Should Addicts Be Told They Have an Incurable Brain Disease?

Should Addicts Be Told They Have an Incurable Brain Disease?

Countless studies have made it accepted fact that how we label and describe things directly affects how others regard them, mentally or emotionally or both.

It is basic human nature to respond positively to positive suggestion, and negatively to negative suggestion.

In fact, nothing may be more basic to life than the influences we follow to survive.

One has to wonder, then, what benefit it is to anyone, especially those struggling with addiction and those contemplating treatment and recovery, of loudly trumpeting the (very negative) idea that addiction is "an incurable brain disease" - the concept endlessly disseminated by the National Institute on Drug Abuse (NIDA), an agency under the National Institutes of Health.

Negative vs positive messaging

A new study at North Carolina State University (NCSU) expands on findings of earlier studies here and here and elsewhere that have shown how people suffering from substance use problems:

  • Negatively view their potential for recovery when addiction is framed in negative terms, such as calling it a disease
  • Positively view their potential for recovery when addiction is not called a disease, but a condition for which recovery indeed exists.

The NCSU team enrolled 214 men and women with substance-use problems and split them into a "disease" group and a "non-disease" group.

One hundred and twenty-four of the participants received a 'growth mindset' message describing various factors that can contribute to substance abuse, how human attributes are malleable, and multiple ways to address addiction. The remaining 90 participants simply received the main message that "addiction is a disease."

"We wanted to see if an alternative message aimed at changing that mindset could affect how people with substance-use problems viewed themselves with regard to addiction," said Jeni Burnette, author of the paper and an associate professor at NCSU. "We know from previous work that it encourages better self-regulatory strategies such as seeking help from others."
Study participants receiving the positive messaging "reported stronger growth mindsets and more confidence in their ability to handle their addiction" compared to those getting the disease message.

Several important questions arise

Numerous studies have shown that the "disease" label for addiction has produced absolutely nothing of value to treatment or recovery in the more than two decades since the "incurable brain disease" message began being disseminated by NIDA Director, psychiatrist Dr. Nora Volkow, and others. Since then, the message has pervaded the medical and treatment communities in spite of the fact that it is far from a proven scientific fact.

This brings up three questions relevant to anyone engaged in communicating about addiction recovery:

  1. Is addiction actually a disease? Or worse, is addiction an "incurable brain disease"?
  2. How do such labels affect those actively involved in recovery, or contemplating addiction treatment?
  3. Whether it's a disease or not, how does anyone benefit from using such a label?

It may have been introduced originally to help remove stigma from addiction.

But numerous scientists offer convincing proof that:

  1. Addiction most certainly is not a disease; and
  2. The disease label is counterproductive to recovery in every way.

For example, Neal Levy of the Florey Institute of Neuroscience in Melbourne, Australia, insists that neural dysfunction is not sufficient for disease. He demonstrates that something is a brain disease "only when neural dysfunction is sufficient for impairment" and in the case of addiction that clearly is not true.

Anke Snoek, Faculty of Health, Maastricht University, Netherlands., maintains that people struggling with addiction "are neither powerless over their addiction, nor are they fully in control." He suggests perhaps it's not a true disease, but rather a "disease-like stage" during addiction that, in fact, does not scientifically qualify as a true disease.

American neuroscientist Dr. Marc Lewis vigorously objects to the "brain disease model of addiction" because it "makes people lose belief in their self-efficacy, and hence hinders their recovery." An addict in his youth who fully recovered as a young adult and went on to earn his PhD, Lewis acknowledges that addiction has compulsive states but such compulsion "is not carved in stone."

In his popular book on the subject, "The Biology of Desire: Why Addiction Is Not a Disease," Lewis argues that labeling addiction as a brain disease seriously underestimates the strength and ability of addicted people, and hinders their recovery. Furthermore, neuroscientists who subscribe to the brain disease model have not shown that changes in the brain caused by addiction are any different from what occurs in normal learning and development, or even extreme events such as falling in love or having children.

"That's where they step onto thin ice," Lewis says. "The kind of brain changes seen in addiction, such as the surges of dopamine in the regions highlighted by Volkow et al, also show up when people become absorbed in a sport, join a political movement, or become obsessed with their sweetheart or their kids."
"The brain contains only a few major traffic routes for goal seeking," Lewis concludes. "Like the main streets of a busy city, the same routes get dug up and paved over time and time again, no matter who's in charge."
Lewis's book offers new perspectives on how addiction can be overcome through "self-directed change in one's goals and perspectives" - a far cry from a self-defeating incurable brain disease.

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