Blaming the Brain
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+ depends on the substance - some substances alter brain chemistry
+ depends on the person - do some people have addictive personalities?
+ is it a question of willpower?
+ at what point does it become a brain issue? does the brain issue follow the consequences of personality-driven decisions?
"We know that synaptic patterns get reinforced with each repetition of the same kind of experience, whether it’s playing the piano, baking bread, or smoking crack. And we know that repetition boosted by strong motivation is the strongest driver of synaptic shaping. Every time desire initiates another run for drugs, drink, porn, or gambling, it refines the network of synapses that anchor the addiction. So imagine the potency of a longed-for reward that only lasts a few hours. In its wake it leaves loss, disappointment, and often depression. Then desire naturally flares again, in the form of longing or craving, and the cycle is very likely to repeat itself." - Marc Lewis
Destigmatizes addiction and seeks to correct the "traditional" view that addiction is a moral failing.
Key Question: Can there be a medical or mental disorder in a biologically normal brain? Is there a personality pre-disposition that makes you more likely to engage in substance-abusive behaviors to the point where your brain changes?
+ Because of neuroplasticity, patterns of behavior that we engage in can alter our brains.
+ Substance use and eventual abuse is often spurred on by the pursuit of escape, exhilaration, self-medication, etc.
Blaming the Brain
+ Neo-Kraepelinean Model - diagnosing based on premise that chronic brain disease CAUSES compulsive, out of control use of substances.
WHY this view?
Arguments against this idea -
(1) Addiction is not a chronic, relapsing condition;
(2) There is no clear boundary between addiction and other strong desires
(3) Negative consequences are not unique to disorders
(4) The brain disease model does not account for behavioral addictions
(5) Addiction is like love
BUT, according to Jerome Wakefield, these criteria fail to take account of the context of addiction and its relation to biological design
+ Neo-Kraepelinean Model - diagnosing based on premise that chronic brain disease CAUSES compulsive, out of control use of substances.
WHY this view?
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Destigmatizes addiction and seeks to correct the "traditional" view that addiction is a moral failing.
With this view, it seems that addiction is more worthy of research, funding for treatment, and it is not something that should be punished and ostracized.
ADDICTION VS. ADDICTIVE DISORDER
+ One can be addicted to caffeine and experience withdrawals from it, but it is not a harmful dysfunction because generally speaking, regular and even chronic use does not disrupt one's life - it is accepted and "beneficial" - use of it doesn't look like a mental disorder.
UK Study on Hypomania and addiction:
Individuals with hypomanic personality features reported tendencies to feel a sense of addiction to various activities and substances, including drugs and alcohol, but also to a variety of benign activities and substances, such as music, internet-surfing, exercise, and work. Many of these relationships—and especially the relationship between hypomanic personality features and addictive tendencies to benign substances/activities—remained significant even after controlling for concurrent mood, age, and gender.
The results suggest that the extraverted, emotionally intense, confident, ambitious, and irritable individuals with so-called hypomanic personality features are likely to pursue a large variety of activities and engage in the pleasurable consumption of a large variety of substances, to the point that they experience these tendencies as having an addictive quality. Indeed, individuals with more pronounced hypomanic personality features were also more likely to regard themselves as having somewhat of an “addictive personality” (regardless of the to-be-determined scientific merit of this construct). It appears that hypomania-prone individuals crave and pursue fun and pleasure in a variety of life domains, and the potentially negative consequences of these pursuits do not appear to mitigate their unyielding pleasure-pursuit.
Factors and pOINTS OF VIEW
Is addiction a brain condition? If so, is it wrong to blame people that are addicted for their behavior?
Personality and Addiction (one example)
DSM-5 and ICD-10: Medical Disorder
+ It has been hypothesized that hypomanic individuals are generally more likely to pursue potentially pleasurable activities, presumably because of their heightened sensitivity and responsiveness of the behavioral activation system.
+ Behavioral Activation System - relates to sensitivity towards reward and an individual's disposition to pursue and achieve goals.
hypomanic tendencies also correlated consistently with the eight aspects of addiction measured across the twelve addiction-domains:
1. Salience/Importance ⁎
2. Euphoria/Enjoyment ⁎
3. Tolerance
4. Withdrawal
5. Conflict 1 (relationships)
6. Conflict 2 (work/hobbies)
7. Relapse and reinstatement
8. Identification with addiction
NIDA: brain disease
The Public's perspective
+ In an Australian study, age, gender and level of education did not predict agreement with the belief that heroin or alcohol addiction is a brain disease, people with personal or vicarious experience of problem alcohol use were more likely to agree that addiction to alcohol is a brain disease than those who did not. This pattern did not hold for heroin addiction. In the case of alcohol, participants who agreed that addiction has biological causes were more likely to agree that alcohol addiction is a brain disease and so were those who were neutral or did not know if addiction has biological causes.
"Those we surveyed were more likely to accept a disease concept of addiction than a brain disease concept. This was more likely to be the case for alcohol than for heroin addiction. The patterns of response suggest that members of the public acknowledge that the causes of addiction are multiple and complex and are ambivalent towards reductionist labels for addiction. Framing addiction as a syndrome may resonate more with the Australian public than disease concepts as it allows multiple causes of addiction to be acknowledged." - Queensland Social Survey
+ A neuroscientific description of the addicted brain should complement more psychological and humanistic perspectives!
Depending on the person, addiction is causally different but effectively (often) similar.
"With the flame of desire rekindled so often, the same neural passages get dredged again and again. The result is accelerated learning.
The disease model of addiction has made its contribution, but it’s time to move on. We don’t have to ignore the biology of addiction to appreciate its psychology and to approach those who suffer humanistically rather than moralistically. " - Marc Lewis
+ Marc Lewis (Neuroscientist) reminds us that "brain change does not necessarily mean a disease process.
Bryn Graham
17 February 2017