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By analyzing the definitions and implications of addiction, the paper posits that motivational factors, identity, and socio-economic contexts must be considered in understanding addictive behavior. It explores the notion that addiction can align with personal values, thereby complicating the concept of moral responsibility in relation to addiction.</p><div class="toggle-truncation-button js-toggle-truncation-button--abstract"><button class="safe-abstract--toggle-truncation-button"><span>... </span><span class="safe-abstract--toggle-truncation-button-text">Read more</span></button></div></div></div></div><div class="ds-key-takeaways--container"><style type="text/css">.ds-loswp-section--container{display:flex;flex-direction:column;width:100%}@media(min-width: 1280px){.ds-loswp-section--container{padding-right:40px}}</style><div class="ds2-5-content-section"><div class="ds2-5-content-section__heading"><h2 class="ds2-5-content-section__heading__text">Key takeaways</h2></div><div class="ds2-5-content-section__main"><div class="ds2-5-content-section__main__content"><div class="ds-loswp-section--container"><ul class="ds2-5-body-md"><li>Like many advocates of the biomedical approach, he believes that seeing addiction as a disease of the brain will reduce social stigma and transform the way the addicts are treated by the public health and criminal justice systems.</li><li>Indeed, the lack of a widely accepted conceptual analysis of the category of disease means that there is no easy answer as to whether addiction is or is not a disease, nor accordingly whether any individual who uses a substance has a disease or not.</li><li>This justifies, in their view, calling addiction a "brain disease" (675).</li><li>Instead, theories of addiction tend to provide a scale of function on which addicts are taken to cluster at the low end.</li><li>Is there another pair of theories --of addiction on the one hand and responsibility on the other --that might justify our intuitions about the mitigating power of addiction?</li></ul></div></div></div></div></div><div class="safe-right-rail--container"><div class="safe-right-rail--related-works"><h2 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js-safe-related-work-related-work " data-collection-position="4" data-entity-id="27009501" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/27009501/Addiction_is_not_a_brain_disease">Addiction is not a brain disease</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32781408" href="https://usc-es.academia.edu/ElisardoBeco%C3%B1a">Elisardo B Becoña</a></div><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">The idea that addiction is a “brain disease” has gradually been consolidated in the medical-psychiatric field over the last years, as it appears in the current DSM-5. In this paper we analyse the way this idea has arisen and been consolidated, as well as the criticisms that it has received, the professional consequences if this model becomes hegemonic, and the underlying interests. The conclusion defends the need to show, as psychologists, our clear contributions to the field of addictions, and the psychological variables that are necessary in order to understand and prevent addictions, as well as the central role of psychological treatment due to its effectiveness. We must also denounce the reductionism that the model of brain disease represents in comparison with a biopsychosocial model of addiction.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Addiction is not a brain disease","attachmentId":47269524,"attachmentType":"pdf","work_url":"https://www.academia.edu/27009501/Addiction_is_not_a_brain_disease","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/27009501/Addiction_is_not_a_brain_disease"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="5" data-entity-id="16777718" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/16777718/Addiction_Not_just_brain_malfunction">Addiction: Not just brain malfunction</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="1378523" href="https://su-se.academia.edu/JanBlomqvist">Jan Blomqvist</a><span>, </span><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="3487326" href="https://qub.academia.edu/AndrewPercy">Andrew Percy</a><span>, </span><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="521440" href="https://gcal.academia.edu/PhilDalgarno">Phil Dalgarno</a><span>, </span><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="4893533" href="https://independent.academia.edu/AnjaKoskiJ%C3%A4nnes">Anja Koski-Jännes</a><span>, </span><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="36210980" href="https://ugent.academia.edu/TomDecorte">Tom Decorte</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Nature, 2014</p><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">Your editorial asserts that framing addiction as a social, as opposed to a medical, problem is akin to denying people hope that their loved ones 'might one day be helped with the terrible burden of this disease'. In the one-dimensional view endorsed in the editorial, substance use is divorced from its social, political, legal and environmental contexts, and is seen primarily or exclusively as a consequence of brain malfunction. This myopic perspective minimizes the enormous impact of people's life chances, choices and circumstances on addictive behaviors. In short, substance users are reduced to little more than mind-free victims of a brain disease. This position also trivializes the thoughts, emotions, and behaviors not only of current addicts but also of those individuals who have overcome dependence in various ways. It also belittles the significant impact public health campaigns and legislations are exerting on curbing harmful substance use. As a result of these efforts, for example, there are now more ex-smokers than current smokers in many countries.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Addiction: Not just brain malfunction","attachmentId":39177848,"attachmentType":"pdf","work_url":"https://www.academia.edu/16777718/Addiction_Not_just_brain_malfunction","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/16777718/Addiction_Not_just_brain_malfunction"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="6" data-entity-id="127792467" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/127792467/Addiction_Current_Criticism_of_the_Brain_Disease_Paradigm">Addiction: Current Criticism of the Brain Disease Paradigm</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="329938105" href="https://independent.academia.edu/MollyDingel">Molly Dingel</a></div><p class="ds-related-work--metadata ds2-5-body-xs">AJOB Neuroscience, 2013</p><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">To deepen understanding of efforts to consider addiction a "brain disease," we review critical appraisals of the disease model in conjunction with responses from in-depth semistructured stakeholder interviews with (1) patients in treatment for addiction and (2) addiction scientists. Sixty-three patients (from five alcohol and/or nicotine treatment centers in the Midwest) and 20 addiction scientists (representing genetic, molecular, behavioral, and epidemiologic research) were asked to describe their understanding of addiction, including whether they considered addiction to be a disease. To examine the NIDA brain disease paradigm, our approach includes a review of current criticism from the literature, enhanced by the voices of key stakeholders. Many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma. We conclude that it is not necessary, and may be harmful, to frame addiction as a disease. Over the last decade, the National Institute on Drug Abuse (NIDA) has proclaimed addiction to be a chronic, relapsing brain disease caused by prolonged substance use ). In the official publication "Drugs, Brains, and Behavior: The Science of Addiction," NIDA director Nora Volkow writes, "Today, thanks to science, our views and our responses to drug abuse have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of drug addiction, enabling us to respond effectively to the problem" (Volkow 2007). However, many social scientists have criticized the recent neurocentric discourse as "reductively inattentive to individual values and social context" (Courtwright 2010).</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Addiction: Current Criticism of the Brain Disease Paradigm","attachmentId":121473888,"attachmentType":"pdf","work_url":"https://www.academia.edu/127792467/Addiction_Current_Criticism_of_the_Brain_Disease_Paradigm","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/127792467/Addiction_Current_Criticism_of_the_Brain_Disease_Paradigm"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="7" data-entity-id="2537848" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/2537848/What_are_the_public_policy_implications_of_a_neurobiological_view_of_addiction">What are the public policy implications of a neurobiological view of addiction?</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32579388" href="https://independent.academia.edu/AdrianCarter5">Adrian Carter</a><span>, </span><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="2470737" href="https://uq.academia.edu/CoralGartner">Coral Gartner</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Addiction, 2012</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"What are the public policy implications of a neurobiological view of addiction?","attachmentId":50579350,"attachmentType":"pdf","work_url":"https://www.academia.edu/2537848/What_are_the_public_policy_implications_of_a_neurobiological_view_of_addiction","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/2537848/What_are_the_public_policy_implications_of_a_neurobiological_view_of_addiction"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="8" data-entity-id="77548377" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/77548377/What_does_acceptance_mean_Public_reflections_on_the_idea_that_addiction_is_a_brain_disease">What does ‘acceptance’ mean? Public reflections on the idea that addiction is a brain disease</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="213232554" href="https://independent.academia.edu/WayneHall20">Wayne Hall</a></div><p class="ds-related-work--metadata ds2-5-body-xs">BioSocieties, 2013</p><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">What does 'acceptance' mean? Public reflections on the idea that addiction is a brain disease. Biosocieties, 8,[491][492][493][494][495][496][497][498][499][500][501][502][503][504][505][506]</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"What does ‘acceptance’ mean? Public reflections on the idea that addiction is a brain disease","attachmentId":84926728,"attachmentType":"pdf","work_url":"https://www.academia.edu/77548377/What_does_acceptance_mean_Public_reflections_on_the_idea_that_addiction_is_a_brain_disease","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/77548377/What_does_acceptance_mean_Public_reflections_on_the_idea_that_addiction_is_a_brain_disease"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="9" data-entity-id="24687948" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/24687948/A_Matter_of_Addiction_Brain_Disease_or_Moral_Failing">A Matter of Addiction: Brain Disease or Moral Failing</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="2698625" href="https://bridgeport.academia.edu/ShirleyGedneyRubel">Shirley Gedney-Rubel</a></div><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"A Matter of Addiction: Brain Disease or Moral Failing","attachmentId":45017169,"attachmentType":"docx","work_url":"https://www.academia.edu/24687948/A_Matter_of_Addiction_Brain_Disease_or_Moral_Failing","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/24687948/A_Matter_of_Addiction_Brain_Disease_or_Moral_Failing"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="10" data-entity-id="37469098" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/37469098/How_Does_the_Brain_Disease_Model_Construct_the_Addict_and_their_Relationship_to_the_Substance">How Does the Brain Disease Model Construct the Addict and their Relationship to the Substance?</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="67176963" href="https://anu-au.academia.edu/PrachiArya">Prachi Arya</a></div><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"How Does the Brain Disease Model Construct the Addict and their Relationship to the Substance?","attachmentId":57437876,"attachmentType":"docx","work_url":"https://www.academia.edu/37469098/How_Does_the_Brain_Disease_Model_Construct_the_Addict_and_their_Relationship_to_the_Substance","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/37469098/How_Does_the_Brain_Disease_Model_Construct_the_Addict_and_their_Relationship_to_the_Substance"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="11" data-entity-id="3304936" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/3304936/De_Medicalizing_Addiction_Toward_Biocultural_Understandings">De-Medicalizing Addiction: Toward Biocultural Understandings</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="69930" href="https://wesleyan.academia.edu/KerwinKaye">Kerwin Kaye</a></div><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"De-Medicalizing Addiction: Toward Biocultural Understandings","attachmentId":32620304,"attachmentType":"pdf","work_url":"https://www.academia.edu/3304936/De_Medicalizing_Addiction_Toward_Biocultural_Understandings","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/3304936/De_Medicalizing_Addiction_Toward_Biocultural_Understandings"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="12" data-entity-id="38521012" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/38521012/Brain_change_in_addiction_as_learning_not_disease_pdf">Brain change in addiction as learning not disease.pdf</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32719334" href="https://unam.academia.edu/MatteoMatteo">Matteo Rivera</a></div><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Brain change in addiction as learning not disease.pdf","attachmentId":58589764,"attachmentType":"pdf","work_url":"https://www.academia.edu/38521012/Brain_change_in_addiction_as_learning_not_disease_pdf","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/38521012/Brain_change_in_addiction_as_learning_not_disease_pdf"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="13" data-entity-id="33351779" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/33351779/How_to_Recover_from_a_Brain_Disease_Is_Addiction_a_Disease_or_Is_there_a_Disease_like_Stage_in_Addiction">How to Recover from a Brain Disease: Is Addiction a Disease, or Is there a Disease-like Stage in Addiction</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="263231" href="https://healthfoodinnovationmanagement.academia.edu/AnkeSnoek">Anke Snoek</a></div><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">People struggling with addiction are neither powerless over their addiction, nor are they fully in control. Lewis vigorously objects to the brain disease model of addiction (BDMA), because it makes people lose belief in their self-efficacy, and hence hinders their recovery. Although he acknowledges that there is a compulsive state in addiction, he objects to the claim that this compulsion is carved in stone. Lewis argues that the BDMA underestimates the agency of addicted people, and hence hinder their recovery. Lewis's work offers us a very much to be welcomed neurobiology of recovery. It offers addicted people a hopeful and respectful narrative for their recovery that treats them as agents rather than as damaged brains. However, I argue that overestimating people's agency can also result in people losing belief in their self-efficacy. Lewis's strong focus on the agency of addicted people might not match their experiences of struggle, hence reinforcing their feelings of guilt when they fail to control their use. I propose to replace the notion of addiction as a disease with a notion of a disease-like stage in addiction. I call this stage the duress stage in addiction, in which the addictive behaviour is largely impervious to the agent's values and to available techniques of self-control. However, the agent can overcome this stage by developing new techniques of self-control, by building on their self-concept and belief in self-efficacy, by changing their environments and habits, and by engaging in projects that are meaningful to the agent.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"How to Recover from a Brain Disease: Is Addiction a Disease, or Is there a Disease-like Stage in Addiction","attachmentId":53410191,"attachmentType":"pdf","work_url":"https://www.academia.edu/33351779/How_to_Recover_from_a_Brain_Disease_Is_Addiction_a_Disease_or_Is_there_a_Disease_like_Stage_in_Addiction","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/33351779/How_to_Recover_from_a_Brain_Disease_Is_Addiction_a_Disease_or_Is_there_a_Disease_like_Stage_in_Addiction"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="14" data-entity-id="106125963" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/106125963/Is_a_brain_based_understanding_of_addiction_predominant_An_assessment_of_addiction_researchers_conceptions_of_addiction_and_their_evaluation_of_brain_based_explanations">Is a brain‐based understanding of addiction predominant? An assessment of addiction researchers' conceptions of addiction and their evaluation of brain‐based explanations</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="279310828" href="https://independent.academia.edu/DOchterbeck">Doris Ochterbeck</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Drug and Alcohol Review</p><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">Introduction: Brain-based explanations of addiction have become a prominent explanatory model in recent decades. Although opposing views have been published, there is no large-scale study of researchers' opinions, unlike for treatment staff, the public and affected individuals. Therefore, this study aimed to examine international addiction researchers' perspectives on: (i) brain-based explanations of addiction; (ii) the perceived dominance of the concept in science, society, treatment and among those affected; and (iii) researchers' general conception of addiction in terms of ontologies and causes. Methods: A sample of 1440 international addiction researchers was compiled. Views were assessed online via LimeSurvey using a 'mixed methods light' approach (Likert-type scales, free-text fields). Qualitative content analyses of freetext comments complemented descriptive statistics. Results: One hundred and ninety researchers participated (13.19% response). The classification of substance use disorders as brain diseases/disorders was shared by about 60% of the respondents. Approximately 80% considered it the dominant view in science, but fewer in treatment, society and affected persons. Approximately 75% found it an oversimplification, but regarded it as helpful for understanding substance use disorders. Altogether, various biological, psychological and social factors were considered causal. Comments indicated that an over-simplistic nature of brain-based explanations of addiction was viewed as particularly problematic. Discussion and Conclusions: A rejection of a simplistic view of addiction in favour of a multi-causal concept in which the brain plays a role seems to be the majority view of participating researchers. Therefore, the orientation of future research, treatment and support for addicted persons need to be reconsidered accordingly.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Is a brain‐based understanding of addiction predominant? An assessment of addiction researchers' conceptions of addiction and their evaluation of brain‐based explanations","attachmentId":105405281,"attachmentType":"pdf","work_url":"https://www.academia.edu/106125963/Is_a_brain_based_understanding_of_addiction_predominant_An_assessment_of_addiction_researchers_conceptions_of_addiction_and_their_evaluation_of_brain_based_explanations","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/106125963/Is_a_brain_based_understanding_of_addiction_predominant_An_assessment_of_addiction_researchers_conceptions_of_addiction_and_their_evaluation_of_brain_based_explanations"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="15" data-entity-id="110121004" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/110121004/Addiction_and_the_Concept_of_Disorder_Part_2_Is_every_Mental_Disorder_a_Brain_Disorder">Addiction and the Concept of Disorder, Part 2: Is every Mental Disorder a Brain Disorder?</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="4288486" href="https://independent.academia.edu/jeromewakefield">jerome C wakefield</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Neuroethics, 2016</p><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">In this two-part analysis, I analyze Marc Lewis's arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. In Part 1, I argued that, even if one accepts Lewis's critique of the brain evidence presented for the brain-disease view, his arguments fail to establish that addiction is not a disorder. Relying on my harmful dysfunction analysis of disorder, I defended the view that addiction is a medical disorder and a brain disorder. In Part 2, I consider some broader philosophical issues raised by Lewis's arguments: (1) I consider a larger puzzle, at the heart of the neo-Kraepelinian program in contemporary psychiatry, that is raised by Lewis's argument that addiction is not a disorder because the brain displays no damage but only normal learning: must all mental disorders be brain disorders, or can mental disorders occur in normal brains? I argue that mental disorders can occur in normal brains. (2) I critique Lewis's response to the evolutionary Bnovel environment^approach to explaining why addiction is a disorder. (3) Lewis agrees with brain-disease proponents that interpreting addiction as brain disorder relieves addicts of moral censure, but I argue that moral defect and brain disease are not exclusive. (4) Finally, I consider Lewis's Neuroethics</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Addiction and the Concept of Disorder, Part 2: Is every Mental Disorder a Brain Disorder?","attachmentId":108037095,"attachmentType":"pdf","work_url":"https://www.academia.edu/110121004/Addiction_and_the_Concept_of_Disorder_Part_2_Is_every_Mental_Disorder_a_Brain_Disorder","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/110121004/Addiction_and_the_Concept_of_Disorder_Part_2_Is_every_Mental_Disorder_a_Brain_Disorder"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="16" data-entity-id="13339083" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/13339083/Views_of_Addiction_Neuroscientists_and_Clinicians_on_the_Clinical_Impact_of_a_Brain_Disease_Model_of_Addiction_">Views of Addiction Neuroscientists and Clinicians on the Clinical Impact of a ‘Brain Disease Model of Addiction’</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32579388" href="https://independent.academia.edu/AdrianCarter5">Adrian Carter</a><span>, </span><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="2470737" href="https://uq.academia.edu/CoralGartner">Coral Gartner</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Neuroethics, 2014</p><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">Addiction is increasingly described as a "chronic and relapsing brain disease". The potential impact of the brain disease model on the treatment of addiction or addicted individuals' treatment behaviour remains uncertain. We conducted a qualitative study to examine: (i) the extent to which leading Australian addiction neuroscientists and clinicians accept the brain disease view of addiction; and (ii) their views on the likely impacts of this view on addicted individuals' beliefs and behaviour. Thirty-one Australian addiction neuroscientists and clinicians (10 females and 21 males; 16 with clinical experience and 15 with no clinical experience) took part in 1 h semi-structured interviews. Most addiction neuroscientists and clinicians did not uncritically support the use of brain disease model of addiction. Most were cautious about the potential for adverse impacts on individuals' recovery and motivation to enter treatment. While some recognised the possibility that the brain disease model of addiction may provide a rationale for addicted persons to seek treatment and motivate behaviour change, Australian addiction neuroscientist and clinicians do not assume that messages about "diseased brains" will always lead to increased treatment-seeking and reduced drug use. Research is needed on how neuroscience research could be used in ways that optimise positive outcomes for addicted persons.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Views of Addiction Neuroscientists and Clinicians on the Clinical Impact of a ‘Brain Disease Model of Addiction’","attachmentId":45449913,"attachmentType":"pdf","work_url":"https://www.academia.edu/13339083/Views_of_Addiction_Neuroscientists_and_Clinicians_on_the_Clinical_Impact_of_a_Brain_Disease_Model_of_Addiction_","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/13339083/Views_of_Addiction_Neuroscientists_and_Clinicians_on_the_Clinical_Impact_of_a_Brain_Disease_Model_of_Addiction_"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="17" data-entity-id="38521013" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/38521013/Brain_disease_model_of_addiction_why_is_it_so_controversial_pdf">Brain disease model of addiction why is it so controversial.pdf</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32719334" href="https://unam.academia.edu/MatteoMatteo">Matteo Rivera</a></div><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">The "Personal View" by Hall, Carter, and Forlini 1 questions the value of the BDMA (brain disease model of addiction) and claims that it is not supported by animal or neuroimaging evidence, that it has not helped deliver more effective treatments and that its impact on public policy have been modest. However, these claims are not supported by the evidence. First, preclinical and clinical studies have consistently delineated specific molecular and functional neuroplastic changes at the synaptic and circuitry level that are triggered by repeated drug exposure. These findings, along with ongoing research, are helping us understand the neurobiological processes associated with the loss of control, compulsive drug taking, inflexible behavior, and negative emotional states associated with addiction ( ). Second, uncovering the molecular targets and circuits underlying addiction has already resulted in several effective medications (naloxone and acamprosate for alcoholism, buprenorphine-naloxone for opioid addiction; varenicline for tobacco addiction) and ongoing clinical trials are taking advantage of this knowledge to test new targets 2, 3 . For the approved medications the effect sizes are similar to those associated with standard antidepressant pharmacotherapies. This knowledge had also provided the basis for the use of stimulation techniques such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) and its variants, to strengthen circuits impaired by addiction with promising results 4, 5 . It has also provided clinicians with a framework to guide targeted interventions to strengthen the impaired circuits (i.e., behavioral interventions to enhance self-control, reduce stress reactivity, improve mood). Finally, the statement that the effects of the BDMA framework on public policy are modest negates some major achievements, such as the passage in 2008 of the parity law (the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, driven by the BDMA model) that requires medical insurance for the first time in the USA to cover costs associated with the treatment of addiction 6 . Finally, the mere framework of BDMA has benefits in treatment as it significantly diminishes the stigma attached with addiction and gives hope for recovery to those fighting this devastating disease.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Brain disease model of addiction why is it so controversial.pdf","attachmentId":58589762,"attachmentType":"pdf","work_url":"https://www.academia.edu/38521013/Brain_disease_model_of_addiction_why_is_it_so_controversial_pdf","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/38521013/Brain_disease_model_of_addiction_why_is_it_so_controversial_pdf"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="18" data-entity-id="75816792" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/75816792/Brain_Change_in_Addiction_as_Learning_Not_Disease">Brain Change in Addiction as Learning, Not Disease</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="95588119" href="https://independent.academia.edu/MarcLewis14">Marc Lewis</a></div><p class="ds-related-work--metadata ds2-5-body-xs">New England Journal of Medicine, 2018</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Brain Change in Addiction as Learning, Not Disease","attachmentId":83436916,"attachmentType":"pdf","work_url":"https://www.academia.edu/75816792/Brain_Change_in_Addiction_as_Learning_Not_Disease","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/75816792/Brain_Change_in_Addiction_as_Learning_Not_Disease"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card js-safe-related-work-related-work hidden" data-collection-position="19" data-entity-id="56919713" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/56919713/What_Is_Wrong_with_the_Brains_of_Addicts">What Is Wrong with the Brains of Addicts?</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="73270" href="https://oslomet.academia.edu/EdmundHenden">Edmund Henden</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Neuroethics, 2016</p><p class="ds2-5-body-sm ds-related-work--abstract hide-on-large">In his target article and recent interesting book about addiction and the brain, Marc Lewis claims that the prevalent medical view of addiction as a brain disease or a disorder, is mistaken. In this commentary we critically examine his arguments for this claim. We find these arguments to rest on some problematical and largely undefended assumptions about notions of disease, disorder and the demarcation between them and good health. Even if addiction does seem to differ from some typical brain diseases, we believe contrary to Lewis, that there are still good reasons to maintain its classification as a mental or behavioral disorder.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"What Is Wrong with the Brains of Addicts?","attachmentId":98453483,"attachmentType":"pdf","work_url":"https://www.academia.edu/56919713/What_Is_Wrong_with_the_Brains_of_Addicts","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/56919713/What_Is_Wrong_with_the_Brains_of_Addicts"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><button class="ds2-5-text-link ds2-5-text-link--inline safe-related-works--view-more-button js-safe-related-works-related-work--view-more-button"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">keyboard_arrow_down</span><span class="ds2-5-text-link__content">View more papers</span></button></div></div><div class="safe-related-topics--container"><h2 class="safe-related-topics--heading">Related topics</h2><div class="safe-related-topics--list"><div class="safe-related-topics--subgroup"><li class="safe-related-topics--list-item"><a class="ds2-5-body-sm ds2-5-body-link js-related-research-interest" data-entity-id="907" href="https://www.academia.edu/Documents/in/Moral_Psychology">Moral Psychology</a><button class="ds-pill-button ds-pill-button--small safe-related-topics--pill js-swp-download-button" data-signup-modal="{"location":"related-topics--follow","work_url":"https://www.academia.edu/Documents/in/Moral_Psychology"}"><span class="material-symbols-outlined" style="font-size: 16px" translate="no">add</span>Follow</button></li><li class="safe-related-topics--list-item"><a class="ds2-5-body-sm ds2-5-body-link js-related-research-interest" data-entity-id="8546" href="https://www.academia.edu/Documents/in/Philosophy_of_Psychiatry">Philosophy of Psychiatry</a><button class="ds-pill-button ds-pill-button--small safe-related-topics--pill js-swp-download-button" data-signup-modal="{"location":"related-topics--follow","work_url":"https://www.academia.edu/Documents/in/Philosophy_of_Psychiatry"}"><span class="material-symbols-outlined" style="font-size: 16px" translate="no">add</span>Follow</button></li></div><div class="safe-related-topics--subgroup"><li class="safe-related-topics--list-item"><a class="ds2-5-body-sm ds2-5-body-link js-related-research-interest" data-entity-id="29777" href="https://www.academia.edu/Documents/in/Free_Will_and_Moral_Responsibility">Free Will and Moral Responsibility</a><button class="ds-pill-button ds-pill-button--small safe-related-topics--pill js-swp-download-button" data-signup-modal="{"location":"related-topics--follow","work_url":"https://www.academia.edu/Documents/in/Free_Will_and_Moral_Responsibility"}"><span class="material-symbols-outlined" style="font-size: 16px" translate="no">add</span>Follow</button></li></div></div></div></div><div class="safe-below-fold--container safe-below-fold--container-daring"><div class="safe-sticky-ctas--container js-loswp-sticky-ctas hidden"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--sticky-ctas","attachmentId":65995922,"attachmentType":"pdf","workUrl":null}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--sticky-ctas","attachmentId":65995922,"attachmentType":"pdf","workUrl":null}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div><div class="ds-work--container js-loswp-embedded-document"><div class="attachment_preview" data-attachment="Attachment_65995922" style="display: none"><div class="js-scribd-document-container"><div class="scribd--document-loading js-scribd-document-loader" style="display: block;"><img alt="Loading..." src="//a.academia-assets.com/images/loaders/paper-load.gif" /><p>Loading Preview</p></div></div><div style="text-align: center;"><div class="scribd--no-preview-alert js-preview-unavailable"><p>Sorry, preview is currently unavailable. 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