Q: Is Addiction a Brain Disease or a Moral Failing? A: Neither
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ORIGINAL PAPER
Q: Is Addiction a Brain Disease or a Moral Failing? A: Neither Nick Heather
Received: 14 October 2016 / Accepted: 2 November 2016 / Published online: 18 May 2017 # The Author(s) 2016. This article is published with open access at Springerlink.com
Abstract This article uses Marc Lewis’ work as a springboard to discuss the socio-political context of the brain disease model of addiction (BDMA). The claim that promotion of the BDMA is the only way the general public can be persuaded to withhold blame and punishment from addicts is critically examined. After a discussion of public understandings of the disease concept of addiction, it is pointed out that it is possible to develop a scientific account of addiction which is neither a disease nor a moral model but which the public could understand. Evidence is reviewed to suggest that public acceptance of the disease concept is largely lip-service and that the claim the BDMA removes stigma among the public and professionals is unsupported by evidence. Further, there is good evidence that biogenetic explanations of mental/behavioural disorders in general have been counterproductive in the attempt to ally stigma. A model of addiction as a disorder of choice may attract special problems in public-facing communications and risks being misunderstood. However, ways of presenting this model to the public are suggested that may avoid such risks. Lastly, the claim that Parts of this article are adapted from text in Heather, Nick. 2017. Overview of addiction as a disorder of choice and future prospects. In Addiction and choice: rethinking the relationship, eds. Nick Heather and Gabriel Segal, 463–482. Oxford, UK: Oxford University Press [1]. N. Heather (*) Department of Psychology, Northumbria University, 8 Roseworth Terrace, Newcastle on Tyne NE3 1LU, UK e-mail: [email protected]
the BDMA is the only way of ensuring access to treatment and of maintaining research funding for addiction is disputed and a way in which these benefits can be retained under a disorder-of-choice model proposed. The article concludes by enthusiastically endorsing Lewis’ call for a third stage in the governing image of addiction. Keywords Brain disease model of addiction . Moral model . Developmental-learning model . Addiction as a disorder of choice . Public-facing communications . Stigma
Introduction Marc Lewis is unusual, perhaps unique,1 in being a neuroscientist interested in addiction who believes that it is not best seen as a brain disease [3–5]. He has done a great service to those of us who share his view that the brain disease model of addiction (BDMA) is mistaken but who lack the expertise to criticise it on neurobiological grounds. But despite this debt of gratitude, I will not be concerned in this article with Lewis’ analysis of where the BDMA goes theoretically wrong or with the internal inadequacies of any other disease account of addiction (but see [6–8]). Rather, I want to use Lewis’ work as a springboard to discuss the socio-political context of the BDMA and
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