Brain Disease Model of Addiction: Sociological and Therapeutic Implications

Introduction

Inspiration for the professionals who authored accounts on chronic brain illnesses came from findings on drugs' impacts on the human brain. The promise that powerful anti-addiction medicines could be found seemed great. The emerging scientific field of addiction biology implied that addiction — a condition which begins with a clear, intentional decision to try drugs, spiraling quickly into an irrepressible, involuntary state — would now be considered seriously, and permanently, as a medical ailment. Using this knowledge, authors hoped to sensitize lawmakers and society to drug addicts' needs, including improved private insurance coverage and greater access to public treatment. The agenda also included moderating puritanical attitudes and reforming penal law enforcement.

The neuro-centric approach, however, supports unjustified optimism regarding pharmaceutical treatments and overrates the requirement for professional aid. Conditions that characteristically remit in young adulthood are branded as "chronic." The brain disease account pays little attention to the fact that drugs and alcohol serve a purpose in the lives of those addicted to them, and that it is possible to override substance-induced neurobiological changes. The brain disease model does contain some truth — alcoholism and drug addiction have a genetic component, as does long-term substance misuse, which often harms brain structures responsible for mediating self-governance (Satel & Lilienfeld, 2013). This paper critically analyzes the therapeutic and sociological implications of the "brain disease" theory of substance abuse, and how this theory biases or limits an understanding of complex human behaviors such as chronic alcohol or drug consumption.

Conception of Deviant Drinking and Drug Use

Deviant drinking refers to a condition in which an individual exhibits behaviors inconsistent with behavioral, societal, or cultural norms. Such individuals may engage in antisocial acts, misuse alcohol and drugs, break societal norms, perpetrate violence, and violate criminal laws. Deviance, however, does not necessarily imply that an individual is antisocial, disengaged, criminal, or violent. It can also mean that their departure from societal norms occurs within a specific social setting or community. Deviant acts are normally associated with delinquent or antisocial activities, as they are usually disruptive and bothersome. Participation in alcohol and drug abuse, crime, aggression, and violence represents some of the most commonly occurring deviant behaviors. Alcohol and drug misuse is included in this listing because people engaging in it typically participate in, or seek out, socially non-conformist activities. They are often identified as easygoing, individualistic, unruly, and pleasure-seeking.

The failure of most drug users to progress to the dependency or abuse phase indicates that there is far more to addiction than the mere landing of drug molecules in the brain's receptor sites. Advocates of the brain disease theory typically assert that chronic drug consumption reduces brain metabolism, giving rise to "brain deficits" within the addict's prefrontal cortex, which help sustain addiction. To explain persistent drunkenness, the addiction-as-a-disease model has assumed different forms. Many people historically held the view that the vice driving drunkenness dwelled in the moral character of individual drunkards. Temperance advocates during the nineteenth century propagated the idea that evil was contained in the bottle itself — that anyone who brought alcohol to their lips would likely begin abusing it, and that everyone was susceptible to acquiring this disease. This view eventually gave rise to the nationwide prohibition of alcohol in 1919. Shortly after its repeal in 1933, the fellowship of Alcoholics Anonymous, together with a growing community of scientific and medical partners, formulated a new theory on the relationship between alcohol and addiction. According to this theory, most individuals could drink moderately; however, some people were highly vulnerable to chronic drinking and therefore prone to uncontrollable dependency (Deviance and Addiction, n.d.).

Drug consumption is labeled a subdivision of non-normative, deviant, and unlawful behavior, as psychoactive substance use elicits violations of societal norms and laws; therefore, drug use is associated with deviance and crime. Containment of drug consumption is achieved through links with, or conformity to, conventional beliefs, individuals, behaviors, and social institutions. Social control theorists consider attachment to conventionality as the factor accounting for abstinence from substances, while weak or absent attachments account for drug consumption. It is evident that crimes, including the use of illegal drugs, vary considerably with participation in conventional social institutions and interaction with other conventional societal aspects (Goode, 2011).

The Medical Model of Addiction

The medical model promises an unambiguous biological foundation for addiction. May (2001, p. 385) writes that the phenomenon of addiction in the medical context is grounded on the subordination of personal agency — and therefore the possibility of individual regulation — to a hypothesized pathological structure. Two major explanatory frameworks in this approach postulate biological mechanisms: the neuro-adaptation model and the genetic model. The neuro-adaptation model is most commonly used to explain addictive behavior. Vrecko (2010) has stressed that though addiction neuroscience rose owing to favorable financial and political conditions, one should not forget that this position has been highly productive, contributing to near-total acceptance of the idea that addiction represents a brain disease. Nevertheless, the approach has also attracted criticism. The medical concept remains popular, as the National Institute on Drug Abuse (NIDA), which finances approximately 85% of global addiction research, supports this approach (Vrecko, 2010). This position is most readily applied in the context of substance use; reconciling it with the notion of behavioral addictions proves considerably more difficult.

Proponents of addiction medicalization typically state that they have transformed how addiction is perceived — rather than a punishable crime, it is now regarded as an ailment requiring therapy. Though some progress toward this view has been made, the claim that addiction is a disease continues to be closely allied with penal prohibition laws, which have brought about mass imprisonment of vulnerable people. Drug courts invoke the disease perspective on a daily basis to justify imprisonment, though framed as an incentive for therapy in addicts' own interest. Drug policies, as has been noted, affect drug users' psychological states as well as the social settings of use, thereby generating behavioral consequences that proponents assert are merely rational responses. Research in critical addiction studies focuses on these linkages, given that drug policies have often had severely negative impacts on social justice and human rights. Such studies endeavor to develop more humane drug policies that will integrate, rather than ostracize, problematic drug users and more effectively reduce drug-related harm. As the disease model expands to encompass greater numbers of behaviors, critically examining responses to and framings of addiction becomes more vital than ever. One will be "chasing a phantom" if fixated on understanding overeating, gambling, compulsive sex, "pathological" Internet use, or innumerable other behaviors that may in the near future be labeled "addictive," solely in brain-chemistry terms (Reinarman & Granfield, 2014).

Conclusion

This paper has explored various perspectives on addiction, situated within different models that outline and govern the understanding and management of addicts. Addiction constructs, as they arise from the key theoretical disease frameworks, are largely problematized because they highlight the addict's vulnerabilities rather than his or her agency and strengths. The creation of a genuinely agentic and integrative addiction model remains a significant challenge.

References

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Deviance and Addiction. (n.d.). Retrieved November 17, 2015, from http://alcoholrehab.com/addiction-articles/deviance-and-addiction/

Goode, E. (2011, March 19). The sociology of drug use. Retrieved November 17, 2015, from https://edge.sagepub.com/system/files/Ballantine5e_6.2SK_0.pdf

May, C. (2001). Pathology, identity and the social construction of alcohol dependence. Sociology, 35, 385–401.

Reinarman, C. (2005). Addiction as accomplishment: The discursive construction of disease. Addiction Research and Theory, 13, 307–320.

Reinarman, C., & Granfield, R. (2014). Addiction is not just a brain disease. Expanding Addiction: Critical Essays.

Satel, S. L., & Lilienfeld, S. O. (2013). Brainwashed: The seductive appeal of mindless neuroscience. New York: Basic Books.

Vrecko, S. (2010). Birth of a brain disease: Science, the state and addiction neuro-politics. History of the Human Sciences, 23, 52–67.