So here I am, on a Saturday afternoon, innocently looking to download this week’s Wait Wait… Don’t Tell Me!, when I stumble upon the headline “Addiction Is Not A Disease of the Brain.” At that point, I know I should just walk away — or, even simpler, click away. I should just let it be. But of course, that’s not what happened.
On the one hand, this article seems to be deliberately baiting scientists — enough so that I probably shouldn’t dignify it with a response. On the other hand, there’s just too much to respond to here to avoid it.
The first point that the author makes, after a fairly standard and obvious introduction with which I have no major issues, is this:
“Let us first ask: what makes something — a substance or an activity — addictive? Is there a property shared by all the things to which we can get addicted?
Unlikely. Addictive substances such as alcohol, heroin and nicotine are chemically distinct. Moreover, activities such as gambling, eating, sex — activities that are widely believed to be addictive — have no ingredients.”
As a scientist, my objective reaction was something along the lines of ” Bu…. Wha….? No.” (I’m paraphrasing here.)
The author is fond of analogies, so let me attempt one of my own. “What makes something — a substance or activity — cause weight gain? Is there a property shared by all things which can cause weight gain?
Unlikely. Substances such as sugar, salt, and fat are chemically distinct. Moreover, activities such as watching too much tv, buying junkfood, and underestimating portion sizes — activities that are widely believed to cause weight gain — have no ingredients.”
A thing doesn’t need “ingredients” to be addictive. The commonality between all addictive substances and activities is their effect on neural pathways — and the differences between brains, let alone the differences between one brain in different states and at different periods within the lifespan, make it impossible to single out neural circuits and say “Aha, this and no other thing causes addiction!” Just as the substances and activities in my analogy above all may cause weight gain despite their differences, certain substances and activities are addictive because they are addictive, tautology or no. The fact that addiction is a complicated process in the brain does not mean that the solution to the problem can’t be found in neuroscience — in fact, I would say it indicates the opposite.
The author even discusses research in which rats will press a lever to trigger a dopamine release, to the exclusion of eating and sleeping, stating: “… there is now a substantial body of evidence supporting the claim that all drugs or activities of abuse (as we can call them), have precisely this kind of effect on this dopamine neurochemical circuit.” Yet he draws insupportable conclusions from these well-known facts.
So. The main premise of the article is scientifically flawed, although (who knows?) perhaps it works in terms of philosophy. But moving on from that point, the author calls into question the premise that drugs and activities of addiction “highjack” the neural pathways involving dopamine.
He states that if addictive substances and behaviors do in fact highjack neural pathways, then “we haven’t discovered, in the reward reinforcement system, a neurochemical signature of addiction. We haven’t discovered the place where addiction happens in the brain. After all, the so-called highjacking of the reward system is not itself a neurochemical process; it is a process whereby neurochemical events get entrained within in a larger pattern of action and decision making.”
That’s kind of the point: the fact that addiction is “a process whereby neurochemical events get entrained within in a larger pattern of action and decision making” is the very reason why addiction can be termed a disorder of the brain.
I feel like the author comes close to making a salient point when he employs another analogy:
“Is addiction a disease of the brain? That’s a bit like saying that eating is a phenomenon of the stomach. The stomach is an important part of the story. But don’t forget the mouth, the intestines, the blood, and don’t forget the hunger, and also the whole socially-sustained practice of producing, shopping for and cooking food.”
I say “comes close,” because comparing the brain to the stomach is flawed in one very obvious way: the stomach digests food, and its state triggers hunger signals, but that’s about it. The brain does everything. If, in the above analogy, we take “the mouth, the intestines, the blood, and the hunger” to mean the physiological craving for the substance or activity, and the withdrawal symptoms that occur — well, those are triggered by the brain.
If the author means to say that the brain does not operate in a vacuum, and that many factors cause and trigger addiction, he is correct on that point. In fact, former addicts are counseled to avoid situations and places in which they previously used their substance of abuse, as such triggers can bring back cravings for the substance, even after a period of abstinence. That is one reason why recovery from addiction can be so difficult — most patients cannot afford or manage to avoid their old lifestyle, relationships, or home, any of which may trigger a relapse. These things, I assume, along with a culture that may glorify substance use, are comparable to “the whole socially-sustained practice of producing, shopping for and cooking food.”
Furthermore, the brain might not become addicted without the accompanying body-wide physiological reaction (“the hunger”), but I think we can all agree (unless I have devoted Cartesian readers that I don’t know about) that the brain is a part of the body, and that the psychological and physiological are inextricably connected. So — this is a point I can agree with, but the argument derived from it does not necessarily follow.
The conclusion, however, brings out the worst of my scientific rage:
“Is addiction a disease of the brain? This strikes me as a dubious falsification of what is, really, a phenomenon that can only be understood in terms of the life, choices, needs and understanding of the whole person.”
Is it just me, or does “studying the functions of the brain” translate directly into “studying the life, choices, needs and understanding of the whole person.” In acknowledging that the brain does more than cool the blood, we acknowledge that it plays a large part (tempered by the rest of the body, the external environment, and past experiences) in determining needs, choices,and understanding.
Now, I am always willing to admit when we need to change our theories or ideas in neuroscience — it’s a fairly young field, so it’s probably bound to happen a few times in my life. But that change must come about by study, by research, by new data calling old paradigms into question. Scientific truths should not — and cannot — be denied simply by a nonscientist positing what-ifs in order to get a rise out of those who hold (with good, empirical reasons at this point in history) to the generally accepted theory.