Crisis, what crisis? Addiction neuroscience and the challenges of translation

Nikolas Rose,Samuel Mclean

doi:10.12688/wellcomeopenres.16265.1

Abstract

In this article we interrogate the claim that there is an opioid crisis: a dramatic rise in drug overdose fatalities in the United States over the past two decades that is also spreading to other countries. The usual argument is that this crisis is largely explained by errant prescription practices leading to an oversupply of opioids, leading to addiction, premature mortality and drug overdose deaths, both among those prescribed opioids for pain relief, and those obtaining them on the illegal market. We argue, that this view is highly problematic and that it is likely to entrench deeper problems with how substance addiction has been perceived and known. In this article, we develop an alternative picture of the addiction crisis based on four years of research and collaboration with addiction neuroscientists. Drug overdose deaths, we claim, are symptoms of what we term the ‘structural distribution of social despair.’ We argue that this is compounded by a translation crisis at the heart of addiction neuroscience. For all its dominance, the ‘dopamine hypothesis’ of addiction that shaped understandings for some three decades, has still not produced a single effective treatment. However, this translation crisis also represents an opportunity for ‘the memory turn’ in addiction neuroscience as it seeks to translate its emerging conception of addiction as a problem of memory into effective forms of treatment. We conclude by arguing that, for the ‘memory turn’ to underpin effective interventions into ‘the opioid crisis’, a new relation between neuroscientists and social scientists of addiction is needed, one that proceeds from the lived experience of human beings.

Highlights

Any reports and responses or comments on the article can be found at the end of the article
We claim, are symptoms of what we term the ‘structural distribution of social despair.’. We argue that this is compounded by a translation crisis at the heart of addiction neuroscience
In contradistinction to the reductionism that governs so much of addiction medicine, we argue that the more restricted our perception of a complex phenomenon such as the opioid crisis is, the more limited is the collective capacity of society and addiction research to know and to manage the harms associated with long-term substance addiction

Summary

14 Sep 2020 report report report

Any reports and responses or comments on the article can be found at the end of the article. The dangers of viewing errant prescription practices as the ‘cause’ of the opioid crisis, and this crisis as distinct from the social pathology expressed through drug overdose deaths and suicides are compounded, we argue, by the way substance addiction has come to be seen and known by medical, political and legal institutions in the United States over the three acts of the opioid In their major review of the “rise and fall of dopamine theory”, Nutt et al (2015) sharpen the focus of this claim, and in so doing elucidate its most important implication. A renewed commitment to evidence-based harm reduction would save lives and reduce misery, and that at least, would be no small thing

Conclusion

Findings

Jaffe JH