We argue that when considering addiction as a disease, the lens of neurobiology is valuable to use. We agree that critiques of neuroscience are warranted [108] and that critical thinking is essential to avoid deterministic language and scientific overreach. A fairer representation of a contemporary neuroscience view is that it believes insights from neurobiology allow useful probabilistic models to be developed of the inherently stochastic processes involved in behavior [see [83] for an elegant recent example]. Changes in brain function and structure in addiction exert a powerful probabilistic influence over a person’s behavior, but one that is highly multifactorial, variable, and thus stochastic. Philosophically, this is best understood as being aligned with indeterminism, a perspective that has a deep history in philosophy and psychology [84].
The threats are based on emotional and moral attitudes towards the existence of the SIS and drug addicts generally, as opposed to empirical evidence (Des Jarlais, Arasteh, and Hagan 2008). Hunt (2004) takes the rights-based notion further and identifies and characterizes two ethics of harm reduction. First, he describes a “weak” rights ethic, wherein individuals have the right to access good healthcare. Second, Hunt identifies a “strong” rights account that acknowledges a basic right to use drugs. Based on this definition, we believe that HAT falls into both camps HAT seeks to promote the right to access good health care, and the basic right as an individual asserting sovereignty over his or her body to inject heroin. Heroin is lipid soluble, which leads to fast penetration of the blood-brain barrier and high abuse potential (Julien 2001).
The Meaning of “Social”
The people around us have a stronger influence on our decisions and actions than we realize.
- Subsequently, between July 2016 and September 2017 deaths due to illicit opioid overdose increased by 30%, leading to an emergency declaration in 45 states [4].
- It also recognizes the importance of patient self-awareness, relationships with providers in the healthcare system, and individual life context.
- How these advances will impact the ethical relationship between our brains and our selves in addiction, is yet to be seen.
- In contrast, in a community-based sample similar to that used in the NESARC [27], stability was only ~30% and 65% for women and men, respectively.
Additionally, just like we can have genetic predisposition to a physical disability, mental health has genetic roots as well. The more an individual’s needs are met within a drug culture, the harder it will be to leave that culture behind. White (1996) gives an example of a person who was initially attracted in youth to a drug culture because of a desire for social acceptance and then grew up within that culture. http://www.fantastika3000.ru/node/15801 Through involvement in the drug culture, he was able to gain a measure of self-esteem, change his family dynamic, explore his sexuality, develop lasting friendships, and find a career path (albeit a criminal one). For this individual, who had so much of his life invested in the drug culture, it was as difficult to conceive of leaving that culture as it was to conceive of stopping his substance use.
The Biopsychosocial Model
In this first demonstration of Palovian conditioning (also known as “classical” or “respondent” conditioning), Pavlov showed that a previously neutral stimulus could come to elicit a biologically relevant response if it was paired with a biologically relevant stimulus (Pavlov, 1927). Such “conditioned reflexes” are ubiquitous in our environment, and they range from the autonomic arousal elicited by the shriek of a fire alarm to the engorgement of our sexual organs when seeing an intimate partner in various stages of undress. In most cases, these types of associations are biologically adaptive to the organism, preparing the organism to respond to events in the environment that are critical for its survival. Just as nature selects physical traits that promote the survival of the species, so does it select behavioral traits, such as the aggressive behavior most mammals exhibit when protecting their young.
Overall, the findings underscore the importance of OUD treatment being guided by trauma-informed modalities, including “complex trauma” (different from PTSD) (77). From a philosophical standpoint, a model based on reciprocal determinism is attractive because it considers addiction as determined by factors both internal and external to the individual. It acknowledges the importance of an individual’s personal characteristics – including past experiences and current “mindset”. It also acknowledges the role of the individual’s behavior – including behaviors involved in the acquisition of drugs, the use of drugs, and ultimately, the abstinence from drugs. Most importantly, it recognizes the functional relationships and interdependence between these factors.
Social Learning and Addiction
This is consistent with the fact that moderate-to-severe SUD has the closest correspondence with the more severe diagnosis in ICD [117,118,119]. Nonetheless, akin to the undefined overlap between hazardous use and SUD, the field has not identified the exact thresholds of SUD symptoms above which addiction would be definitively present. http://сварог-фонд.рф/index.php/o-nas/date/2014/component/component?start=1260 Although our principal focus is on the brain disease model of addiction, the definition of addiction itself is a source of ambiguity. When neurogenetic attributions are presented in the clinic, pharmacological treatments are often believed to be a more effective option over psychotherapy (Phelan, Yang, and Cruz-Rojas 2006).
These spontaneous remission rates are argued to invalidate the concept of a chronic, relapsing disease [4]. Translating the principals of social learning theory into actionable practices for addiction does not mean that inpatient treatment should cease – indeed, some components of inpatient treatment are absolutely critical (e.g., detoxification). It also does not mean that the solution for addiction is already at hand in the church basements and community centers across the country where 12-step programs meet. https://www.trudtox.com/2016/07/25/what-does-the-poop-say/ Rather, successful translation of social learning principals into clinical practice involves creating treatments that are socially and environmentally invasive – in much the same way that new treatments for pancreatic cancer and valvular heart disease are physiologically invasive. Indeed, Bandura elaborated extensively on the role of agency in his model of receptible determinism. Specifically, he argued that agency is defined by intentionality, forethought, self-reactiveness, and self-reflectiveness.
Criticism of the Biopsychosocial Model
Interventions focusing only on prescription opioids are unlikely to be sufficient as long as heroin and other synthetic opioids such as fentanyl and carfentanil continue to flood the market. Illicit drugs are increasingly available through the “dark web” and are an important but less documented mechanism driving the opioid crisis. A common criticism of the notion that addiction is a brain disease is that it is reductionist and in the end therefore deterministic [81, 82].
