Is Addiction a Brain Disease?
Ethan Nadelmann, head of the Drug Policy Alliance and the person most responsible for reforming drug laws in the United States, said in an interview with The Fix in 2014, the first year in which marijuana was legal in Colorado and Washington: “On the issue of drugs, there were two books that really had a significant impact on me. One was the Andrew Weil’s book, The Natural Mind,about why people use drugs. The second book that really made an impact on me was Stanton Peele’s book, The Meaning of Addiction, which I read in 1986.”
In, 1998, I wrote a preface for a new edition of Meaning, which was originally published in 1985.
I have been gratified to see The Meaning of Addiction become the classic expression of the extensive research that shows addiction cannot be resolved biologically—lived human experience and its interpretation are central to the incidence, course, treatment, and remission of addiction. The data presented in this book indicate this is permanently the case. The idea, on the other hand, that new genetic and neurochemical discoveries will eliminate this irrefutable truth is the greatest of all myths about addiction. [emphasis added]
After decades of growing acceptance, the concept that addiction is a medical disease (more exactly, a chronic brain disease) is all of the sudden being linked to the drug war—and being challenged—by a number of contemporary theorists. Most notably, Johann Hari has taken that position in his new book, Chasing The Scream: The First and Last Days of the War on Drugs, synopsized in a recent piece in the Huffington Post titled, “The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think.”
Hari—a popular journalist—tells a great story, or series of stories. One primary narrative concerns the experimental work Bruce Alexander conducted with rats and morphine at Simon Fraser University in Vancouver. Titled “Rat Park,” Alexander’s series of studies found that not only were rats only inclined to become habituated to the drug solution in a cage, but when given a choice of the tinctured drug or inert water in a capacious, rich environment in the company of other rats, even previously addicted animals preferred water.
The correct interpretation of these results is that addiction is not strictly, or largely, a result of the effects of drugs, even powerful narcotics. Rather, it is determined by the situations of those who use the drugs, a point Carl Hart makes and that I made in The Meaning of Addiction in a chapter I co-wrote with Alexander about his work. That addiction is only possible with caged—rather than free-range animals—indicates that people are more likely to be addicted when severely constricted in their life options, and that opening up an organism’s options makes recovery likely.
In The Meaning of Addiction, I quoted my earlier book, written with Archie Brodsky, Love and Addiction:
The difference between not being addicted and being addicted is the difference between seeing the world as your arena and seeing the world as your prison—or is it cage? It is striking that animal research in laboratories, even that conducted with a reductionist bent of mind, affirms this complex truth about addiction.
This was demonstrated by the Vietnam experience, when well over 90% of GIs addicted to heroin in Asia returned home and quit drugs, nearly always without treatment. That people withdrawn from the field of battle should be able to desist their drug use would not seem to be newsworthy. And, yet, as I noted in 1975 in Love and Addiction:
Dr. Richard S. Wilbur, then Assistant Secretary of Defense for Health and Environment, said that this conclusion to the heroin experience in Vietnam amazed him, and caused him to revise the notions about addiction that he had learned in medical school, where he “was taught that anyone who ever tried heroin was instantly, totally, and perpetually hooked.”
But the view of addiction refuted by Rat Park and Vietnam is alive and well. Indeed, it has grown stronger since Vietnam and Rat Park. Last year, an authoritative editorial in the world’s leading scientific journal, Nature, declared unambiguously that “Drug addiction is a disease,” one it traces to the brain’s neurochemically mediated reward system. Nature’s declaration is all the more impressive since the journal is published in the UK, and Europeans are less impressed as a rule by the brain-disease model, which is much more ardently embraced here.
But, Nature insists, “Europe should look to the United States and to inspirational figures such as Nora Volkow, head of the US National Institute on Drug Abuse . . . who regularly testifies on the science of addiction to the US Congress to justify the institute’s research budget. . . . Given the technical tools now available for looking deep inside the brain, there is realistic hope that such treatments will emerge from research in the coming decades.”
It might seem surprising to read that there is only hope about finding tools to address addiction in the brain “in the coming decades.” In fact, it’s not enough to say that no person in the world today is declared addicted on the basis of a brain scan, or that “not a single treatment“ has been developed out of the brain disease meme. The research itself doesn’t relate brain activity to behavior—a scan of a cocaine user doesn’t tell us that he is addicted, or that he will go out and use cocaine again now, or ever.
Most particularly, the brain scan tells us nothing about the majority of people who quit, or cut back or struggle to quit then succeed—which is really the single thing we want to know. This process can only be known subjectively, in terms of the person’s values, purpose, motivation, and options.
Creating a theory to deal with such complexity is a task worthy of science, as I did in 1985 in The Meaning of Addiction, which may be why I caught Ethan Nadelmann’s attention:
People become addicted to experiences. The addictive experience is the totality of effect produced by an involvement; it stems from pharmacological and physiological sources but takes its ultimate form from cultural and individual constructions of experience. The most recognizable form of addiction is an extreme, dysfunctional attachment to an experience that is acutely harmful to a person, but that is an essential part of the person’s ecology and that the person cannot relinquish. This state is the result of a dynamic social-learning process in which the person finds an experience rewarding because it ameliorates urgently felt needs, while in the long run it damages the person’s capacity to cope and ability to generate stable sources of environmental gratification.
Addiction takes place with an involvement that provides essential rewards that the individual’s need, and cannot obtain otherwise, as Carl Hart shows through his own experience in the Miami ghetto. But the continued pursuit of the involvement, as compared with other alternatives, is a function of an additional layer of social, situational, and personality variables. All of these elements are in flux as the individual grows up, changes environments, develops more mature coping mechanisms, loses and gains new opportunities for satisfaction, and is supported or undermined in forming new outlooks and self-conceptions.
There are indeterminate elements in addiction—for example, the person’s value commitments—affecting whether the person will continue to return to an experience that is progressively more damaging to the rest of their life. Even after the person has developed an addictive attachment, he or she can suddenly (as well as gradually) rearrange the values that maintain the addiction. This process is the remarkable one of maturing out, or natural remission in addiction.
It is this process of realizing the person’s power, of realizing or surfacing submerged values, that Ilse Thompson and I address in our book, Recover!
That addiction is so complex, so human, so engrained in the person’s consciousness of themselves and their worlds, doesn’t make addiction a less scientifically valid concept. It does make addiction a fully human phenomenon, one that we should embrace as such, for both good and bad.