Negotiating the Relationship Between Addiction, Ethics, and Brain Science

National Core for Neuroethics, The University of British Columbia, Vancouver, BC, Canada.
AJOB neuroscience 02/2010; 1(1):36-45. DOI: 10.1080/21507740903508609
Source: PubMed


Advances in neuroscience are changing how mental health issues such as addiction are understood and addressed as a brain disease. Although a brain disease model legitimizes addiction as a medical condition, it promotes neuro-essentialist thinking, categorical ideas of responsibility and free choice, and undermines the complexity involved in its emergence. We propose a 'biopsychosocial systems' model where psycho-social factors complement and interact with neurogenetics. A systems approach addresses the complexity of addiction and approaches free choice and moral responsibility within the biological, lived experience and socio-historical context of the individual. We examine heroin-assisted treatment as an applied case example within our framework. We conclude with a discussion of the model and its implications for drug policy, research, addiction health care systems and delivery, and treatment of substance use problems.

Download full-text


Available from: W. J. Wayne Skinner,
  • Source
    • "These barriers to providing smoking cessation among people with drug and alcohol problems may be addressed through providing enhanced staff education and training in smoking cessation, supporting staff to quit smoking and creating a smoke-free environment for drug and alcohol treatment services [42]. The magnitude of the barriers to treatment provision and uptake for prisoners coupled with the major adverse biological and social factors associated with severe drug dependence [43], suggests that very powerful interventions to assist smoking cessation will be required to increase quit rates in this population. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Prisoners have extremely high rates of smoking with rates 3-4 times higher than the general community. Many prisoners have used heroin. The aims of this study were to investigate the impact of heroin use on smoking cessation and the social determinants of health among prisoners. Secondary analysis of data from a randomised controlled trial of a multi-component smoking cessation intervention involving 425 Australian male prisoners. Inmates who, prior to imprisonment, used heroin regularly were compared to those who did not use heroin regularly. Self-reported smoking status was validated at baseline and each follow-up by measuring carbon monoxide levels. Readings exceeding 10 ppm were defined as indicating current smoking. Over half (56.5%) of the participants had ever used heroin while 37.7% regularly (daily or almost daily) used heroin in the year prior to entering prison. Prisoners who regularly used heroin had significantly worse social determinants of health and smoking behaviours, including lower educational attainment, more frequent incarceration and earlier initiation into smoking. Prisoners who regularly used heroin also used and injected other drugs significantly more frequently. At 12-month follow-up, the smoking cessation of prisoners who had regularly used heroin was also significantly lower than prisoners who did not regularly use heroin, a finding confirmed by logistic regression. Regular heroin use prior to imprisonment is an important risk factor for unsuccessful attempts to quit smoking among prisoners and is also associated with worse social determinants of health, higher drug use, and worse smoking behaviours. More effective and earlier smoking cessation interventions are required for particularly disadvantaged groups. This trial is registered with the Australian New Zealand Clinical Trials Registry 12606000229572.
    BMC Public Health 12/2013; 13(1):1200. DOI:10.1186/1471-2458-13-1200 · 2.26 Impact Factor
  • Source
    • "Such viewpoint may lead to “increasing alienation, stigmatization, and social distance” (75) of human beings abusing drugs. Multi-leveled overlooks of addiction that include biological/psychological/social (76), and even spiritual (77) elements are suggested as potential candidates to restrain such an undesirable possibility (78). Along these lines, the multiscale standpoint of the framework shown in Figure 1 aims to promote a comprehensive understanding of addiction that provides prospect for recovery, which seems to occur more often than commonly believed (79). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The allostatic theory of drug abuse describes the brain's reward system alterations as substance misuse progresses. Neural adaptations arising from the reward system itself and from the antireward system provide the subject with functional stability, while affecting the person's mood. We propose a computational hypothesis describing how a virtual subject's drug consumption, cognitive substrate, and mood interface with reward and antireward systems. Reward system adaptations are assumed interrelated with the ongoing neural activity defining behavior toward drug intake, including activity in the nucleus accumbens, ventral tegmental area, and prefrontal cortex (PFC). Antireward system adaptations are assumed to mutually connect with higher-order cognitive processes occurring within PFC, orbitofrontal cortex, and anterior cingulate cortex. The subject's mood estimation is a provisional function of reward components. The presented knowledge repository model incorporates pharmacokinetic, pharmacodynamic, neuropsychological, cognitive, and behavioral components. Patterns of tobacco smoking exemplify the framework's predictive properties: escalation of cigarette consumption, conventional treatments similar to nicotine patches, and alternative medical practices comparable to meditation. The primary outcomes include an estimate of the virtual subject's mood and the daily account of drug intakes. The main limitation of this study resides in the 21 time-dependent processes which partially describe the complex phenomena of drug addiction and involve a large number of parameters which may underconstrain the framework. Our model predicts that reward system adaptations account for mood stabilization, whereas antireward system adaptations delineate mood improvement and reduction in drug consumption. This investigation provides formal arguments encouraging current rehabilitation therapies to include meditation-like practices along with pharmaceutical drugs and behavioral counseling.
    Frontiers in Psychiatry 12/2013; 4:167. DOI:10.3389/fpsyt.2013.00167
  • Source
    • "Those who favor the addiction-as-disease framework often believe that the objective, biological gaze debunks the moralized argument that addiction is a problem for weak-willed people (Buchman 2010). In the same vein, opponents of the disease framework often claim that the biological understanding will remove the onus of personal responsibility and moral culpability, that patients will use their " disease " as a " crutch " (Dingel et al. 2012; Rosenberg 1992), The majority of our interviewed patients found the disease model useful. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To deepen understanding of efforts to consider addiction a "brain disease," we review critical appraisals of the disease model in conjunction with responses from in-depth semistructured stakeholder interviews with (1) patients in treatment for addiction and (2) addiction scientists. Sixty-three patients (from five alcohol and/or nicotine treatment centers in the Midwest) and 20 addiction scientists (representing genetic, molecular, behavioral, and epidemiologic research) were asked to describe their understanding of addiction, including whether they considered addiction to be a disease. To examine the NIDA brain disease paradigm, our approach includes a review of current criticism from the literature, enhanced by the voices of key stakeholders. Many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma. We conclude that it is not necessary, and may be harmful, to frame addiction as a disease.
    AJOB Neuroscience 07/2013; 4(3):27-32. DOI:10.1080/21507740.2013.796328
Show more