Curing stigma

I’ve been buried deep in reading scientific articles about the neurobiology of addiction. Interesting stuff. Much of it is speculative, but it is definitely where addiction research has been and will keep heading. One of the things that strikes me most in reading these articles is the relatively overt and self-conscious acknowledgment of scientists that they are engaged in a rhetorical war to transform our understandings of addiction with the laudatory goal of decreasing the stigma surrounding addiction. There are certainly other motivations, but that’s for another blog post.

Perhaps the country’s most vociferous proponent of the brain disease paradigm of addiction is Nora Volkow, Director of NIDA, who wrote: “scientists are now able to portray addiction as a medical disease with physiological and molecular changes thanks to the scientific and technological advances that have occurred over the past decade.” She and others claim that these new understandings are critical to ending the stigmatization of addicts. The crux of this argument is that science has proven that addiction is not volitional. Again to quote Volkow:

[D]espite these advances in understanding the neuroplastic changes to drugs and alcohol, addicted individuals continue to be stigmatized by the pernicious but enduring belief that their affliction stems from a loss of voluntary behavior. The loss of behavioral control in the addicted individual should spur a renewed discussion of what constitutes volition, challenge us to identify the neurobiological substrates that go haywire, and influence evolving strategies...

Truly, one of the things that fascinates me most about the study of addiction is how it implicates notions of agency and volition, but I am not sure that ‘brain science’ is where I would root that discussion. Even if we were to accept that the brain has been hijacked, how is one to regain their volition under this model? I fear the answer lies in more changes to the neurobiology of the brain – strategies which we may want to embrace but only after careful scrutiny of the motives behind them and alternative understandings. Nor does it seem to me that the only way out of stigmatizing addictions (which I agree is pernicious and destructive) is to argue that addicts have a brain disease. What if, for instance, we focused instead on a paradigm that looked to economic and political causes of addiction? Wouldn’t individual stigma be diminished by understanding addiction is caused, in part, by the lack of meaningful opportunities and alternatives; personal and collective histories of abuse and oppression; or the emptiness and frustration generated by neoliberal consumer capitalism? I am not arguing that these are the causes of addiction; I am arguing that there are paradigms beyond a brain disease model that might decrease stigma without a message to people who use drugs that their brains have “been hijacked” and that they have lost their volition and agency.