Over on the NPR website Alva Noe (Philosopher, UC Berkeley) writes an interesting opinion blog (aren’t they all?) about why we shouldn’t call addiction a disease of the brain. As you will see from the hundreds of comments, he surely riled a bunch of people up. Some of the comments are quite clear, others just humorous. But I commend his blog for you to read. It makes you think about how some of our language regarding addiction unhelpfully narrows down the problem, thereby making it more difficult to pinpoint all that needs to change when fighting addiction.
Is addiction a disease of the brain? Following his logic, no. Is it a disease that involves the brain? Yes. We must recognize that we are not mere machines and as a result mental illness and addiction both must be viewed from socio-cultural-biological-relational-experiential-spitual-will perspective. A lot goes into creating an addiction. We ought not single out neural structures and activity as if that says all we need to know.
However, on the flip side, to suggest the that addiction isn’t a disease or a biological problem may also send the wrong message. In fact, addicts rarely can “just say no.” By the time they seek help their bodies are working against whatever little will power they have left.
So, addiction is a disease of the person. It may not qualify as a disease that we can identify on a specific cell, but the addicted person is no longer functioning properly and thus their entire person is diseased.
Musings on Faith and Psychology 
[must be viewed from socio-cultural-biological-relational-experiential-spitual-will perspective] I would like to find even one counselor or psychiatrist who views mental illness or addiction in such a holistic way.
My daughter has fetal alcohol syndrome. She was in court last week. Her treatment team (mental health caseworker, chemical dependency worker, public health nurse and probation officer) was seeking commitment for the remainder of her pregnancy in order to protect the baby from further prenatal exposure to alcohol and meth. The recommendation from the psychiatric team at the rehab facility did not mention that she had FASD. It isn’t in the DSM. So, she has ADHD. There was NO mention of her borderline IQ or her dismally poor executive functioning. The judge was told my daughter used once. She was not told that my daughter had been in a group home most of her pregnancy and was kicked out because of a rage in which the police were called or that her recent behavior was so poor that she had lost free time in the community. She was supervised all. the. time. She was also not told that my daughter bought drugs within 24-hours of getting her August SSI payment. She had gotten the money from her representative payee by telling her she was going to use it to pay rent to someone who was letting her sleep on their couch.
My daughter “wins.” I hope that she will cooperate with her rehab plan, but I know her. She will have a week or two of good behavior and when she isn’t released without supervision for “being good” she will bolt. Her unborn child loses… My daughter’s mother has FAS too. So, society will be able to support yet another prenatally-exposed generation. Whatever else it is, addiction is a social, political and spiritual problem and will never be solved by physicians who view it ONLY as a disease.
I have only recently begun working as an IOP therapist with addicted patients, but I’ve been highly suspicious of the traditional beliefs about addiction that are commonly flung around as if they are indisputable facts in our industry. I’ll give this artical a read, should be interesting.
I have been working as an addictions counselor since I completed graduate school in 2008. I was mocked at my university by professors because I refused to call addiction a disease of the brain.
I was super grateful to come across Ed Welch’s book “Addictions: A Banquet in the Grave” and this article seems like additional support that while addictions involve the brain, a person’s cultural, family, environment, worldview, values, biology, and will are also involved. Thanks for sharing this.
Yes, I agree that addiction involves much more than just a chemical reaction in the brain–but that chemical release is a part of the problem. The first few times a person gives in to the substance or activity, there is a choice. But after addiction (and the dopamine) takes hold, there is such a physiological bond that it is near-next-to-impossible to break the cycle. As we know from behavioral science, the greatest reinforcing activity is to be relieved from pain, and when the addict is away from the source of addiction, s/he is in pain–very literally because of the lack of dopamine. My brother, who is alcohol dependent, once told me that when he isn’t drinking, it’s like he can’t breathe. Once he takes that drink, it causes this huge wave of relief, like your first breath after you’ve nearly drowned.
Thankfully we know that nothing is impossible with God. But every person has his/her own pathway to coming clean. Sometimes addicts are self-medicating for other conditions that need to be uprooted in order for the addiction to end. It takes so much discernment for those serving in the help professions to find the appropriate pathway to health for those suffering with addiction. God help us all.
I do agree with what you have stated. I do believe that there is a wide variety of substance issues; from use, to abuse, to dependence. I do question that if the brain is a biological organ why it could not be dieseased at the cellular level.
Joe, it absolutely could be diseased at the cellular level. We just can’t provide the kind of slam dunk evidence of it yet.