That may be good public relations, but it is bad public education. We also argue that it is fundamentally bad science. The brain-disease model of addiction is not a trivial rebranding of an age-old human problem. It plays to the assumption that if biological roots can be identified, then a person has a “disease.” And being afflicted means that the person cannot choose, control his or her life, or be held accountable. Now introduce brain imaging, which seems to serve up visual proof that addiction is a brain disease. But neurobiology is not destiny: The disruptions in neural mechanisms associated with addiction do constrain a person’s capacity for choice, but they do not destroy it. What’s more, training the spotlight too intently on the workings of the addicted brain leaves the addicted person in the shadows, distracting clinicians, policy makers, and sometimes patients themselves from other powerful psychological and environmental forces that exert strong influence on them.
…The brain-disease narrative misappropriates language better used to describe such conditions as multiple sclerosis or schizophrenia — afflictions of the brain that are neither brought on by the sufferer nor modifiable by the desire to be well. It offers false hope that an addict’s condition is completely amenable to a medical cure (much as pneumonia is to antibiotics). Finally, as we’ll see, it threatens to obscure the vast role of personal agency in perpetuating the cycle of use and relapse.