Free Will, Black Swans and Addiction

Ted Fenton,Reinout W Wiers

doi:10.1007/s12152-016-9290-7

Abstract

The current dominant perspective on addiction as a brain disease has been challenged recently by Marc Lewis, who argued that the brain-changes related to addiction are similar to everyday changes of the brain. From this alternative perspective, addictions are bad habits that can be broken, provided that people are motivated to change. In that case, autonomous choice or “free will” can overcome bad influences from genes and or environments and brain-changes related to addiction. Even though we concur with Lewis that there are issues with the brain disease perspective, we also argue that pointing to black swans can be important, that is: there can be severe cases where addiction indeed tips over into the category of brain disease, but obviously that does not prove that every case of addiction falls into the disease category, that all swans are black. We argue that, for example, people suffering from Korsakoff’s syndrome, can be described as having a brain disease, often caused by alcohol addiction. Moreover, the brain changes occurring with addiction are related to choice-behaviour (and the related notions of willed action), habit formation and insight, hence essential mental abilities to break the addiction. We argue for a more graded perspective, where both black swans (severe brain disease which makes recovery virtually impossible) and white swans (unaffected brain) are rare, and most cases of addiction come as geese in different shades of gray.

Highlights

The current dominant perspective on addiction as a brain disease has been challenged recently by Marc Lewis, who argued that the brain-changes related to addiction are similar to everyday changes of the brain
From our perspective, the interesting empirical question would be who describes the white swans and who describes the black swans of addiction: is a brain disease the exception or the rule? Given that epidemiological data demonstrate that most cases of addiction cure without treatment, Lewis, might be right that the rule is more that addictions are excessive cases of normal motivational mechanisms and habit formation [44], but, as argued above, there are more severe cases, where the term brain-disease might be more appropriate
One interesting aspect of the debate is that here Lewis and Volkow appear to be on the same side: both recognize the importance of those mental functions which we describe under the vague notion of Bfree will^ in overcoming addictive behaviours; the debate centers around what is left after addiction, and what is the norm

Summary

Addiction a Brain Disease?

There is no question that addictive behaviours can have negative effects for the individual, including social problems, physical harms and premature death. The question here is whether these brain-changes should be called a brain-disease In his well-written book and accompanying paper, Marc Lewis argues against this perspective [16, 17]. If addiction would be a brain disease where the capacity for autonomous choice is lost (in everyday language closely related to the philosophically difficult notion of Bfree will^), the capacity to have the necessary clarity of mind to change the detrimental addictive behaviour could be gone. [1, 9] So, the cases described in Lewis’ book make clear that even people suffering from severe addictions can sometimes have enough willpower to successfully change In this positive scenario this mental capacity can function as an engine for positive change in the plastic brain, in line with the developmental model of Lewis. Bill Miller argued that studying mechanisms in spontaneous recovery can help to develop effective interventions [32], and motivational interviewing, the therapeutic technique based on this insight, has been found effective in the treatment of addiction and beyond [33]

Black Swans and a Gradual Model of Addiction

What Do we Lose when we Are Addicted?

Conclusion