Does it matter if addiction is a brain disease?

Alan Leshner, then head of the US National Institute on Drug Abuse (NIDA), was in no doubt: “Addiction Is a Brain Disease, and It Matters,” was the title and claim of his pivotal paper published in 1997. His thesis was that repeated drug use rewires and chemically alters the brain in ways which result in compulsive drug seeking and use – “The addicted brain is distinctly different from the non-addicted brain.” For treatment this was said to matter because “a major goal … must be either to reverse or to compensate for those brain changes … through either medications or behavioural treatments … Elucidation of the biology underlying the metaphorical switch is key to the development of more effective treatments, particularly anti-addiction medications.”

Writing in 2010, years after his tenure at NIDA had ended, Dr Leshner revealed that his depiction and promotion of the model owed much to its public relations utility. He had appreciated its “powerful potential to change the way the public sees addiction”, and sought a resonant metaphor to realise that potential. The solution was to liken changes in brain structure functioning caused by repeated drug use to a ‘switch’, transforming what was voluntary into compulsively involuntary drugtaking – a metaphor which he admitted was chosen without too much regard to the reality of neural functioning. For him, “Perhaps the most important consequence of conceptualizing addiction as a brain disease was that it explained why one cannot just quit by force of will alone – why treatment is essential.” It was an explanation of a non-fact – most dependent substance users do remit without treatment – but one which might be good for treatment budgets, and he hoped, for the prospective patients. (drug&alcohol findings, UK, 15.12.2017)

http://findings.org.uk/PHP/dl.php?file=brain_disease.hot&s=eb