Addiction as a brain disease revised: why it still matters, and the need for consilience

Research output: Contribution to journalReview articleContributedpeer-review

Contributors

  • Markus Heilig - , Linköping University (Author)
  • James MacKillop - , McMaster University, Homewood Research Institute (Author)
  • Diana Martinez - , Columbia University (Author)
  • Jürgen Rehm - , Chair of Behavioral Epidemiology, University of Toronto, TUD Dresden University of Technology, Sechenov First Moscow State Medical University (Author)
  • Lorenzo Leggio - , National Institutes of Health (NIH) (Author)
  • Louk J.M.J. Vanderschuren - , Utrecht University (Author)

Abstract

The view that substance addiction is a brain disease, although widely accepted in the neuroscience community, has become subject to acerbic criticism in recent years. These criticisms state that the brain disease view is deterministic, fails to account for heterogeneity in remission and recovery, places too much emphasis on a compulsive dimension of addiction, and that a specific neural signature of addiction has not been identified. We acknowledge that some of these criticisms have merit, but assert that the foundational premise that addiction has a neurobiological basis is fundamentally sound. We also emphasize that denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing access to healthcare and treatment, the consequences of which are catastrophic. Here, we therefore address these criticisms, and in doing so provide a contemporary update of the brain disease view of addiction. We provide arguments to support this view, discuss why apparently spontaneous remission does not negate it, and how seemingly compulsive behaviors can co-exist with the sensitivity to alternative reinforcement in addiction. Most importantly, we argue that the brain is the biological substrate from which both addiction and the capacity for behavior change arise, arguing for an intensified neuroscientific study of recovery. More broadly, we propose that these disagreements reveal the need for multidisciplinary research that integrates neuroscientific, behavioral, clinical, and sociocultural perspectives.

Details

Original languageEnglish
Pages (from-to)1715-1723
Number of pages9
JournalNeuropsychopharmacology
Volume46
Issue number10
Publication statusPublished - Sept 2021
Peer-reviewedYes

External IDs

PubMed 33619327

Keywords