Is Addiction a Brain Disease?

Mark Lewis says No.

What say you?

Addiction to substances (e.g., booze, drugs, cigarettes) and behaviors (e.g., eating, sex, gambling) is an enormous problem, seriously affecting something like 40% of individuals in the Western world. Attempts to define addiction in concrete scientific terms have been highly controversial and are becoming increasingly politicized. What IS addiction? We as scientists need to know what it is, if we are to have any hope of helping to alleviate it.

There are three main definitional categories for addiction: a disease, a matter of choice, and self-medication. There is some overlap among these meta-models, but each has unique implications for treatment, from the level of government policy to that of available options for individual sufferers….

To get a bit more specific, every experience that has potent emotional content changes the NAC (nucleus accumbens) and its uptake of dopamine. Yet we wouldn’t want to call the excitement you get from the love of your life, or your fifth visit to Paris, a disease. The NAC is highly plastic. It has to be, so that we can pursue different rewards as we develop, right through childhood to the rest of the lifespan. In fact, each highly rewarding experience builds its own network of synapses in and around the NAC, and that network sends a signal to the midbrain: I’m anticipating x, so send up some dopamine, right now! That’s the case with romantic love, Paris, and heroin. During and after each of these experiences, that network of synapses gets strengthened: so the “specialization” of dopamine uptake is further increased. London just doesn’t do it for you anymore. It’s got to be Paris. Pot, wine, music…they don’t turn your crank so much; but cocaine sure does. Physical changes in the brain are its only way to learn, to remember, and to develop. But we wouldn’t want to call learning a disease.

So how well does the disease model fit the phenomenon of addiction? How do we know which urges, attractions, and desires are to be labeled “disease” and which are to be considered aspects of normal brain functioning? There would have to be a line in the sand somewhere. Not just the amount of dopamine released, not just the degree of specificity in what you find rewarding: these are continuous variables. They don’t lend themselves to two (qualitatively) different states: disease and non-disease.

In my view, addiction (whether to drugs, food, gambling, or whatever) doesn’t fit a specific physiological category. Rather, I see addiction as an extreme form of normality, if one can say such a thing. Perhaps more precisely: an extreme form of learning. No doubt addiction is a frightening, often horrible, state to endure, whether in oneself or in one’s loved ones. But that doesn’t make it a disease.

About Scot McKnight

Scot McKnight is a recognized authority on the New Testament, early Christianity, and the historical Jesus. McKnight, author of more than forty books, is the Professor of New Testament at Northern Seminary in Lombard, IL.

  • http://www.mindfuljustice.com Jim

    If you believe science, substance and behavioral addictions have been proved to be part of a brian disorder. I woud agree the explanation is far more complicated and that’s why treatment has to be more than a pill, another group, more quiet time, etc. I have worked in this field as a case manager for the mentally ill (almost all have been duel diagnosed) for twenty years and my experience leads me to believe that addictions begin as a choice (often self-medicating – but that might be an overused generalization) and they become a disorder. There is ample evidence that substances and behavior re-wire the brain. There is a good text to read called “The Addicted Brain.”

    The old saying goes: “No one chooses addiction, you can chose recovery.” We all need to be compassionate – both with others and ourselves.

  • http://www.mindfuljustice.com Jim

    That should read a brain disorder – sorry.

  • barb

    Could we hear from someone who has experienced both addiction and recovery?

  • Joe Canner

    A broader question is: why do we consume things or do things that are harmful to us in the first place?

    From an evolutionary standpoint, many things that contribute to ill health today were valued for their survival value (eating sugar and fat, sexual promiscuity) in our distant past or at least not selected against because they didn’t exist (drugs, alcohol, cigarettes). In other words, our genes are not well matched for the environment in which we find ourselves.

    I am also convinced that there are a number of vices (e.g., smoking) that would never get to the addictive stage if it were not for peer pressure.

    For me, this just reinforces Jim’s conclusion in #1 regarding the need for compassion. Yes, addiction can be tamed, but it is more than just an act of the will.

  • Sandra

    I am no psychologist but from observing people and dealing with people all my life I have a general viewpoint about addictions. Most addicts comes from a traumatic and/or lonely pasts. A few just wanted to have fun or gave in to peer pressure out of ignorance. Those majority of bad pasts as youngsters, when they face small and big crisis, they may not have the right support or people with the know how in teaching them how to face those kinds of crisis. Too many families are dysfunctional in this way. Too many parents don’t make the first 18 years of a child’s life the time to teach them moral values and the facts of life. They live it to the teachers or Hollywood media. Some of those parents don’t know how to deal with life either so they can’t teach their kids and those parents may even be addicts too. In other cases the traumas of evil events(like molestation, abuse, physical problems, etc.) are beyond what a caring parent know how in order to help their own child. They sometimes make the mistake of not seeking the right outside help. Those youngsters who don’t have the loving support and mentors in their lives will take longer to get out of their addictions, if they ever make it out. Yet I don’t think it is ever too late, even way past adulthood and decades of addictions.

  • Sandra

    Sorry, my writing above was sloppy.

  • Stephen Hesed

    Most psychiatric diseases are “extreme versions of normality.” It’s a well-recognized problem that disorders are typically the extremes on spectrums that most people fall on somewhere, and that where to draw the line is arbitrary. Still, we draw the line somewhere, because of the obviously destructive consequences psychiatric disorders can have on people’s lives.

  • Mike M

    I do addictionology as part of my practice. About half of the addicts coming to me became addicted (to narcotics in the majority) because of pain issues and about half from recreational use. Many of the reccers started because of peer pressure, and many because they were trying to escape reality. After 3 or so weeks of continued use or abuse, the opiate receptors in the brain begin to change physical shape so that a person requires more and more narcotics to obtain the same result whether for pain control, getting goofed up, or self-medicating for depression, anxiety, insomnia, or whatever.
    Ultimately, chronic users/abusers continue to use because of the fear of withdrawal. It’s a standard psychological insight: fear of pain is a much stronger motivator than anticipation of pleasure. Good addictionology works because there are medications that prevent and/or alleviate withdrawal while allowing neurons to recover their primal shape. There are also better medications (and other therapies) for anxiety, depression, insomnia, etc.
    Addictionology works best with the proper medications plus psychotherapy. Psychotherapy allows a person to sort through those issues that not only facilitated dependence in the first but also those that enable continuing addiction. Depending on the type of psychotherapy (I like CBT the best), new neural pathways are developed and old, dysfunctional ones are abandoned. And that’s really what defines addiction as a DISease: when it results in dysfunctional thinking, behaviors, and talk.

  • Alex

    http://dictionary.reference.com/browse/disease?s=t

    I checked Dictionary.com for the definition of the word disease and it would seem that addiction only fits into 1 of the 4 definitions provided, #3. Being a harmful, depraved or morbid condition of the mind or society. It doesn’t fit with #1 one because from what the article says, addiction is only the result of what the brain normaly does. But this process seems to lead to the harmful condition known as addiction.

    From personal experience being addicted to prescription pain killers this makes sense to me. It starts as a choice to self-medicate or even just being curious about the feeling, but it can soon spin out of control. Leading to chemical dependancy that can seriously harm your self physically as well as the relationships you have with others.

    I thank God often for the work of the Holy Spirity in me to bring me out of my addiction and for my wonderful wife who was patient and loving as we struggled through it together.

  • Patrick

    I think most our compulsions we’re born with.

  • Bill P

    That might give insight as to why 12 Step groups have such a low rate of success.

  • Bob

    I thought 12 step groups are at least 30-50% successful, vrs all aothe types of treatment No?

  • http://earthymonk.wordpress.com Niles Comer

    I fall under the following “categories”: I have been a lover and follower of Jesus for over 25 years; I have been addicted to drugs and alcohol; I have been in recovery; and I have worked with people living with and struggling with addictions and recovery. So that being said, addiction is a cunning and baffling dis-ease with some people who can find recovery without losing everything and some people having years of recovery relapsing back into active addictions. Addiction is a spiritual dis-ease AND a physiological one that is impacted by our genome makeup as well as by our cultural, social, economic and community upbringing. I have heard people claim it is demonic only, medical only, and some variation of the two. Some things that are good to remember when speaking of addictions and dealing with addicts: compassion works and is mandated by Jesus, but that does not mean we have “Welcome Mats” on our backs. Tough love is tough. Doing it alone is almost impossible. Shaming people with a “pull yourself up by your bootstraps” is ineffective and can be likened to asking someone with no hands to pull themselves up by their bootstraps…or asking someone with no boots to do so. The Lord Jesus desires mercy not sacrifice and came for the sick, the broken and the wounded, not the perfect or righteous. And as to “success” with addictions, some define it by complete sobriety for a number of years while others define it differently. When it comes to addictions, it might be helpful if we defined success the way Mother Teresa did: “success is defined by our obedience to God.” So, if we are focused on abundant compassion, lavish grace, belief in a God Who is bigger than ANY sin or addiction as well as good treatment methods (somewhat arbitrary depending upon people’s training and perspective), believing that treatment works (and works MUCH BETTER than incarceration) and working on NOT being judgmental or moralistic about it, more people will find hope in Jesus and in authentic community (koinonia). No one truly understand addiction but God alone, for we see through a glass dimly. But if we are faithful to Jesus and His call to compassion and we are open, honest, transparent, and authentic, then people can get real about addictions and get real about becoming open to healing. And finding healing for addictions is similar to our relationship to Jesus: it is not a one day, historical event; it is however a Life-long Journey towards the God of All Comfort and Grace. And we would all do well to trust God’s Spirit working in people rather than in laws, rigidity, religious piety, and moralistic arrogance. Thanks for writing about this important pandemic that is affecting millions of Americans and hundreds of millions of people world-wide.


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