Abstract
According to the brain disease model of addiction (BDMA), substance addiction is a chronic, relapsing brain disease. The BDMA is currently influential in informing addiction policy and the development of new treatments, but remains highly controversial across the addiction research community. We draw on resources from philosophy of science and applied ethics to re-examine the methodological and ethical implications of the BDMA and offer a new forward-looking and constructive conceptualization of the BDMA as a heuristic reductionist research hypothesis. We argue that this not only allows a sharper delineation of the empirical shortcomings of the BDMA, but also helps skeptical social scientists appreciate and incorporate the empirical successes of the BDMA to a broader, social understanding of addictions. We apply this view to the ethical implications of the BDMA, especially to the key concept of vulnerability. The BDMA states that it is the brain that has been hijacked by the drug and the brain thus compels the individual to act in ways that are often disastrous for the individual. The proponents of the BDMA ascribe ‘vulnerability’ to multiple levels of organization, such as genes, specific neural systems, the brain, and the person, thus resulting in confusion and highly problematic ethical, social and even legal implications. The BDMA locates the vulnerability firmly within the individual and treats it as a matter of susceptibility to changes in brain chemistry. This may well be a part of the phenomenon, but the kind of vulnerability relevant for understanding and treating addiction is, however, embedded in normativity, as it concerns the agency of individuals with addiction. Agency is not simplistically reducible to the competencies of the individual, but rather it is also constituted in the interactions with their environment.
Highlights
The human brain is susceptible to psychoactive substances
Neuroscientific perspectives have gained prominence in the scientific and public understanding of behavioral addictions, most notably of pathological gambling, we focus here on substance addictions, as these are the phenomena to which the full brain disease model of addiction (BDMA) has been most explicitly formulated
We do not claim that this is what the proponents of the BDMA have in mind. We propose this as a forward-looking way of repositioning the debate—one that helps the opponents of the model to appreciate more what has been learnt about the constitution of agency in addiction by looking inside the heads of individuals with addiction
Summary
The human brain is susceptible to psychoactive substances. This fact has been widely acknowledged and utilized in medicine, recreational activities, spiritual experiences, as well as in the enhancement of physiological and psychological performance (see e.g., Goodman et al, 2007). Substance use is initially voluntary, the pharmacological effects in the brain reduce the individual’s ability to control her own behavior (e.g., Leshner, 1997) Whether or not this is factually so, the view has ethical, legal and social implications that need scrutiny. The empirical and normative problems of the model arise out of the fundamental difficulties in integrating the ever-increasing empirical findings about altered brain functionality to the broader social scientific bodies of knowledge about the social reality and the lived experience of people using psychoactive substances This tug-of-war between the neurobiological and sociological perspectives on addiction is but one front in the broader re-negotiation of boundaries of expertise and authority on normatively contested behavior brought about by advances in neuroscience (e.g., Pickersgill, 2013; Rose and Abi-Rachid, 2013). We consider these fundamental challenges from the perspectives of philosophy of science and applied ethics, in that order
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