Is Addiction a Brain Disease?
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ORIGINAL PAPER
Is Addiction a Brain Disease? Kent C. Berridge
Received: 12 April 2016 / Accepted: 18 April 2016 # Springer Science+Business Media Dordrecht 2016
Abstract Where does normal brain or psychological function end, and pathology begin? The line can be hard to discern, making disease sometimes a tricky word. In addiction, normal ‘wanting’ processes become distorted and excessive, according to the incentive-sensitization theory. Excessive ‘wanting’ results from drug-induced neural sensitization changes in underlying brain mesolimbic systems of incentive. ‘Brain disease’ was never used by the theory, but neural sensitization changes are arguably extreme enough and problematic enough to be called pathological. This implies that ‘brain disease’ can be a legitimate description of addiction, though caveats are needed to acknowledge roles for choice and active agency by the addict. Finally, arguments over ‘brain disease’ should be put behind us. Our real challenge is to understand addiction and devise better ways to help. Arguments over descriptive words only distract from that challenge. Keywords Addiction . Desire . Wanting . Liking . Brain . Dopamine
Marc Lewis writes books on addiction that are wonderfully engaging and illuminating [1, 2]. He describes with clarity what it’s like to be an addict, and what is scientifically known about addiction’s causes and treatments.
K. C. Berridge (*) University of Michigan, Ann Arbor, MI 48109, USA e-mail: [email protected]
He ably blends these themes with compelling portraits of the experiences of individual addicts, who have made personal journeys often through depths of despair, yet eventually found the strength to make a positive change in their lives. Recently Marc has also argued the view that addiction should not be viewed as a brain disease. He gives several reasons in the target article for this commentary [3], as well as in his recent book [2]. First, he notes that some addicts may not regard themselves as diseased. Also, those who eventually do give up drugs may never see themselves as cured or reversed into a pre-addiction state, but rather as having reached an entirely new stage of life. Second, though addiction is accompanied by distinct changes in the brain, many changes in the brain also occur in normal life. Third, he suggests that to view addicts as medical patients is to regard them as passive and so neglect their active agency, and even make less likely their personal act of re-invention that will be required in order to successfully give up drugs. Finally, he points out that brain dopamine mechanisms of addiction overlap not only with those of other behavioral addictions (for example, compulsive gambling, sex addiction, or binge eating), but also with the mechanisms of ordinary desires such as love or hunger that are shared by everyone. So BIf addiction is a disease, then so apparently is love^, Marc Lewis concludes [3]. Marc and I are friends. We came to know each other while participating in a week-long seminar on craving and addiction with t
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