Chapter 44 Replacing the BDMA: A paradigm shift in the field of addiction


Is addiction a maladaptive choice or an involuntary compulsion, or some amalgam of the two? This central “puzzle of addiction” has not been solved, despite intensive scientific investigation for over a century and serious consideration by philosophers that began in ancient times.

Currently, the dominant Brain Disease Model of Addiction (BDMA) anchors addiction theory well towards the compulsion end of the continuum, although the supporting evidence and therapeutic utility of this model have been seriously challenged. While the central “puzzle of addiction” thus remains unsolved, dangerous addictions, to drug use as well as to countless other habits, continue to plague the modern world.

This chapter proposes a paradigm shift that will redirect attention away from the apparently unsolvable puzzle – including the BDMA – to an entirely different question. What adaptive functions do addictions to drug use and other pursuits that do not involve drugs serve for addicted people in the modern world, notwithstanding the harm that they can bring?

The chapter outlines an “adaptive paradigm” for addiction and argues that a paradigm shift can open up a more timely and productive discussion of theory and policy.


Bruce K. Alexander - ORCiD:


Evaluating the Brain Disease Model of Addiction is available from: