NPR: Addiction Is Not A Disease Of The Brain

[rhody]

I thought I would throw http://www.npr.org/blogs/13.7/2011/09/09/140307282/addiction-is-not-a-disease-of-the-brain" into the Lion's den, and watch, I mean read the reactions to it (and possibly contribute if it gets interesting, you never know with this crowd). Mentors, if you feel this belongs in the philosophy section feel free to move it, but I thought it would get a wider viewing and response from GD instead.

And yet it is remarkable — as Gene Heyman notes in his excellent book on addiction — that there are only 20 or so distinct activities and substances that produce addiction. There must be something in virtue of which these things, and these things alone, give rise to the distinctive pattern of use and abuse in the face of the medical, personal and legal perils that we know can stem from addiction.
and
When the American Society of Addiction Medicine recently declared addiction to be a brain disease their conclusion was based on findings like this. Addiction is an effect brought about in a neurochemical circuit in the brain. If true, this is important, for it means that if you want to treat addiction, you need to find ways to act on this neural substrate.

All the rest — the actual gambling or drug taking, the highs and lows, the stealing, lying and covering up, the indifference to work and incompetence in the workplace, the self-loathing and anxiety about getting high, or getting discovered, or about trying to stop, and the loss of friends and family, the life stories and personal and social pressures — all these are merely symptoms of the underlying neurological disease.

But not so fast. Consider:

All addictive drugs and activities elevate the dopamine release system. Such activation, we may say, is a necessary condition of addiction. But it is very doubtful that it is sufficient. Neuroscientists refer to the system in question as the "reward-reinforcement pathway" precisely because all rewarding activities, including nonaddictive ones like reading the comics on sunday morning or fixing the leaky pipe in the basement, modulate its activity. Elevated activity in the reward-reinforcement pathway is a normal concomitant of healthy, nonaddictive, engaged life.

Neuroscientists like to say that addictive drugs and activities, but not the nonaddictive ones, "highjack" the reward-reinforcement pathway, they don't merely activate it. This is the real upshot of the rat example. The rat preferred lever-pressing to everything; it dis-valued everything in comparison with lever-pressing. And not because of the intrinsic value of lever-pressing, but because of the link artificially established between the lever-pressing and the dopamine release.

If this is right, 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.

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.

Rhody... by the sidelines, popcorn in hand... for now...

 

[wuliheron]

We've had over a hundred years of "talk therapy" for addiction and the success rate is still 5% at best. That alone suggests we've been taking the wrong approach to the subject out of desperation more then anything else. All this nonsense about the "dopamine reward system" merely highlights just how little we do know about the underlying neurology.

A 150 years ago epileptics were considered to be "acting out" because there was no concrete explanation for their behavior. Before that people thought they were possessed by the devil or god. The entire history of western medicine is filled with such examples including shell shocked soldiers being treated as cowards and traitors. It is long overdue time to try a different approach and make at least the starting assumption that this is just another neurological problem.

 

[dlgoff]

I thought I would throw http://www.npr.org/blogs/13.7/2011/09/09/140307282/addiction-is-not-a-disease-of-the-brain" into the Lion's den, and watch, I mean read the reactions to it...

Addiction is an effect brought about in a neurochemical circuit in the brain.

Thanks man. I thought it was the beer itself.

 

[wuliheron]

Thanks man. I thought it was the beer itself.

That's just the beer talking.

 

[apeiron]

I thought I would throw http://www.npr.org/blogs/13.7/2011/09/09/140307282/addiction-is-not-a-disease-of-the-brain" into the Lion's den, and watch, ...

So what is the question here?

Noe makes the point that a reward pathway is a necessary but not sufficient condition for addiction. On the other hand, in the worst cases (rat self-stimulation, p-addicts) it pretty much is all that you need.

So the reduction to a neural mechanism isn't way off here.

Are you bothered about it being called a disease? Yes, that seems the wrong word if the response of the brain to a drug is not abnormal or atypical.

Clearly there is individual variety involved. Some people are far more easily hooked for various reasons.

There is also neural complexity in the fact that the rewarding eventually becomes the habitual. People are hooked as much on the familiar pattern of action as any strong feelings. And reward also moves to the anticipatory set - the preparing of the syringe, the spin of the wheel.

So reduction to neurology is not in any way a simple explanation.