How to Recover from a Brain Disease: Is Addiction a Disease, or Is there a Disease-like Stage in Addiction?
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ORIGINAL PAPER
How to Recover from a Brain Disease: Is Addiction a Disease, or Is there a Disease-like Stage in Addiction? Anke Snoek
Received: 6 February 2017 / Accepted: 23 February 2017 # The Author(s) 2017. This article is published with open access at Springerlink.com
Abstract People struggling with addiction are neither powerless over their addiction, nor are they fully in control. Lewis vigorously objects to the brain disease model of addiction (BDMA), because it makes people lose belief in their self-efficacy, and hence hinders their recovery. Although he acknowledges that there is a compulsive state in addiction, he objects to the claim that this compulsion is carved in stone. Lewis argues that the BDMA underestimates the agency of addicted people, and hence hinder their recovery. Lewis’s work offers us a very much to be welcomed neurobiology of recovery. It offers addicted people a hopeful and respectful narrative for their recovery that treats them as agents rather than as damaged brains. However, I argue that overestimating people’s agency can also result in people losing belief in their self-efficacy. Lewis’s strong focus on the agency of addicted people might not match their experiences of struggle, hence reinforcing their feelings of guilt when they fail to control their use. I propose to replace the notion of addiction as a disease with a notion of a disease-like stage in addiction. I call this stage the duress stage in addiction, in which the addictive behaviour is largely impervious to the agent’s values and to available techniques of self-control.
A. Snoek (*) Faculty of Health, Medicine & Life Sciences, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands e-mail: [email protected] A. Snoek Faculty of Arts, Philosophy Department, Macquarie University, Sydney, NSW 2109, Australia
However, the agent can overcome this stage by developing new techniques of self-control, by building on their selfconcept and belief in self-efficacy, by changing their environments and habits, and by engaging in projects that are meaningful to the agent. Keywords Addiction . BDMA . Recovery . Qualitative research . Lewis . Agency . Compulsion . Duress
How to Recover from a ‘Brain Disease’? Lewis provocatively subtitles his book: ‘Why addiction is not a disease’ [1]. He especially seems to object to the brain disease model of addiction (BDMA). The BDMA consists of three parts. The first part is a technical description of how repeated substance use influences brain chemistry. For example, there is how the dopamine released in substance use influences attention and makes us highly sensitive to substance-related cues. The second part consists of normative claims (closely or less closely) based on these described mechanisms. We have to, for example, translate these mechanisms into human behaviour, into a more normative and less technical language. Dopamine release during substance use provides an extreme reward and this leads to continued use, and eventually compulsive use. Howeve
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