviations from the norm in, say, the function of dopamine receptors. But is the point valid? Is it logical? I sometimes feel that the d-word is justified for severe cases. I've personally known individuals for whom it might ring true, one of whom was a good friend who ended up dead from suicide when the money ran out. I sometimes think of my friend as a black swan rather than a gray goose. But that's a feeling, not a definition – and certainly not an explanation. In fact, when I try to turn the feeling into a sensible definition, I bump up against the same obstacle as Fenton and Wiers: where on earth do we draw the line? How can the demarcation point be identified? What are the cri
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