Is Addiction a Chronic Brain Disease?

Drug addiction is not caused by the effects of drugs alone.

After decades of growing acceptance, the concept that addiction is a medical disease (more exactly, a chronic brain disease) is suddenly being linked to the drug war—and being challenged. Most notably, Johann Hari has taken that position in his book, Chasing The Scream: The First and Last Days of the War on Drugs, synopsized in a recent viral 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 in the early 1980s 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 alone 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 prefer water.

The Rat Park results showed that addiction isn't caused by the effects of drugs alone, even with simple mammals whose additions were thought to prove that addiction is a biological construct. How much more complex, then, is human addiction? Such addiction involves people, their situations, and drugs and other powerful experiences (like gambling and sex). When an individual finds such an experience sufficiently rewarding in that place in their lives, and alternative sources of satisfaction aren't available to them, they may become addicted—although human choice always remains an essential factor in the equation.

That people are not trapped by their addictions was shown by the Vietnam War, where more than 90 percent of addicted soldiers quit their heroin addictions stateside. The natural remission of addiction in ordinary circumstances has been affirmed through surveys of people's lifetimes of drug and alcohol use. Gene Heyman, of Boston College, reanalyzed data from three major national surveys of drug use and mental health in 2013.  His results showed that people quit at every stage of their addictions—thus refuting the progressive and chronic relapsing addiction meme popularly portrayed.

That soldiers withdrawn from the danger, discomfort, and isolation inherent in Vietnam should be able to desist their drug use would not seem to be newsworthy; nor that people quit addictions all the time (think about smokers). And, yet, as I noted in 1975 in my book with Archie Brodsky, Love and Addiction, undersecretary of defense for health and environment and medical doctor Richard Wilbur declared that Vietnam disproved everything that he had learned in medical school—which was that people, once addicted, were irrevocably and permanently hooked on narcotics.  
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 United Kingdom, and Europeans are less impressed as a rule by the brain disease model, which is much more ardently embraced here in the United States.

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." (Emphasis added.)

It might seem surprising to read that there is only hope of 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, as I describe in my 2014 book (written with Ilse Thompson) Recover! Stop Thinking Like an Addict.

The practical implications are inescapable. We can peer all we want into brains, like mad Dr. Frankensteins, and we won't move a quarter inch closer to helping people deal with the range of addictions they confront. We've proven the futility of the brain-in-isolation approach a million times over. We cannot solve addiction magically, by circumventing people's consciousness and lived experience in society. Instead, we need to use these dimensions of human experience to make people happier, to feel that they belong on earth, and to realize that they are able to control their lives.

The 21st Century, rather than ushering in some miracle brain cure for addiction, can only reaffirm this basic truth.