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El trabajo traza un recorrido desde la historia del concepto de adicción hasta la actual perspectiva dominante, impuesta por la psiquiatría biológica, de "enfermedad cerebral crónica" y "patología dual". Se plantean muchas evidencias que refutan esa concepción de la adicción como enfermedad. Finalmente, se proponen los nuevos hallazgos de la neurociencia y la psicología, planteando cuestiones como el paradigma del enriquecimiento ambiental, el modelo de empoderamiento y el paradigma de la recuperación de la adicción, como alternativas científicas, pero también como enfoques respetuosos con las personas. The work traces a path from the history of the concept of addiction to the current dominant view imposed by biological psychiatry, of "chronic brain disease" and the "dual pathology". A great amount of evidence to refute this concept of addiction as a disease arise. Finally, it propose the new findings of neuroscience and psychology, raising questions as the paradigm of environmental enrichment, the empowerment model and the paradigm of recovery from addiction, as scientific alternatives, but also as more respectful approaches to people with addictive behaviors are proposed. DOI: 10.13140/RG.2.1.3386.8649
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... There has been much criticism of this model, as can be imagined [e.g., de Leon, 2015;Hall, Carter, & Forlini, 2015;Hammer et al., 2013;Levy, 2013;Pedrero, 2015;Pérez, 2013). ...
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Background: In recent years, we have repeatedly been told that addictions are a brain disease, leaving aside their classic biopsychosocial explanation. Objective: To describe both models and discusses the weakness and reductionism of the brain disease model following the consumption of heroin by North American soldiers in the Vietnam war in the 1970s. Method: A literature review of the Vietnam Veteran Study in relation to drug consumption. Results: The soldiers greatly increased their consumption of heroin in Vietnam, but almost all of them ceased using it upon returning home. The analysis of the environmental factors related to this self-healing is a critique of the brain disease model of addictions because it cannot explain this or other studies. Conclusion: The biopsychosocial model is still the best model to guide the fi eld of addiction due to its utility, coherence, and effi cacy in treatment. Keywords: Addiction, brain disease, biopsychosocial, Vietnam Veteran Study, heroin.
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118 n el volumen 507 de la prestigiosa revista Nature , se publicó el 6 de marzo de 2014 una carta al director con el título " Addiction: not just brain malfunction " [Adicción: no sólo un mal funcionamiento cerebral] firmada por Derek Heim (2014). A pie de pá-gina del mismo le acompañaban 94 firmantes, relevan-tes investigadores, clínicos, directores de revistas de adicciones, de centros de tratamiento, etc., de varios pa-íses, criticando la consideración de " la adicción como una enfermedad cerebral " ya que " el abuso de sustan-cias no puede ser separado de sus contextos sociales, psicológicos, culturales, políticos, legales y ambientales; no es simplemente una consecuencia del mal funciona-miento cerebral " (p. 40). E insistían en que " tal perspec-tiva miope socava el enorme impacto de las circunstancias y las elecciones de las personas que tie-nen en las conductas adictivas. Trivializa los pensamien-tos, emociones y conductas de los adictos actuales y de los que lo han sido " (p. 40). Algunos de los firmantes son personas bien conocidas como Estamos ante un tema importante, central en la concep-tualización de las adicciones y que tiene claras repercu-siones sobre la prevención, el tratamiento y la política de drogas. También sobre el rol profesional de distintas pro-fesiones, como la psicológica. Desgraciadamente, en los últimos años la conceptualización biológica-cerebral de las adicciones está cogiendo un derrotero reduccionista, por estar supeditado a claros intereses y grupos de pre-sión alrededor del mismo y por la ruptura, o distancia-miento, a la que estamos asistiendo después de décadas de colaboración fructífera entre distintas disciplinas en el campo de las adicciones. En estas páginas analizamos qué hechos han permiti-do llegar a la situación actual y qué nos depara el futuro desde una lectura psicológica. ¿QUÉ ES LO QUE HA LLEVADO A ESTA SITUACIÓN? Los primeros planteamientos de la adicción como una enfermedad cerebral Han sido varios los modelos que han predominado en el campo de las adicciones a lo largo de la historia has-ta que se convirtió en un importante problema social, en-tre los años 60 y 80 del pasado siglo, en la mayoría de los países desarrollados. En los últimos años se ha ido consolidando la idea en el campo médico-psiquiátrico de que la adicción es una " enfermedad cere-bral " , como ya así recoge el DSM-5. En este articulo se analiza cómo ha surgido y se ha consolidado esta idea, las críticas que ha recibido, las consecuencias profesionales si este modelo se hace hegemónico, junto a los intereses subyacentes al mismo. Se concluye defendiendo la necesidad de mostrar como psicólogos nuestras claras aportaciones al campo de las adicciones, como el de las variables psicológicas que son necesarias para la comprensión de las adicciones, para su prevención, junto con el papel central del tra-tamiento psicológico por su eficacia en las mismas. También debemos denunciar los reduccionismos, como el que representa el modelo de enfermedad cerebral frente a un modelo biopsicosocial de las adicciones. Palabras clave: Adicción, Drogas, Enfermedad cerebral, Psicología. The idea that addiction is a " brain disease " has gradually been consolidated in the medical-psychiatric field over the last years, as it appears in the current DSM-5. In this paper we analyse the way this idea has arisen and been consolidated, as well as the criticisms that it has received, the professional consequences if this model becomes hegemonic, and the underlying interests. The conclusion defends the need to show, as psychologists, our clear contributions to the field of addictions, and the psychological variables that are necessary in order to understand and prevent addictions, as well as the central role of psychological treatment due to its effectiveness. We must also denounce the reductionism that the model of brain disease represents in comparison with a biopsychosocial model of addiction.
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En los últimos años se ha ido consolidando la idea en el campo médico-psiquiátrico de que la adicción es una “enfermedad cerebral”, como ya así recoge el DSM-5. En este articulo se analiza cómo ha surgido y se ha consolidado esta idea, las críticas que ha recibido, las consecuencias profesionales si este modelo se hace hegemónico, junto a los intereses subyacentes al mismo. Se concluye defendiendo la necesidad de mostrar como psicólogos nuestras claras aportaciones al campo de las adicciones, como el de las variables psicológicas que son necesarias para la comprensión de las adicciones, para su prevención, junto con el papel central del tratamiento psicológico por su eficacia en las mismas. También debemos denunciar los reduccionismos, como el que representa el modelo de enfermedad cerebral frente a un modelo biopsicosocial de las adicciones.
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Full-text available
The idea that addiction is a “brain disease” has gradually been consolidated in the medical-psychiatric field over the last years, as it appears in the current DSM-5. In this paper we analyse the way this idea has arisen and been consolidated, as well as the criticisms that it has received, the professional consequences if this model becomes hegemonic, and the underlying interests. The conclusion defends the need to show, as psychologists, our clear contributions to the field of addictions, and the psychological variables that are necessary in order to understand and prevent addictions, as well as the central role of psychological treatment due to its effectiveness. We must also denounce the reductionism that the model of brain disease represents in comparison with a biopsychosocial model of addiction.
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The article which follows this introduction was originally published as a Special (Cover) Article in the American Journal of Psychiatry in the November, 1985 issue, the same month in which the First International Drug Symposium, sponsored by The Bahamas Ministry of Health and The Embassy of the United States of America, was convened to discuss the rock-cocaine epidemic in the Bahamas and other Caribbean Islands. Based on my article, I was invited to participate in the Symposium and to speak about some of my views on the psychological predispositions for drug dependence in general, and in particular, on the psychological predisposition for cocaine dependence. At first, I did not grasp the seriousness and scope of the cocaine problem, but I accepted the invitation, believing I might make a contribution to the Symposium. I was not long in attendance at the Symposium before I realized that the Bahamian citizens, professionals, and health care leaders were facing a major crisis as a consequence of the cocaine epidemic.
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