Is addiction science undergoing a paradigm shift?

By Nick Heather PhD
Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, UK

In this post I assume that a radical transformation is currently occurring in addiction science and suggest the possibility that this might been seen as a Kuhnian ‘paradigm shift’. The puzzle of addiction is that people labelled as addicts persist in behaving in ways they know cause harm to themselves and others. In the currently dominant ‘normal science’, the answer to this puzzle is that addictive behavior represents a kind of compulsion caused by a disease of the brain. However, this is contradicted by anomalous findings from several types of evidence that addictive behavior is not automatic and compelled but is, rather, voluntary and intentional. The emerging paradigm is therefore based on the assumption that addictive behavior is a disorder of choice. How the puzzle addiction can be solved is the first task to be addressed under this new paradigm but some possibilities are suggested. If it is believed that evidence from neuroimaging is sufficient proof that addiction must be a brain disease, reasons are provided for why such a belief is unfounded. Implications for the treatment and prevention of addiction arising from the new paradigm are explored. The article concludes by pointing to two commonly-encountered misconceptions of what a new paradigm for addiction might look like - that it implies a return to a ‘moral model’ of addiction and that it regards the consequences of addictive behavior as less serious than previously thought. Neither of these objections is credible.

KEYWORDS: Addiction/ Science/ Paradigm shift/ Brain disease/ Compulsion/ Voluntary and intentional behavior/ Disorder of choice

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