Neuroscience and other brain disease models of addiction are highly selective, seductive and visually alluring. Consequently, they lead to neglecting or ignoring the awkward complexities of the human level, which include irrationality, emotionality, spin, knowledge as power, politics, and the mutability of discourse.
The human level is essential for understanding addiction. Examining opiate and opioid problems illustrates questions whether addiction can be understood at all without considering the following: social construction of addiction; wider social context of opioid use in medicine; interplay between common types of human suffering; medical and commercial promotion of drugs and other products as cures for psychological distress. The human level is characterised by reflexivity, teleological explanation, embodiment, phenomenology and knowledge/power.
Research influences and is influenced by social ideas, customs and behaviors. The biopsychosocial model might be an alternative, but it is often invoked to focus on the ‘bio’ part. Ignoring the human level has led to inappropriate interventions being offered that are unsuitable for people with severe addiction problems.
Alternatives are discussed, including the possibility of embodied theories of addiction using phenomenology and the power-threat-meaning framework, which eschews diagnoses in favour of formulation.
Richard Hammersley - ORCiD: https://orcid.org/0000-0002-0172-7899
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