Is addiction (only) a brain disease? (Lombera)

Addiction is a brain disease.  This is undeniably a bold and controversial statement and one which usually elicits varied reactions ranging from denial and skepticism to wholehearted agreement.  The lack of consensus means that when Canada’s “neuroscientist in chief” is defending this view, people to sit up and pay close attention. During his recent talk as part of our “Neuroethics of Addiction” workshop, Dr. Anthony Phillips, the newly appointed scientific director of the Canadian Institutes for Health Research’s (CIHR) Institute for Neuroscience, Mental Health and Addiction (INMHA), explored how the brain networks and chemistry change as a result of repeated drug abuse. Dr. Phillips explained that people who abuse drugs are in the process of changing their brain chemistry (mainly through fluctuations in dopamine levels), which has semi permanent effects on decision-making processes.

From the data Dr. Phillips presented, it is clear that the brain plays a role in addiction.  The ‘reward network’ and dopamine-glutamate system function pathologically such that basic needs such as food are ignored and seeking a particular drug is prioritized.  But is addiction only a brain disease?  I think it would be shortsighted to conceptualize the condition in that way.  In addition to brain activity, socioeconomic, psychological and political factors, among others contribute to onset of the addictive behavior as well as to the disease course itself.  This is not to say that investigating the neuroscience of addiction and addictive behavior is not a worthy endeavor.  After all, Dr. Phillips expressed hope that research on the neuroplasticity (the brain’s ability to change itself) may have important implications for treatment of addiction.  The contributions that science can make towards understanding and managing addiction are undoubtedly valuable. It is important, however, to acknowledge the complexity of the condition and avoid reductionist perspectives on addiction.