Introduction
Kate Seear in Law, Drugs and the Making of Addiction, 2019
In recent years, a particular disease model of addiction known as the ‘brain disease model’ has become increasingly popular and influential. This is largely a result of the work of the US National Institute on Drug Abuse (NIDA), which first articulated this view under the leadership of Alan Leshner (1997), and has since invested heavily in it under the direction of Nora Volkow. For leading proponents of this model, addiction is a chronic, relapsing disease which represents ‘the neurobiology of behavior gone awry’ (Volkow & Li, 2004). It holds that drugs ‘hijack’ the brain’s reward system by binding to the receptors in the brain that produce sensations of pleasure (Nestler & Malenka, 2004; Robinson & Berridge, 2004). Nancy Campbell argues that this definition ‘provided scaffolding for a new optics that reorganized the federal research apparatus, reorienting it toward neuroscience with the goal of pinpointing molecular “targets” for medications development’ (2010: 90).
Addiction
Jenny Svanberg in The Psychology of Addiction, 2018
Why is the disease model so problematic? At first, it provided relief and compassion, and many people who have struggled with alcohol and drug addiction in particular see it as part of their identities. I have a disease, I’m not bad, it’s not my fault. It still provides an explanation to families desperate to understand behaviour that can seem incomprehensible. At the most severe end of the addiction spectrum, the brain changes caused by decades of drug and alcohol abuse, alongside the equally (if not more) toxic decades of poor nutrition, poverty, poor mental health and self-neglect that often go along with it, can become irreversible. Recovery from this extreme position is longer and more difficult, and is more likely to require specialist support. Is this not the sign of a disease? While interminable debates over how to classify addiction can feel like ivory tower bickering and may be irrelevant to many people’s personal experiences, it is worth considering why aspects of the disease model are damaging. The way that we define addiction influences its treatment. Understanding the flaws of the disease model will allow us to move towards a more empowering and evidence-based model, which doesn’t reduce complex behaviour to our biology alone.
Exercise in the Prevention, Treatment, and Management of Addictive Substance Use
Henning Budde, Mirko Wegner in The Exercise Effect on Mental Health, 2018
Additional animal research conducted in the 1970s and 1980s by Bruce K. Alexander examined the effects of housing on self-administered morphine within rats (Alexander, Coambs, & Hadaway 1978; Alexander, Beyerstein, Hadaway, & Coambs 1981). It aimed to investigate the effect of environment on addiction to investigate the disease model of addiction. It found that rats kept in isolation would consume more morphine than water compared to rats housed in enriched colony environments (with space, other rats, exercise wheels) where it was thought consumption of morphine interfered with species-specific behavior. Even when morphine-addicted rats were moved from isolation to enriched environments, there was a tendency for the rats to wean themselves off the morphine solution. This points towards the powerful influence of environment in mediating addiction, and the important role it plays in addiction (Figure 10.1).
Bringing SBIRT into the Community: An Evaluation of a Continuing Education Training for Social Workers
Published in Journal of Social Work Practice in the Addictions, 2019
Karlynn Brintzenhofeszoc, M. Nicole Belfiore, Joseph J. Shields
The Understanding of Substance Abuse Scale (USAS) is based on a scale measuring beliefs about the nature and treatment of alcoholism developed and modified by Moyers and Miller (1993). For this study, we extracted the items representing the disease, psychosocial, and moral deficits models from the updated Moyers and Miller (2001) scale. The disease model emphasizes physiological factors and endorses the view that substance abuse is a progressive, incurable disease that can only be cured by abstinence. The psychosocial model focuses on social and environmental factors and reflects the view that substance abuse is a learned behavior shaped by cultural influences and family environment. The moral/spiritual model reflects the view that substance abuse is the result of moral deficiencies in the character of the person (Moyers & Miller, 2001). We are calling this model the moral deficit model and an increase in the score reflects an increased belief that substance abuse results from moral deficits in the character of the person with a substance use issue. We have also adopted the expansion of the construct as used by Humphreys et al. (1996) to include all substance abuse, not just alcoholism.
Applying the developmental model of use disorders to hedonic hunger: a narrative review
Published in Journal of Addictive Diseases, 2022
Mary Takgbajouah, Joanna Buscemi
A use disorder is defined as “a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.”19 This brain disease model of use disorders is the gold standard conceptual model and asserts that drug use alters brain systems associated with reward, perception, memory, stress, and self-control, and that these changes are lasting and challenging, if not impossible, to resolve without pharmaceutical or rehabilitative treatment.19,20 A core principle of this model is that dopamine functioning, which is crucial for synaptogenesis and synaptic pruning, is altered over time as a result of drug use. Therefore, as per the brain disease model, exposure to drugs decreases the synaptic network and gray matter of the brain and leads to long lasting or permanent diminished cognition and reward response, and increased, compulsive drug use.20 It is important to note that the Brain Disease Model describes a two-way relationship between brain function and drug use. In addition to drugs changing the brain, the Brain Disease Model also suggests that there are genetic and neurological factors that predispose individuals to drug use disorders.
Reconceptualizing Autism: An Alternative Paradigm for Social Work Practice
Published in Journal of Progressive Human Services, 2018
The medical profession has been the major force in constructing our modern understanding of autism and how it is treated. Within the medical model, disabilities are considered disease states brought about by physical abnormalities or system failures (Olkin, 2002), and those illnesses are biological problems that can be remediated using medical interventions. Within this framework, the autistic person is the primary target for intervention (i.e., in need of cure). One of the main criticisms of the medical model is that it limits understanding disability as anything other than an individual’s problem and that treating conditions as diseases means eradicating them. Neurodiversity proponents have argued that under medical model of disability, the focus on a cure agenda could lead to unintended consequences, such as using eugenics to eliminate autism (Waltz, 2008).
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