Disease Model Of Addiction Research Articles

Addiction as Disease

This Article advocates for federal funding of local public health campaigns based upon a disease model of addiction that incorporates findings from neuroscience, genetics, and public health. Rather than endorsing the idea that addiction stems from either immoral choices (the moral choice model) or a “hijacked” brain (the brain disease model), this Article offers a nuanced model that reflects its multifaceted etiology. I refer to this model as the “integrated disease model,” or IDM, as it explains addiction as a neurogenetic phenomenon but does not locate addiction entirely in the brain. The IDM recognizes that neurobiological vulnerabilities can lead to addiction, as opposed to just flow from it. But it situates the brain inside a human being, who has been exposed to various environmental stressors and responds differently to drug use. Simply put, the IDM places addiction on equal footing with other chronic diseases, such as lung cancer or diabetes, each of which has significant genetic, behavioral, and environmental causes. Early research demonstrates that by explaining addiction as a disease that can successfully be treated (and it is worth noting: most people with opioid use disorder who receive adequately dosed medication achieve recovery), we can reduce the stigma of addiction and get more people into treatment. Stigma leads many to avoid seeking treatment until their disease is too far gone, as they cannot bear to adopt the label of “addict.” The stigma surrounding addiction fuels, and is significantly fueled by, its criminalization. To combat our devastating opioid crisis, we need to put our collective legislative and public health efforts into explaining addiction as a disease—a disease that must be treated in the clinic, and not the courtroom.

Addiction is a Disability, and it Matters

Previous discussions of addiction have often focused on the question of whether addiction is a disease. This discussion distinguishes that question – the disease question – from the question of whether addiction is a disability. I argue that, however one answers the disease question, and indeed on almost any credible account of addiction, addiction is a disability. I then consider the implications of this view, or why it matters that addiction is a disability. The disease model of addiction has led many to see addiction as primarily a medical problem, and to make medical treatment of the addicted person the first priority in addressing addiction. Once addiction is viewed as a disability (whether or not it is also a disease), different concerns are foregrounded. The problem of addiction resides not only in the addicted person, but also in the social environment in which the addicted person finds herself. The fundamental ethical question about addiction is not how addicted persons can be treated or otherwise changed, but how a just society can make reasonable accommodations for addicted persons.

Implications of addiction diagnosis and addiction beliefs for public stigma: A cross-national experimental study.

Stigmatisation of alcohol and other drug (AOD) use disorders poses a significant barrier to treatment access. A review by the World Health Organization concluded that addictive disorders were the most stigmatised health condition. Few studies have examined whether different etiological models of addiction (MOA) have implications for public stigma toward AOD disorders. The current study examined whether beliefs representative of five MOA predict public stigma levels and whether stigma differs for AOD use disorders relative to other health conditions. Survey data were collected from Canada, the USA and Australia using an online data collection platform. Participants were randomised to one of four vignette manipulations describing an individual with an alcohol use disorder and/or other disorder. Participants' stigma toward the vignette character and beliefs related to five MOA (disease, moral, psychological, sociological, nature) were measured. Stigma ratings were significantly higher in the alcohol use disorder condition compared to other conditions. Two MOA accounted for significant variance in stigma ratings, where greater beliefs in the nature and psychological MOA predicted significantly lower levels of stigma toward alcohol use disorder. Contrary to predictions, beliefs in the disease MOA did not relate to lower stigma. Lastly, beliefs in the moral MOA partly accounted for geographical region differences (the USA vs. Canada) in public stigma. The current study provides further experimental support that AOD disorders are more stigmatised than others. Additionally, the findings suggest that MOA may relate differentially to perceived stigma, and that regional variability in such beliefs exists.

Supplemental Material for The Effect of the Brain Disease Model of Addiction on Juror Perceptions of Culpability

Supplemental Material for The Effect of the Brain Disease Model of Addiction on Juror Perceptions of Culpability

Problematising ‘Recovery’ in Drug Policy within Great Britain: A Comparative Policy Analysis Between England, Wales and Scotland

Abstract Drug strategies in Great Britain emphasize the notion of recovery, with the concept being central in England, Wales and Scotland. There are however tensions, with recovery being defined differently across jurisdictions. In this study we address this dilemma by critically interrogating how the term recovery is represented, how these presentations are shaped and what effects are subsequently had. We applied an adapted version of Bacchi's What's the Problem Represented to Be? (WPR) policy analysis approach to the 2017 UK Drug Strategy, the 2008–2018 Welsh Drug Strategy and the 2008 Scottish Drug Strategy notions of service user responsibility; (b) recovery as ‘a problem of product quality’, shaped by the implicit notion of service provider responsibility and the disease model of addiction; (c) recovery as ‘a problem of service collaboration and teamwork’, underpinned by the bio-psycho-social model of addiction. We conclude that the problematisations found in GB’s current drug policies have the ability to shape the drug policy-making process which may limit mainstream knowledge of recovery, and thereby unintentionally contribute to a narrow understanding of how to effectively support the service user community in their recovery from problematic drug use.

Psychoeducation impact for family members of substance users: An evaluation the workbook “Addiction: A Family Disease”

ABSTRACT Background In countries such as Malaysia, extended families are common and therefore more people are affected when a loved one is substance dependent. Interventions for family members are as equally important as treating the substance-dependent person in order to ensure holistic treatment is achieved. This study focuses on evaluating a workbook developed for family members of loved ones seeking treatment in a private residential treatment facility in Malaysia. Methods: This evaluation study employs a mixed methodology approach guided by the Kirkpatrick model. Semi-structured interviews were conducted with family members using the workbook, triangulating findings with results from pre-and post-intervention questionnaires. Results: Findings from the evaluations were observed at three levels of the Kirkpatrick model: reaction to program – participants revealed high satisfaction levels; learning achieved – an increase in knowledge; behavior – knowledge acquired on a disease model of addiction impacting on their belief system. Conclusions: Findings from this study suggest that creating awareness among affected family members on the impact of substance dependency on the family dynamics can empower a substance user’s significant others and engender hope and realistic beliefs, and that employing a culturally appropriate workbook effectively supports the psychoeducation element of a family intervention program.

Determinism and Destigmatization: Mitigating Blame for Addiction

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.

Educational Program to Increase Substance Use Disorder Knowledge and Decrease Stigma in First-Year Nursing Students

PurposeThe opioid epidemic in the United States is changing the population nurses serve. Stigma and bias among healthcare providers towards patients with substance use disorder occurs across disciplines and negatively impacts the care provided to this population. We sought to assess the knowledge and perceptions of first-year nursing students at a large college of nursing towards those with opioid use disorder and to provide an educational intervention with the goals of decreasing bias, increasing substance use disorder knowledge, and increasing the understanding of multi-pronged treatment strategies. DesignThe program consisted of an interactive two-hour presentation based on the disease model of addiction. MethodsFirst year nursing students from a large urban college were administered a pre- and post-presentation survey designed to evaluate their perceptions towards those with opioid use disorder. ResultsThematic analysis indicated stigma and bias was present in some first-year nursing students towards those with opioid use disorder. Results from a summary t-test showed a significant increase in the mean scores from pre- to post-test (t = −2.224, df 429, p = .027). ConclusionsOur project results indicate that knowledge and bias towards those with substance use disorder can be changed with education, which may improve the delivery of healthcare to this vulnerable population. Clinical ImplicationsSince bias and stigma negatively impact care provided by clinicians, presentations such as this one can not only provide education on evidence based practices, but may change the attitudes of future providers, improving the quality of healthcare delivered to this vulnerable population.

Support for the psychosocial, disease and brain disease models of addiction: A survey of treatment providers' attitudes in Australia, the UK, and U.S.

BackgroundHow addiction treatment providers view different models of addiction has implications for workforce development and addiction treatment, however research exploring their views is limited. This study examined Australian, UK and US treatment providers': (1) levels of support for the psychosocial, disease model of addiction (DMA) and brain disease model of addiction (BDMA); and, (2) individual demographic characteristics that were associated with support for these models. MethodsA total of 1438 treatment providers in Australia (n = 337), the UK (n = 165) and US (n = 936) completed an online survey. Support for the psychosocial and DMA were measured using the Short Understanding of Substance Abuse Scale (SUSS) (Humphreys et al., 1996) and BDMA support using a measure created by the authors. Hierarchical multiple linear regression analyses were used to analyze associations between treatment providers' demographic characteristics (i.e., previous addiction status, attended 12-step programmes, age, gender, education level) and level of support for each model. ResultsThere were no significant differences in treatment providers' support for the psychosocial model between the three country groups. US participants had significantly higher levels of support for the DMA than the UK group, and the UK group was higher than the Australian group. US participants had significantly higher levels of support for the BDMA than Australian and UK participants. Regression analyses found that being younger in all three country groups and a higher level of education in the UK group was associated with greater psychosocial model support. A personal experience of addiction and 12-step programmes was associated with stronger support for the DMA, as was older age in the Australian and US treatment provider groups. In the US group, a personal experience of addiction and 12-step programmes was associated with support for the BDMA. ConclusionTreatment providers from different backgrounds and in different countries vary in how they view the etiology of addiction. How differences in views about addiction impact service delivery and clients' experience of care remains an important topic for future research. Furthermore, policy makers should consider treatment providers' heterogenous views about addiction and the implications for service delivery and workforce policy development.

Race as a Ghost Variable in (White) Opioid Research

This paper traces the unspoken, implicit white racial logic of the brain disease model of addiction, which is based on seemingly universal, disembodied brains devoid of social or environmental influences. In the United States, this implicit white logic led to “context-free” neuroscience that made the social hierarchies of addiction and its consequences invisible to, and thus exacerbated by, national policies on opioids. The brain disease model of addiction was selectively deployed among the white middle-class population that had long accessed narcotics and pharmaceutical treatments for narcotics disorders from biomedical clinics, as opposed to from illegal sources subject to law enforcement. In turn, new treatments for opioid addiction were racially marketed to the same white clientele to which newly patented opioid analgesics were marketed, tapping into a circumscribed but highly lucrative consumer base that has long benefited from a legally protected, racially segregated safe space for white narcotics consumption. The connecting thread for the contemporary white opioid “crisis,” therefore, is white race as a ghost variable in addiction neuroscience and in its pharmaceutical and biotechnological translation.

Physicians' and Attorneys' Beliefs and Attitudes Related to the Brain Disease Model of Addiction.

Addiction is increasingly considered a chronic, relapsing brain disease; however, many scholars still disagree with the brain disease model of addiction. We set out to provide evidence of attorneys' and physicians' beliefs regarding the model. First, we asked the following question: do attorneys and physicians affirm the full brain disease model, or its modified form, or do they believe that addiction is driven by deficits in self-control or moral weakness? Second, we evaluated the extent to which such beliefs correspond to attitudes toward individuals with substance use disorders (SUDs). A questionnaire was sent to resident physicians (N = 301) and criminal defense attorneys (N = 483) practicing in the United States. It was comprised of (i) an attitudes measure, (ii) a measure regarding conceptions of addiction, and (iii) demographic questions. Attorneys were more likely to believe that individuals with SUDs had "practically no choice" about whether to seek and use, whereas physicians were more likely to believe that such individuals had "genuine choice." For both groups of participants, the rejection of the full brain disease model of addiction was associated with more negative attitudes toward individuals with SUDs. These results represent an important advance, as past research has neglected attorneys' attitudes and is inconclusive regarding the manner in which beliefs about the brain disease model of addiction are related to attitudes toward individuals with SUDs. Educating practitioners regarding this relationship would raise awareness regarding when and to what extent stigma is likely to be present, which may in turn provide a foundation from which to address stigma. (Am J Addict 2020;00:00-00).

Of mice and men.....The unforgettable narrative of how social factors shape substance use, addiction, and recovery

The currently predominant model to explain addiction is the brain disease model of addiction, which emphasizes drug-induced brain changes at the individual level, producing an uncontrollable, chronic relapsing disease. It tacitly de-emphasizes the complex sociocultural, contextual, and other environmental determinants of substance use and addiction. In this oration, I challenge these assumptions with a hop-and-stop tour of five countries: Canada, the USA, India, Vietnam, and Iceland. The journey covers five narratives: isolation, pain, frustration, and then the positive narrative of recovery, and finally the narrative of hope. The socially enriched rats in the “Rat Park” in a laboratory in Canada consumed much less morphine than the isolated, caged rats. People dying of opioid overdose in the worst-ever opioid epidemic in the USA might be using opioids as an escape from broadly defined “pain,” where pain is an emblem of deeper societal isolation and suffering. In Punjab, India, frustrated youths due to complex socio-political-economic reasons are falling easy prey to the profiteering drug mafia. On the positive side of the narratives, most of the Vietnam war veterans who had been using heroin heavily while in Vietnam quit after returning to the comfort of their home, family, and friends, thus providing the narrative of recovery. Finally, the Icelandic Model, a series of pro-social policy measures at the government level targeting the children, the parents, the school, and the environment in Iceland, where teenage substance abuse had been peaking alarmingly in the mid-1990s, demonstrated the preventive prowess of these measures. All in all, this journey teaches us vital lessons not to forget the social psychiatry of addiction. It also teaches us that it would be a wise investment to improve the social determinants of health, including mental health and addiction.

Management of Pain in Opioid Addicted Patients: An Education Plan for Psychiatric Nurses

Background: Identified on an acute care behavioral health unit has been a gap in nursing education and knowledge about opioid addiction and pain management. Nurses are often frustrated that there seems to be no clear way to manage acute pain in individuals suffering with opioid addiction. Because of difficult behavior sometimes displayed in those with opioid addiction, nurses may be prone to attitudes that reflect bias on their part when administering care. The psychiatric nurses need to learn about the disease model of addiction so its premise can be shared with the opioid addicted patients and their families. Purpose: The purpose of this proposal is to create a plan to teach the Behavioral Health nurses about opioid addiction and management of acute pain to help those afflicted with opioid addiction. Plan: The plan for addressing the gap includes education about opioid addiction, the barriers presented by stigma and bias, and the use of opioid replacement therapy to manage acute pain in those with opioid addiction. Patient education will focus on addiction as a disease and the impact of stigma on those with the disease. Implementation: Implementation of the project will include the development of two classes about management of acute pain in opioid addicted patients emphasizing education of the nurse and patient as the prime solution to this dilemma. The classes will stress the need to model conversations with psychiatric physicians to develop strategies to manage acute pain in patients with opioid addiction. Conclusion: Opioid replacement therapy seems to be the only answer for individuals in need of rehabilitation to end their burden of addiction. It should be accessible to any person with addiction to opioids in every healthcare setting.

‘But I’m not a doctor’: pending trust in science among laypeople discussing the brain disease model of addiction

Aim: In recent decades, the notion of addiction as a brain disease has become influential among scientists, public institutions, and addiction treatment professionals, and its popularity raises the question of how biomedical science affects public perceptions of illness. Although existing research has examined how laypeople interpret disease models of addiction, few studies address how they interpret the brain disease model as presented by the media, the version that most citizens are likely to encounter in their everyday lives. This article contributes to existing research by examining Swedish laypeople’s interpretations of a news article presenting biomedical research on addiction and analyzing how trust intervenes in their interpretations.Methods: Drawing on an audience study design with qualitative interviews, the participants were asked to read and discuss a newspaper article that explained how alcohol, amphetamine, and nicotine affect the brain.Results: The analysis shows that their interpretations depended on how they perceived their own ability to assess the science portrayed in the article. The participants trust doctors and scientists but doubt their own ability to assess the science, and trust is therefore provisional or pending until this situation changes. In addition, trust requires that the participants are able to recognize and identify with the contents of the news article.Conclusion: This pattern can be understood as a way of dealing with the contradictory expectations laypeople face – they are expected to trust scientific knowledge and to evaluate knowledge claims rationally, but they do not have access to the knowledge that would, supposedly, enable them to do so.

Overcoming Alcohol Addiction in Patients with Alcohol-Related Liver Disease

This review provides a brief overview of key concepts in addiction medicine and provides tips and tricks as it pertains to treating patients with alcohol addiction in the setting of advanced alcohol-related liver disease (ALD). Understanding the brain disease model of addiction by both providers and patients is a vital springboard for establishing a therapeutic relationship. Despite a paucity of high-quality evidence, psychosocial treatments have withstood the test of time and still form the foundation of alcohol use disorder (AUD) treatment in advanced ALD. Despite the inescapable link between AUD) and advanced ALD, there are no FDA-approved medications for use in this special population. In this urgent subgroup, only baclofen, used off-label, has been shown to be effective for AUD in randomized controlled trials. An integrated, multidisciplinary and longitudinal approach remains the best option for the management of AUD in advanced ALD.

Re-socializing the Vulnerable Brain: Building an Ethically Sustainable Brain Disease Model of Addiction

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.

Interpretive Phenomenological Analysis of the Spiritual Characteristics of Recovery Experiences in the Context of the Brain Disease Model of Addiction

Spirituality persists as a mechanism of behavior change for addiction recovery. The aim of this project was to carefully attend to how those in recovery construct meaning of their experience of addiction, regardless of the addiction treatment modality or ideological framework. Participant accounts reflected the increased public interest in and research funding based on the brain disease model of addiction (BDMA). The qualitative study used interpretive phenomenological analysis to investigate the experiences of six adults (age range from 24 to 72) with at least three years of sustained recovery from substance use disorders. In-depth key informant interviews tracked their construction of their experiences and their understanding of addiction. Participants who entered recovery after 2010 sought to integrate BDMA-related constructs into their understanding of addiction and recovery. Addiction recovery narratives featuring BDMA-related constructs integrated neuroscience-related ideas with spirituality-related constructs rather than completely replacing the latter. Notable innovations and paradoxical tensions were found within participant accounts. Such features echo the insights on secularity of Harvard philosopher Charles Taylor, particularly his notion of the “buffered self,” which offers a theoretical framework for understanding these shifts in meaning-making. For persons entering recovery in the twenty-first century, the brain disease model of addiction carries more explanatory authority than it does for previous generations, despite the lack of agreement across addiction-related neuroscientific findings. As a model, it engenders more mechanistic, agential, brain-centered (“buffered”) senses of self, ostensibly making it less compatible with spiritual understandings of addiction than other medical models of addiction. However, this study’s findings indicate that those in recovery are likely to devise complex narratives of the etiology of addiction that combine elements from various models.

Drug and alcohol treatment providers' views about the disease model of addiction and its impact on clinical practice: A systematic review.

Addiction treatment providers' views about the disease model of addiction (DMA), and their contemporary views about the brain disease model of addiction (BDMA), remain an understudied area. We systematically reviewed treatment providers' attitudes about the DMA/BDMA, examined factors associated with positive or negative attitudes and assessed their views on the potential clinical impact of both models. Pubmed, EMBASE, PsycINFO, CINAHL Plus and Sociological Abstracts were systematically searched. Original papers on treatment providers' views about the DMA/BDMA and its clinical impact were included. Studies focussing on tobacco, behavioural addictions or non-Western populations were excluded. The 34 included studies were predominantly quantitative and conducted in the USA. Among mixed findings of treatment providers' support for the DMA, strong validity studies indicated treatment providers supported the disease concept and moral, free-will or social models simultaneously. Support for the DMA was positively associated with treatment providers' age, year of qualification, certification status, religious beliefs, being in recovery and Alcoholics Anonymous attendance. Greater education was negatively associated with DMA support. Treatment providers identified potential positive (e.g. reduced stigma) and negative (e.g. increased sense of helplessness) impacts of the DMA on client behaviour. The review suggests treatment providers may endorse disease and other models while strategically deploying the DMA for presumed therapeutic benefits. Varying DMA support across workforces indicated service users may experience multiple and potentially contradictory explanations of addiction. Future policy development will benefit by considering how treatment providers adopt disease concepts in practice.

Popular Views on Addictions and on Prospects for Recovery in Poland

ABSTRACTBackground: Popular views of addictive substances and behaviors constitute an important research topic because these views have an impact upon the functioning of treatment systems and societal responses to substance use disorders. Methods: The analysis is based on a random sample of N = 1000 telephone interviews collected in Poland in 2013. Questionnaire measures targeted such issues as the perceived risks of addictions and beliefs about potential recovery from various types of addictions. Results: First, a coherent view of the addiction potential of various addictive substances and/or behaviors emerges, distinguishing licit drugs and types of behavior from illicit drugs. Second, treatment optimism proves to be quite high independent of the type of addictive behavior, while chances of recovery without treatment are considered less likely. Third, chances for assisted change (change with treatment) and self-change are considered largely independent of perceived addiction-related risks and are not perceived as contradictory. Conclusions: The results point to the persistence of the disease model of addiction in Poland, placing responsibility for addiction on the individual and pairing it with the expectation of undergoing specialized treatment. This individualistic approach was applied as a framework for addiction problems in the 1950s to deflect from the shortcomings of the ‘‘new socialist society.’’ Neo-liberal market reform and socioeconomic changes have provided reinforcement for this individualistic framework.

Do Neurobiological Understandings of Smoking Influence Quitting Self-Efficacy or Treatment Intentions?

Addiction is increasingly defined as a "brain disease" caused by changes to neurochemistry. While nicotine addiction has historically been excluded in the brain disease model of addiction (BDMA), it is beginning to be labeled a chronic brain disease. We investigated whether Australian smokers endorse brain-based explanations of smoking, and whether these beliefs are associated with quitting self-efficacy or treatment intentions. Cross-sectional study of Australian smokers (N = 1538) who completed a survey measuring their agreement with statements on the brain's role in smoking. Logistic regressions tested associations between these items and socio-demographic variables, quitting self-efficacy and intention to use cessation medications. The majority (57.9%) agreed that smoking changed brain chemistry and 34.4% agreed that smoking was a brain disease. Younger participants and those with more education were more likely to endorse brain-based understandings of smoking. Participants who agreed smoking changed brain chemistry were more likely to report an intention to use cessation medicines (OR 1.5, 95% CI = 1.0-2.2) as were those who agreed that smoking was a brain disease (OR 1.5, 95% CI = 1.1-2.1). Self-efficacy did not differ between those who agreed and disagreed that smoking changed brain chemistry. However, those who agreed that smoking was a brain disease had higher self-efficacy than those who disagreed (OR 1.7, 95% CI = 1.3-2.3). A neurobiological view of smoking does not dominate public understandings of smoking in Australia. Endorsement of neurobiological explanations of smoking were associated with increased intention to use cessation aids, but were not associated with reduced self-efficacy. Explaining tobacco dependence in neurobiological terms is unlikely to induce feelings of fatalism in relation to smoking cessation. Those who endorse biomedical explanations of smoking may be more open to using cessation pharmacotherapies. Describing smoking in terms of alterations in brain chemistry may be more acceptable to smokers than labeling smoking a "brain disease" or "brain disorder."