1st Edition

Evaluating the Brain Disease Model of Addiction

Edited By Nick Heather, Matt Field, Antony Moss, Sally Satel Copyright 2022
    572 Pages 40 B/W Illustrations
    by Routledge

    572 Pages 40 B/W Illustrations
    by Routledge

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    This ground-breaking book advances the fundamental debate about the nature of addiction. As well as presenting the case for seeing addiction as a brain disease, it brings together all the most cogent and penetrating critiques of the brain disease model of addiction (BDMA) and the main grounds for being skeptical of BDMA claims.

    The idea that addiction is a brain disease dominates thinking and practice worldwide. However, the editors of this book argue that our understanding of addiction is undergoing a revolutionary change, from being considered a brain disease to a disorder of voluntary behavior. The resolution of this controversy will determine the future of scientific progress in understanding addiction, together with necessary advances in treatment, prevention, and societal responses to addictive disorders. This volume brings together the various strands of the contemporary debate about whether or not addiction is best regarded as a brain disease. Contributors offer arguments for and against, and reasons for uncertainty; they also propose novel alternatives to both brain disease and moral models of addiction. In addition to reprints of classic articles from the addiction research literature, each section contains original chapters written by authorities on their chosen topic. The editors have assembled a stellar cast of chapter authors from a wide range of disciplines – neuroscience, philosophy, psychiatry, psychology, cognitive science, sociology, and law – including some of the most brilliant and influential voices in the field of addiction studies today.

    The result is a landmark volume in the study of addiction which will be essential reading for advanced students and researchers in addiction as well as professionals such as medical practitioners, psychiatrists, psychologists of all varieties, and social workers.

    General introduction

    Nick Heather, Matt Field, Antony C. Moss, and Sally Satel



    1. Introduction to Section I

    Matt Field, Antony C. Moss, Sally Satel, and Nick Heather

    2. Addiction is a brain disease, and it matters

    Alan I. Leshner

    (Reprinted from Science, 278, 45–47, 1997)

    3. Neurobiologic advances from the brain disease model of addiction

    Nora D. Volkow, M.D., George F. Koob, Ph.D., and A. Thomas McLellan, Ph.D.

    (Reprinted from New England Journal of Medicine, 374, 363–371, 2016)

    4. Time to connect: bringing social context into addiction neuroscience

    Markus Heilig, David H. Epstein, Michael A. Nader and Yavin Shaham

    (Reprinted from Nature Reviews Neuroscience, 17, 592–599, 2016)

    5. Drug addiction: updating actions to habits to compulsions ten years on

    Barry J. Everitt and Trevor W. Robbins

    (Reprinted from Annual Review of Psychology, 67, 23–50, 2016)

    6. Is addiction a brain disease? The incentive-sensitization view

    Kent C. Berridge

    7. Addiction is a brain disease (but does it matter?)

    Gabriel Segal



    8. Introduction to Section II

    Sally Satel, Nick Heather, Antony C. Moss, and Matt Field

    9. Giving the neurobiology of addiction no more than its due

    Wayne Hall, Adrian Carter, and Cynthia Forlini

    10. The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises?

    Wayne Hall, Adrian Carter, and Cynthia Forlini

    (Reprinted from Lancet Psychiatry, 2, 105–110, 2015)

    11. Brain disease model of addiction: why is it so controversial?

    Nora D. Volkow and George Koob

    (Reprinted from Lancet Psychiatry, 2, 677–679, 2015)

    12. Brain disease model of addiction: misplaced priorities?

    Wayne Hall, Adrian Carter, and Cynthia Forlini

    (Reprinted from Lancet Psychiatry, 2, 867, 2015)

    13. Addiction and the brain-disease fallacy

    Sally Satel and Scott O. Lilienfeld

    (Reprinted from Frontiers in Psychiatry, 4, 141, 2014)

    14. Recovery is possible: overcoming ‘addiction’ and its rescue hypotheses

    Derek Heim and Rebecca L. Monk

    15. Superpower rivalry, the American Grand Narrative, and the BDMA

    Bruce K. Alexander

    16. My brain disease made me do it: bioethical implications of the Brain Disease Model of Addiction

    Frederick Rotgers

    17. Addiction is a human problem, but brain disease models divert attention and resources away from human-level solutions

    Richard Hammersley

    18. Before ‘rock bottom’? Problem framing effects on stigma and change among harmful drinkers

    James Morris

    19. Brain change in addiction: disease or learning? Implications for science, policy, and care

    Marc Lewis

    20. Brains or persons? Is it coherent to ascribe psychological powers to brains?

    Tim Leighton

    21. The persistence of addiction is better explained by socioeconomic deprivation-related factors powerfully motivating goal-directed drug choice than by automaticity, habit or compulsion theories favored by the brain disease model

    Lee Hogarth

    22. Addiction and criminal responsibility: the law’s rejection of the disease model

    Stephen J. Morse

    23. One cheer for the brain-disease interpretation of addiction

    Gene M. Heyman



    24. Introduction to Section III

    Nick Heather, Sally Satel, Matt Field, and Antony C. Moss

    25. In search of addiction in the brains of laboratory animals

    Serge H. Ahmed

    26. Addiction treatment providers’ engagements with the Brain Disease Model of Addiction

    Anthony Barnett, Michael Savic, Martyn Pickersgill, Kerry O’Brien, Dan I. Lubman, and Adrian Carter

    27. Balancing the ethical and methodological pros and cons of the BDMA

    Susanne Uusitalo and Jaakko Kuorikoski

    28. The making of the epistemic project of addiction in the brain

    Matilda Hellman and Michael Egerer

    29. Addiction and the meaning of disease

    Hanna Pickard

    30. The pitfalls of recycling substance-use disorder criteria to diagnose behavioral addictions

    Maèva Flayelle, Adriano Schimmenti, Vladan Starcevic and Joël Billieux



    31. Introduction to Section IV

    Antony C. Moss, Matt Field, Sally Satel, and Nick Heather

    32. Addiction is socially engineered exploitation of natural biological vulnerability

    Don Ross

    (Reprinted from Behavioural Brain Research, 386, 112598 Online, 2020)

    33. Toward an ecological understanding of addiction

    Darin Weinberg

    34. Addiction biases choice in the mind, brain, and behavior systems: beyond the brain disease model

    Paul F. M. J. Verschure and Reinout W. Wiers

    35. Multiple enactments of the brain disease model: which model, when, for whom, and at what cost?

    Helen Keane, David Moore, and Suzanne Fraser

    36. The social perspective and the BDMA’s entry into the non-medical stronghold in Sweden and other Nordic countries

    Jessica Storbjörk, Lena Eriksson, and Katarina Winter

    37. Beyond the medical model: addiction as a response to trauma and stress

    Gabor Maté

    38. Psychotherapeutic strategies to enhance motivation and cognitive control

    Frank Ryan

    39. Addiction is not (only) in the brain: molar behavioral economic models of etiology and cessation of harmful substance use

    Samuel F. Acuff, Jalie A. Tucker, Rudy E. Vuchinich, and James G. Murphy

    40. Understanding substance use disorders among veterans: virtues of the Multitudinous Self Model

    Şerife Tekin, Alicia A. Swan, Willie J. Hale, and Mary Jo Pugh

    41. How an addiction ontology can unify competing conceptualizations of addiction

    Robert M. Kelly, Janna Hastings, and Robert West

    42. Looping processes in the development of and desistance from addictive behaviors

    Anja Koski-Jännes

    43. Recovery and identity: a socially focused challenge to brain disease models

    Beth Collinson and David Best

    44. Replacing the BDMA: a paradigm shift in the field of addiction

    Bruce K. Alexander

    Concluding comments

    Nick Heather, Antony C. Moss, Matt Field, and Sally Satel


    Nick Heather is Emeritus Professor of Alcohol & Other Drug Studies in the Department of Psychology, School of Life Sciences at Northumbria University, UK. A clinical psychologist by training, he is mainly interested in research on treatment and brief interventions for alcohol problems and in theories of addiction.

    Matt Field is Professor of Psychology at the University of Sheffield, UK, where he conducts research into the psychological mechanisms that underlie the development and persistence of, and recovery from, addiction.

    Antony C. Moss is Professor of Addictive Behaviour Science in the Centre for Addictive Behaviours Research, London South Bank University, UK. His interests include theories of addiction, public health aspects and prevention of addictive behaviour, and understanding the needs of individuals and groups who have historically been overlooked in research, treatment, and policy.

    Sally Satel is an addiction psychiatrist. She treats patients at a methadone clinic in Washington DC, USA, and is interested in conceptual frameworks of addiction.

    "This book is an exceptionally wide-ranging exploration of the contested terrain of human troubles labelled addiction. The distinguished editors have invited the best brains across the various fields that bear upon addiction -- those who advocate the brain disease view, those opposed, and those carving creative paths in between. It will stand as the definitive inter-disciplinary collection on the brain disease paradigm and its alternatives, providing lively, point-for-point debates about the nature of addiction and why this matters."

    Craig Reinarman, University of California, Santa Cruz, USA

    "This collection presents an excellent, well-balanced overview of different views on the brain disease model of addiction. Eminent international authors from a variety of theoretical and disciplinary perspectives discuss the emergence of the model and its growing popularity, challenges to the model and possible novel alternatives. Divided into four sections - for, against, unsure and innovative ideas – the book is informative, stimulating and a welcome reminder that the brain disease model is still far from universally accepted."

    Betsy Thom, Middlesex University, UK

    "What an exceptional book this is! Although understanding addiction as a ‘brain disease’ is accepted by many, it is in fact a controversial approach, contested by a large number of leading researchers, theoreticians and practitioners. This book offers a wonderfully encyclopaedic and yet very clear road map of this contested space. Divided into four stimulating sections (for, against, unsure, alternatives) the book brings together almost all of the leading figures in this debate, allowing all voices to be heard and yet also offering a clear set of statements from the Editors of the position that they hold. I strongly recommend this book to anyone interested in this area, from novices through to ‘experts’."

    Richard Velleman, University of Bath, UK and Addictions Research Group, Sangath, India

    "This book provides a rich compendium of seminal papers in the addiction field positioned alongside ground-breaking new contributions that consider the biopsychosocial, policy, and public health implications of a variety of models of addiction, as well as the specific benefits and downsides of the brain disease model. This book does way more than evaluate the brain disease model – it also provides a compelling retrospective and encourages introspection of our beliefs and attitudes about addiction. It also provides fascinating and thoughtful alternative models that have great potential to change how we study, treat, and frame addiction. Over the course of 44 chapters, Evaluating the Brain Disease Model of Addiction presents a paradigm shift and a call for us to reconsider how we study and conceptualize addiction. The overarching conclusion that is quite evident from reading this book is that, as a field, we have been asking the wrong questions. The chapters in this exceptionally curated book provide a plethora of ideas for alternative questions and conceptualizations that might ultimately reduce human suffering."

    Katie Witkiewitz, University of New Mexico, USA

    "As well as giving an excellent overview of the debate on how to conceptualize addiction, this book also raises questions about the essence of science. Rejecting a neopositivist view, according to which science is almost exclusively data driven, the debate on the brain disease model of addiction (BDMA) shows that science is about the interpretation of data and model building, and that these models can have a profound impact on the way we deal with social realities. While no pathognomonic brain lesions have been identified that can be used for diagnosing addiction, proponents of the BDMA have argued that understanding addiction as a brain disease would be helpful for overcoming stigma and improving treatment. However, 25 years after the first seminal paper introducing the BDMA, effects on treatment and public policies are, at best, modest, and the ‘othering’ associated with the BDMA apparently has unintended side effects. This book brings together a plethora of perspectives on the validity and utility of the BDMA from distinguished experts from addiction research as well as from the humanities, including proponents and critics of the model as well as authors who consider themselves ‘undecided’."

    Gallus Bischof, University of Lűbeck, Germany