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:
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.