Abstract
The brain disease model of addiction is widely endorsed by agencies concerned with treating behavioral disorders and combatting the stigma often associated with addiction. However, both its accuracy and its effectiveness in reducing stigma have been challenged. A proposed alternative, the “choice” model, recognizes the residual rational behavior control capacities of addicted individuals and their ability to make choices, some of which may cause harm. Since harmful choices are ordinarily perceived as blameworthy, the choice model may inadvertently help justify stigma. This paper seeks to fully naturalize the choice model by highlighting the determinants of voluntary action and thus increase its potential for destigmatizing addiction. In light of a deterministic understanding of behavior, it is unreasonable to suppose that addicted individuals could have made different choices in becoming addicted and in subsequent situations. To the extent that stigma is motivated by the supposition that addicted individuals could have chosen otherwise in actual situations, a deterministic understanding of addictive behavior promises to mitigate blame and stigma.
Highlights
The brain disease model of addiction is widely endorsed in the drug prevention and treatment community as a means to reduce stigma [1]
Skepticism is growing about the cogency of the disease model and its efficacy in combatting stigma and promoting recovery [2,3,4,5,6]
Disease model skeptics can agree with proponents that, as substance use continues, the brain changes in ways that help explain the syndromes typical of addiction: persistent drug-seeking and consumption that significantly compromise an individual’s physical and psychological welfare and hinder pursuit of non-drug-related goals
Summary
Models of AddictionThe brain disease model of addiction is widely endorsed in the drug prevention and treatment community as a means to reduce stigma [1]. I will argue that since indeterminism cannot add to or enhance control or responsibility, we are justified for all practical purposes in taking a deterministic view of human behavior, including the voluntary choices involved in addiction.
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