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


The "brain-disease" model of addiction highlights changes in brain systems that mediate action, reward-acquisition, perception, and cognitive control. Despite its popularity in some sectors, many addiction researchers reject the disease definition and instead view addiction in terms of learning and environmental variables.

"Non-disease" approaches typically omit the brain from any role in explaining addiction. Yet brain change accompanies all learning. Why should the powerful habit-learning that leads to addiction be viewed as if the brain were not involved? This chapter samples some of the neural data highlighted by disease models, demonstrates how these data can be interpreted in terms of learning rather than pathology, and suggests how "disease thinking" by addiction doctors can cause more harm than good.

By assessing the neurobiological as well as behavioural manifestations of addiction, this analysis allows disease and non-disease models to be compared across the board. It is concluded that synaptic reorganization indeed helps explain the compulsive and habitual thinking that favours addictive activities without any suggestion of pathology, brain damage, or disease.


Marc Lewis - ORCiD:


Evaluating the Brain Disease Model of Addiction is available from: