Addiction and the Meaning of Disease

Abstract

Is addiction a brain disease? Cards on the table: I don’t know. The aim of this chapter is to clarify what it would mean for the brain disease model of addiction (BDMA) to be true, rather than to argue decisively for or against it. This requires: (1) distinguishing the question of whether addiction is a brain disease from the question of whether labeling it thus has beneficial consequences, such as, e.g., combating addiction stigma; (2) differentiating possible models of disease and their relationship to the BDMA; (3) understanding the challenges of providing an account of normal brain function by which to measure brain dysfunction; and (4) addressing the complexity of establishing the hypothesis that brain dysfunction is the cause of the personal-level observable signs and experienced symptoms characteristic of addiction. I conclude by arguing for agnosticism and heterogeneity; addiction may be in some cases a brain disease, in others not. Either way, we should not rest our hopes on the brain disease label as a means of combating addiction stigma, but rather fight directly against drug moralism and moralistic policies.