Criticisms (and some defenses) of the Brain Disease Model of Addiction
Version 6, January 2022
Alexander, B. K. (2008). The Globalisation of Addiction: A Study in Poverty of the Spirit. Oxford University Press. https://oxfordmedicine.com/view/10.1093/med/9780199588718.001.0001/med-9780199588718
A radical but influential view of addiction as a form of social and cultural dislocation.
Brief for 11 Addiction Experts as Amici Curiae Supporting Appellee, Commonwealth v. Julie Eldred, No. SJC-12279 (Mass. 2017). https://www.washingtonpost.com/news/volokh-conspiracy/wp-content/uploads/sites/14/2017/10/EldredAddictionBrief.pdf
An Amicus Brief compiled by addiction experts (Morse, Heyman, Satel, Lilienfeld, et al.) to answer the question: “May the probationer permissibly be required to ‘remain drug free’ as a condition of her probation, and may she permissibly be punished for violating that condition, where the probationer suffers from substance use disorder [SUD], and where her continued use of substances despite negative consequences is a symptom of that disorder.” Important reading for those interested in the legal implications of the BDMA.
Davies, J. B. (1992). The Myth of Addiction. Harwood Academic.
A concerted argument that the concept of addiction is not useful in either science or practice, leading to the conclusion that ‘addiction’ is in fact a myth.
Hall, W., Carter, A., & Forlini, C. (2014). The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises? Lancet Psychiatry, 2, 105-110. https://doi.org/10.1016/S2215-0366(14)00126-6
The authors answer to the questions in their subtitle is ‘no’. The article is reprinted in the ATN book – Heather et al. (2022), see below.
[Volkow, N., & Koob, G. (2015). Brain disease model of addiction: why is it so controversial? Lancet Psychiatry, 2, 677-679. https://doi.org/10.1016/S2215-0366(15)00236-9
Prominent advocates of the BDMA (the Directors of the US National Institute on Drug Abuse and the National Institute on Alcohol Abuse & Alcoholism) reply to criticisms by Hall et al.. They cannot understand why the BDMA should be criticised. Reprinted in the ATN book – Heather et al. (2022), see below.]
Hall, W., Carter., A, & Forlini, C. (2015). Brain disease model of addiction: misplaced priorities? Lancet Psychiatry, 2, 867. https://doi.org/10.1016/S2215-0366(15)00417-4
Hall and colleagues reply to the reply. Reprinted in the ATN book – Heather et al. (2022), see below.
Hammersley, R., & Reid, M. (2002). Why the pervasive addiction myth is still believed. Addiction Research & Theory, 10, 7-30. https://doi.org/10.1080/16066350290001687
An influential attack on the concept of addiction itself.
Hart, C.L. (2017). Viewing addiction as a brain disease promotes social injustice. Nature Human Behavior, 1. https://doi.org/10.1038/s41562-017-0055
A short but effective piece by a neuroscientist on the consequences of the BDMA for social injustice and racist policies.
Heather, N. (2017). Is the concept of compulsion useful in the explanation or description of addictive behaviour and experience? Addictive Behavior Reports, 6, 15-38.
An analysis of evidence bearing on the concept on which disease models of addiction, and the BDMA in particular, crucially rest. https://doi.org/10.1016/j.abrep.2017.05.002
Heather, N. (2017). Q: Is addiction a brain disease or a moral failing? A: Neither. Neuroethics, 10, 115-124.
A protest against the idea, promoted by supporters of the BDMA, that the only alternative to seeing addiction as a brain disease is to see it as a moral failing. https://doi.org/10.1007/s12152-016-9289-0
Heather, N., Field, M., Moss, A.T., & Satel, S. (2022). Evaluating the Brain Disease Model of Addiction. Routledge. https://www.routledge.com/Evaluating-the-Brain-Disease-Model-of-Addiction/Heather-Field-Moss-Satel/p/book/9780367470067
A collection of essays representing four different attitudes to the validity of the BDMA: For; Against; Unsure; Alternatives. The editors compiled the book of behalf of the Addiction Theory Network and chapter authors include some of the most original and influential voices in the addiction field.
Heather, N., Best, D., Kawalek, A., Field, M., Lewis, M., Rotgers, F., Wiers, R.W. & Heim, D. (2017). Challenging the brain disease model of addiction: European launch of the Addiction Theory Network (Editorial). Addiction Research & Theory, 26, 249-255. https://doi.org/10.1080/16066359.2017.1399659
Summaries of papers given at the launch of the Addiction Theory Network in Europe, together with a brief account of the origins of the network and its aims and activities.
Heilig, M., Epstein, D., Nader, M., & Shaham, Y. (2016). Time to connect: bringing social context into addiction neuroscience. Nature Reviews Neuroscience, 17, 592-599. https://doi.org/10.1038/nrn.2016.67
An attempt to incorporate social exclusion and marginalization into neuroscientific accounts of addiction and make it more clinically relevant. Reprinted in Heather et al. (2022) – see above.
Heilig, M., MacKillop, J., Martinez, D., Rehm, J., Leggio, L., & Vanderschuren, L. (2021). Addiction as a brain disease revised: why it still matters, and the need for consilience. Neuropsychopharmacology, 46, 1715-1723. https://doi.org/10.1038/s41386-020-00950-y
The presentation of a revised brain disease model of addiction that attempts to take into account recent criticisms while retaining the depiction of addiction as a disease of the brain. Discussed in the ‘Concluding Comments’ chapter in Heather et al. (2022) – see above.
Heyman, G.M. (2009). Addiction: A Disorder of Choice. Harvard University Press. https://www.hup.harvard.edu/catalog.php?isbn=9780674057272
An influential presentation of an alternative to the disease view of addiction and the evidence in support of that alternative.
Heyman, G. (2013). Quitting drugs: quantitative and qualitative features. Annual Review of Clinical Psychology, 9, 29-59. https://doi.org/10.1146/annurev-clinpsy-032511-143041
A summary of evidence showing that most people meeting diagnostic criteria for addiction recover on their own without professional help.
Hogarth, L. (2020). Addiction is driven by excessive goal-directed drug choice under negative affect: translational critique of habit and compulsion theory. Neuropsychopharmacology, 45, 720-735. https://doi.org/10.1038/s41386-020-0600-8
Winner of the 2021 Neuropsychopharmacology review award. Criticises the key claim of the BDMA that addiction is automatic and compulsive on the grounds that animal behavioural neuroscience paradigms have failed to translate to human drug users, who remain goal-directed in contrast to rodents.
Kalant, H. (2010). What neurobiology cannot tell us about addiction. Addiction, 105, 780-789. https://doi.org/10.1111/j.1360-0443.2009.02739.x
This article by a distinguished neuroscientist shows that the postulation of neural mechanisms given causal roles in the portrayal of addiction as a brain disease caused by chronic exposure to drugs has not been experimentally or clinically supported.
Kvaale, E. P., Haslam, N., & Gottdiener, W. H. (2013). The 'side effects' of medicalization: a meta-analytic review of how biogenetic explanations affect stigma. Clinical Psychology Review, 33, 782-794. https://doi.org/10.1016/j.cpr.2013.06.002
Meta-analysis demonstrating that biogenetic explanation of mental health problems and addiction have mixed blessings in reducing blame but increasing prognostic pessimism and perceived dangerousness of the individual.
Levy, N. (2013). Addiction is not a brain disease (and it matters). Frontiers in Psychiatry, 4. https://doi.org/10.3389/fpsyt.2013.00024
A reasoned critique of the BDMA by an eminent philosopher.
Levy, N. (Ed.) (2013). Addiction and Self-control: Perspectives from Philosophy, Psychology and Neuroscience. Oxford University Press. https://oxford.universitypressscholarship.com/view/10.1093/acprof:oso/9780199862580.001.0001/acprof-9780199862580
A collection of fascinating essays analysing the relationship between the concepts of addiction and self-control.
Lewis, M. (2015). The Biology of Desire: Why Addiction Is Not a Disease. PublicAffairs. https://www.publicaffairsbooks.com/titles/marc-lewis-phd/the-biology-of-desire/9781610394376/
A neuroscientist argues that brain changes seen in addiction result from deep learning, as occurs when any highly-motivating reward is pursued repeatedly with limited opportunities or resources to pursue its alternatives.
Lewis, M. (2017). Addiction and the brain: development, not disease. Neuroethics, 10, 7-18. https://doi.org/10.1007/s12152-016-9293-4
Another presentation of Lewis’ ideas forming the basis for an important special issue of Neuroethics giving a range of commentaries on his developmental-learning model of addiction.
Lewis, M. (2018). Brain change in addiction as learning, not disease. New England Journal of Medicine, 379, 1551-1560. https://doi.org/10.1056/NEJMra1602872
An article in a leading medical journal setting forth Lewis’ position on the nature of addiction.
Morse, S. (2016). Addiction, choice and criminal law. In N. Heather & G. Segal (Eds.), Addiction and Choice: Rethinking the Relationship (pp. 426-447). Oxford University Press. https://oxford.universitypressscholarship.com/view/10.1093/acprof:oso/9780198727224.001.0001/acprof-9780198727224
One of several discussions of the legal implications of the concept of addiction from the world’s leading authority on this topic.
Peele, S. (2015). Is addiction a brain disease? The Fix, 16 March. https://www.thefix.com/content/meaning-addiction%E2%80%94-addiction-brain-disease
One of many critiques of the BDMA from a pioneer of objections to biological reductionism in the addictions field.
Pickard, H. (2020). What we’re not talking about when we talk about addiction. Hastings Center Report, 50, 37-46. https://doi.org/10.1002/hast.1172
One of several penetrating discussions of addiction in society from a leading philosopher in the addiction field.
Pickard, H. (2021). Is addiction a brain disease? A plea for agnosticism and heterogeneity. Psychopharmacology, Online ahead of print. https://doi.org/10.1007/s00213-021-06013-4
The author argues that we do not yet have sufficient evidence to decide whether or not addiction is a brain disease.
Pickard, H., & Ahmed, S. (Eds.). (2019). The Routledge Handbook of Philosophy and Science of Addiction. Routledge. https://www.routledge.com/The-Routledge-Handbook-of-Philosophy-and-Science-of-Addiction/Pickard-Ahmed/p/book/9780367571504
An indispensable collection of essays exploring relationships between scientific and philosophical accounts of addiction.
Pitts-Taylor, V. (2019). Neurobiologically poor? Brain phenotypes, inequality, and biosocial determinism. Science, Technology, & Human Values, 44, 660-685. https://doi.org/10.1177/0162243919841695
A fascinating philosophical claim that the overemphasis on biological determinants by reductionist theories ignores social and economic causation, justifying criminalisation and control of marginalised groups over social justice interventions.
Reinarman, C., & Granfield, R. (2015). Addiction is not just a brain disease: critical studies in addiction. In R. Granfield & C. Reinarman (Eds.), Expanding Addiction: Critical Essays (pp. 1-21). Routledge. https://www.routledge.com/Expanding-Addiction-Critical-Essays/Granfield-Reinarman/p/book/9780415843294
The key introductory chapter in a book containing many of the classic contributions from social science on whether addiction is best regarded as a brain disease.
Ross, D. (2020). Addiction is socially engineered exploitation of natural biological vulnerability. Behavioural Brain Research, 386, 112598. https://doi.org/10.1016/j.bbr.2020.112598
The author argues that, rather than a disease of the brain, addiction should be seen as a disease at the scale of public health research and policy but not at the level of clinical intervention. The article is reprinted in the ATN book – Heather et al. (2022), see above.
Satel, S, & Lilienfeld, S. (2014). Addiction and the brain-disease fallacy. Frontiers in Psychiatry, 4(141). https://doi.org/10.3389/fpsyt.2013.00141
One of several penetrating critiques of the BDMA by these authors. The article is reprinted in the ATN book – Heather et al. (2022), see above.
Satel, S, & Lilienfeld, S. (2017, June 22). Calling it ‘brain disease’ makes addiction harder to treat. Boston Globe. https://www.bostonglobe.com/ideas/2017/06/22/calling-brain-disease-makes-addiction-harder-treat/ehaJs5ZYIXpPottG89KOGK/story.html
An eloquent newspaper feature commenting on the ‘opioid crisis’ in the USA.
Volkow, N.D., Koob, G.F., & McLellan, AT. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374, 363-371. https://doi.org/10.1056/NEJMra1511480
A key defence of the BDMA by Volkow and colleagues, including in an appendix their attempt to refute what the authors take to be the main criticisms of their model of addiction. Reprinted in the ATN book – Heather et al. (2022), see above.
Wakefield, J. C. (2020). Addiction from the harmful dysfunction perspective: How there can be a mental disorder in a normal brain. Behavioural Brain Research, 389, 112665. https://doi.org/https://doi.org/10.1016/j.bbr.2020.112665
Argues for an “evolutionary hijack” model, wherein addiction is not automatic as proposed by the BDMA but supernormal positive reinforcement of deliberate value-based choice due to the recency of drugs in the evolutionary history of the species.
Wiens, T.K., & Walker, L.J. (2015). The chronic disease concept of addiction: helpful or harmful? Addiction Research & Theory, 23, 309-321. https://doi.org/10.3109/16066359.2014.987760
A useful analysis of some of the main claims of the BDMA.