THREAD 1/
This article on "addiction as a brain disease" is a must-read update on an age-old debate.
IMO, much of it equally applies to "addiction" as other mental disorders.
(thanks to @zivacooper for sending).
This article on "addiction as a brain disease" is a must-read update on an age-old debate.
IMO, much of it equally applies to "addiction" as other mental disorders.
(thanks to @zivacooper for sending).
2/
A few points worth discussing. First, addiction as disease is a counter-narrative in response to the:
"prevailing nonscientific, moralizing, and stigmatizing attitudes to addiction [that framed it as a] moral failing or weakness of character, rather than a 'real' disease.
A few points worth discussing. First, addiction as disease is a counter-narrative in response to the:
"prevailing nonscientific, moralizing, and stigmatizing attitudes to addiction [that framed it as a] moral failing or weakness of character, rather than a 'real' disease.
3/
"This argument was particularly targeted to the public, policymakers and health care professionals, many of whom held that since addiction was a misery people brought on themselves, it fell beyond the scope of medicine..."
"This argument was particularly targeted to the public, policymakers and health care professionals, many of whom held that since addiction was a misery people brought on themselves, it fell beyond the scope of medicine..."
4/
The authors stake out a firmly non-reductionist view of addiction -- not an either/or of biology/social/environment:
The authors stake out a firmly non-reductionist view of addiction -- not an either/or of biology/social/environment:
6/
this applies to "mental disorder" as well as "addiction":
"...stating that brain mechanisms are critical for understanding & treating addiction in no way negates the role of psychological, social & socioeconomic processes as both causes & consequences of substance use."
this applies to "mental disorder" as well as "addiction":
"...stating that brain mechanisms are critical for understanding & treating addiction in no way negates the role of psychological, social & socioeconomic processes as both causes & consequences of substance use."
7/
The authors also tackle head on what the term "disease" (which especially applies to the concept of "mental disorder"):
"simply a label" and not necessarily an "entity... that has its own independent existence, apart from other things."
The authors also tackle head on what the term "disease" (which especially applies to the concept of "mental disorder"):
"simply a label" and not necessarily an "entity... that has its own independent existence, apart from other things."
8/
the oft-claimed "arbitrary" boundaries of diagnosis are common features of substance use disorders, mental disorders more generally, *as well as* less frequently debated "real diseases" like cancer:
the oft-claimed "arbitrary" boundaries of diagnosis are common features of substance use disorders, mental disorders more generally, *as well as* less frequently debated "real diseases" like cancer:
9/
though here, the authors seem to reveal that they don't spend much time on Twitter... citing RD Laing and Foucault to suggest that "misguided" claims of mental disorders like schizophrenia not being real diseases are antiquated:
though here, the authors seem to reveal that they don't spend much time on Twitter... citing RD Laing and Foucault to suggest that "misguided" claims of mental disorders like schizophrenia not being real diseases are antiquated:
10/
The authors also make a great point about how "spectrum" views of addiction [and mental illness more generally] and the failure to reliably utilize diagnostic categories can lead to apparent problems with validity:
The authors also make a great point about how "spectrum" views of addiction [and mental illness more generally] and the failure to reliably utilize diagnostic categories can lead to apparent problems with validity:
11/
Next, the authors tackle claims about non-specific genetic and neuroimaging "lesions" in addiction, noting that such claims misunderstand polygenetic risk and over-estimate the value of imaging in disorders like epilepsy.
Next, the authors tackle claims about non-specific genetic and neuroimaging "lesions" in addiction, noting that such claims misunderstand polygenetic risk and over-estimate the value of imaging in disorders like epilepsy.
12/
while also noting that vast amount of research demonstrating evidence of brain network anomalies in people with addiction
while also noting that vast amount of research demonstrating evidence of brain network anomalies in people with addiction
13/
They then offer some great paragraphs on how biomedical perspectives can be integrated with psychosocial factors.
This one:
They then offer some great paragraphs on how biomedical perspectives can be integrated with psychosocial factors.
This one:
14/
...this one:
...this one:
15/
and this one are 🔥:
and this one are 🔥:
16/
there's also a good section on free will, choice, and "compulsion" claims that have long been central to debates about addiction as a disease
there's also a good section on free will, choice, and "compulsion" claims that have long been central to debates about addiction as a disease
17/
and finally, an excellent concluding section that calls for complementary and integrated perspectives:
and finally, an excellent concluding section that calls for complementary and integrated perspectives:
18/
Kudos to the authors for this accessible review and response to critical claims.
Well worth reading beyond my excerpted quotations. As I said, much of it can be applied more generally to mental disorders.
Kudos to the authors for this accessible review and response to critical claims.
Well worth reading beyond my excerpted quotations. As I said, much of it can be applied more generally to mental disorders.
19/
My own meta-take is that preferences for "disease" vs. "non-disease" perspectives are often influenced by notions of blame & free will.
Within addiction, disease narratives point us away from blaming individuals...
My own meta-take is that preferences for "disease" vs. "non-disease" perspectives are often influenced by notions of blame & free will.
Within addiction, disease narratives point us away from blaming individuals...
20/
...but for many it doesn't do that enough for mental illness in general such that trauma narratives are often felt to be most validating.
Bottom line is there's no good reason to frame these perspectives as mutually exclusive and there's plenty of room for integration.
...but for many it doesn't do that enough for mental illness in general such that trauma narratives are often felt to be most validating.
Bottom line is there's no good reason to frame these perspectives as mutually exclusive and there's plenty of room for integration.
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