📰 Addiction and the Brain-Disease Fallacy
Full Title: Addiction and the Brain-Disease Fallacy
“Salience” is the term that neuroscientists often use to describe the pull of substances on the addicted – it’s more of a sense of wanting, even needing, than liking. The development of salience has been traced to the nerve pathways that mediate the experience as they emerge from the underside of the brain, in an area called the ventral tegmentum, and sweep out to regions such as the nucleus accumbens, hippocampus, and prefrontal cortex, which are associated with reward, motivation, memory, judgment, inhibition, and planning.
Lawford (), himself in recovery from drugs and alcohol, edited a 2009 collection of essays called Moments of Clarity in which the actor Alec Baldwin, singer Judy Collins, and others recount the events that spurred their recoveries. Some quit on their own; others got professional help. A theme in each of their stories is a jolt to self-image: “This is not who I am, not who I want to be” (). One recovered alcoholic describes the process: “You tear yourself apart, examine each individual piece, toss out the useless, rehabilitate the useful, and put your moral self back together again” (). These are not the sentiments of people in helpless thrall to their diseased brains. Nor are these sentiments the luxury of memoirists. Patients have described similar experiences to us: “My God, I almost robbed someone!” “What kind of mother am I?” or “I swore I would never switch to the needle.”
Recovery is a project of the heart and mind. The person, not his or her autonomous brain, is the agent of recovery.
The brain-disease narrative misappropriates language better used to describe such conditions as multiple sclerosis or schizophrenia – afflictions of the brain that are neither brought on by the sufferer nor modifiable by the desire to be well. It offers false hope that an addict’s condition is completely amenable to a medical cure (much as pneumonia is to antibiotics). Finally, as we’ll see, it threatens to obscure the vast role of personal agency in perpetuating the cycle of use and relapse.
Addicts embarking on recovery often need to find new clean and sober friends, travel new routes home from work to avoid passing near their dealer’s street, or deposit their paycheck directly into a spouse’s account to keep from squandering money on drugs. A teacher trying to quit cocaine switched from using a chalkboard – the powdery chalk was too similar to cocaine – and had a whiteboard installed instead. An investment banker who loved injecting speedballs – a cocktail of cocaine and heroin in the same syringe – made himself wear long-sleeved shirts to prevent glimpses of his bare and inviting arms. Former smokers who want to quit need to make many fine adjustments, from not lingering at the table after meals to ridding their homes of the ever-present smell of smoke, removing car lighters, and so on.
Brain research is yielding valuable information about the neural mechanisms associated with desire, compulsion, and self-control – discoveries that may one day be better harnessed for clinical use. But the daily work of recovery, whether or not it is abetted by medication, is a human process that is most effectively pursued in the idiom of purposeful action, meaning, choice, and consequence.