Explain and critically discuss the view that addiction is a brain disease of some

kind.

INTRO
- In his 1997 paper entitled ‘Addiction is Brain Disease and it Matters’,
Alan Leshner puts forward an argument in favour of the brain disease
model.
- Leshner argues that addiction is a brain disease of some kind and points
towards biological evidence to back this up?
- This essay will be divided into three main sections. I will begin by
outlining the paradox of addiction and defining what I mean when saying
addiction
- Secondly I will outline the brain disease model put forward by Leshner
- I will then discuss the strengths of this view
- Finally I will introduce critiques to this view which ultimately render the
model as unsuccessful.
- Ultimately I will conclude that addiction is not a brain disease of some
kind

PARA 1- paradox of addiction/defining addiction

- To begin with it is essential to firstly explain the puzzle of addiction.
- Puzzle of addiction questions why addicts continuously take drugs when
they know there will be negative consequences- cite Hannah Pickard
here-
https://www.researchgate.net/publication/337945333_THE_PUZZLE_OF
_ADDICTION - pg 10
- I’m giving an account of addiction we want an explanation as to why
someone might do something that is harmful, know it to be harmful and
do it anyway- we want something that makes sense of this initial puzzle-
framing it as a disease attempts to do this
- E.g I run into a house on fire- clearly harmful- potentially super harmful-
why do I do this deliberately- someone in there want to save- makes
sense of the risk
- Can come up with good explanations that rationalise your actions- have
this in case of addiction- characteristic of addiction that people continue
to seek drugs etc. despite experiencing directly harmful effects as they
unfold. Can see how explanation for this is harder to obtain that me
running into burning house.
- It is important to note that when I talk about addiction, for the purposes
of this essay I will be solely referring to the use of drugs.
 - According to NIDA addiction is defined as a chronic, relapsing brain
disease that is characterized by compulsive drug seeking and use,
despite harmful consequences-
https://www.drugabuse.gov/publications/drugs-brains-behavior-
science-addiction/drug-misuse-addiction

PARA 2- Disease model general

- One explanation that makes sense of this initial puzzle is that addiction is
a disease. The addict has no control over the matter, thus despite
knowing the consequences continues to take the drugs.
- Makes sense of the puzzle in terms of compulsion- compulsion is a
psychological notion like desire or something- brain disease model is
giving answer to puzzle of addiction in terms of compulsion
- helps explain this repeated engagement in behaviour that leads to
known harmful behaviour- the compulsion is a motive that cannot be
controlled so addicts cant help what they are doing and so don’t exercise
voluntary free choice.
- Its not a choice, it is a compulsion
- Motivation is to get away from condemning addicts for morally bad
behaviour
- Core of addiction is a neurophysiological change to the brain
- Might have involved free choice at the beginning before addiction but
once addicted involves no free choice. Nicotine is highly addictive-might
be case when hanging around peers and you start smoking free choice
then. Not addicted to the thing. But when u become a smoker all the
free choice you had goes away- you compulsively smoke. Fact ur
compulsively doing it makes it outside your free control- G notes
- Says addiction is a disease and hence something that drives choices that
is outside realm of rational choice
- By looking at changes in the function and structure of the nervous
system, the disease model helps explain why it is so difficult to achieve
abstinence through the exercise of willpower

PARA 3- Leshner disease model

- Defines addiction as a ‘chronic, relapsing illness, characterised by
compulsive drug seeking and use’
- Looks at research which has shown that there are major differences
between brains of addicted and brains of non-addicted
- A critique from within the field- he is a scientist
- Neurological evidence that addiction is a brain disease= talks about the
mesolimbic pathway being affected- This pathway, the mesolimbic
 reward system, extends from the ventral tegmentum to the nucleus
accumbens, with projections to areas such as the limbic system and the
orbitofrontal cortex. Activation of this system appears to be a common
element in what keeps drug users taking drugs. This activity is not
unique to any one drug; all addictive substances affect this circuit.
- Prolonged drug use causes pervasive changes in brain function that
persist long after the individual stops taking the drug.
- Main view is that= addiction is tied to changes in brain structure and
function- this is what makes it, fundamentally, a brain disease.

PARA 4- evidence and support of this

- There is evidence that addictive substances actively change the brain-
e.g the dopaminergic system- the system that regulates dopamine
release and production in the brain- empirically demonstrated change
due to drug consumption
- The drug ingested gives rise to massive increases of dopamine which
leads to excessive amounts of pleasure- has causal effect of dramatic
increase of pleasure
- So addictive behaviors are caused by these irregular amounts for liking
for addictive substances.
- Our brains are wired to increase the odd that we will repeat pleasurable
activities- whenever the reward circuit is activiated by a healthy,
pleasurable experience, a burst of dopamine signals that something
important is happening that needs to be remembered. Drugs produce
much larger surges of dopamine- large surges of dopamine teach the
brain to seek drugs at the expense of other, healthier goals and
activities- https://www.drugabuse.gov/publications/drugs-brains-
behavior-science-addiction/drugs-brain
- Can use example of cannabis that Gabi used or find another one?-
cannabis- activate neurons because their chemical structure mimics that
of a natural neurotransmitter in the body. This allows the drugs to attach
onto and activate the neuron-
https://www.drugabuse.gov/publications/drugs-brains-behavior-
science-addiction/drugs-brain
- Research has shown that cannabis can cause long-term or possibly
permanent adverse changes in the brain-
https://www.drugabuse.gov/publications/research-reports/marijuana/
what-are-marijuanas-long-term-effects-brain- there seems to be
disruption to cannabinoid receptors in the brain- affect hippocampus-
 responsible for memory formation- leads to structural and functional
changes in the hippocampus.
- it is this kind of research where we have evidence about changes in
dopaminergic system that lead people to believe it is a disease- it is a
disease that hijacks the desire system and compels people.

PARA 5- evidence is wrong- Lewis critique

- Most convincing critique is that the biological evidence to support the
brain disease is actually flawed
- Lewis argues framing addiction as a disease will be harmful
- What is important is that Lewis is a neuroscientist- critique from within
the field
- Brains are supposed to change- there are stages in child and adolescent
development which are underpinned by changes in cortex and limbic
regions.
- Neuroplasticy- describes brain changeability and elevates it to a first
principle- when brains of addicts are compared to those of drug-naïve
controls, scientists say look they have changed- yet doesn’t say anything
at all- brain is supposed to change with new experiences- when our
experience of the world produces strong emotions the brain changes.
- No clear dividing line between addiction and the repeated pursuit of
other attractive goals- how do we know what to label disease and what
to label as normal experience
- Behavioural addiction can be just as severe as substance addictions
- LOVE- People pursue certain activities with little control- could be
anything from spending sprees to jihadism- one normal human
endeavour that most of us recognise as the epitome of blind desire-
falling in love- they think obsessively about the other person- can easily
become compulsive and difficult to control- with little regard for the
long-range forecast
- When looking at the neuroscience of love- some remarkable similarities
with addiction- increased levels of central dopamine
- ‘if addiction is a disease, then so apparently is love’

PARA 6- reply- if not disease wont get treatment

- The fact that addiction is a brain disease helps explain why people need
treatment- they are in a very different brain state- best treatments
would be medications, behavioural therapies and necessary psychosocial
services.
 - Massive implication for thinking of addiction as not a brain disease as
that people believe they do not deserve treatment- stigma attached that
they are weak or bad people unwilling to control their behaviour
- Prior to viewing addiction as this chronic, relapsing brain disease- addicts
were viewed as responsible and blameworthy- they have opted for a
lifestyle where they make bad choices and are culpable
- Major goal of treatment must be to either reverse or compensate for
those brain changes- either medicine or behavioural treatments.
- Links to our understanding of our criminal justice strategies- if criminal is
drug addicted, imprisoning them without treatment would be futile-
more likely to commit crimes and do more drugs- however if treated in
prison will be much better
- Understanding addiction as a brain disease explains in part why
strategies that solely focus on social or criminal justice aspects of
addiction have been unsuccessful- missing at least half the issue- if brain
is core of the problem, attending to the brain needs to be a core part of
the solution.
- Also helps us think about strategies to deal with addicted criminal
offenders- explains why untreated addicted offenders have such high-
post incarceration rates of recidivism both to drugs use and criminality.
- Happened for schizophrenia and Alzheimer’s- were putting
schizophrenics in prisonlike asylums- now we know they require medical
treatments.
- Addicts need treatment- if we don’t define addiction as a disease, they
wont get the help they require

Para 7- reply to this strength

- Do we really need to call something a disease in order to get help? yes it
may help but people in todays world face vast array of problems-
bullying, child abuse, unemployment, poverty etc- we don’t need to call
these problems diseases in order to tackle them- instead of medical
interventions we implement inventive, humanistic measures, financial
aid, public resources etc- we don’t need to call these diseases in order to
justify funding for prevention and intervention?
- For second critique- the stigma surrounding addicts- if we don’t call
addiction a disease does this mean we go back to seeing addicts as self-
indulgent spinless pariahs? NO- we have gotten better at recognizing
that life circumstances can dictate personal suffering and stragedy-
many famous figures have crossed the line into addiction- Elton John,
Robin Williams, Prince, Phillip Seymour Hoffman. Social norms seem to
 be advancing as personal struggles are made public in the internet age.
We are also starting to recognize addiction as a consequence of social ills
rather than individual flaw- pointing to a disease does not necessarily
diminish stigma

Conclusion
- Addiction is not a brain disease