Sunday, August 1, 2010

Addiction Neuroscience & Volition

Below is a small part of a very, very rough draft of a chapter on the neuroscience of addiction that I am working on.   Feedback and comments are welcome as I am still very much thinking through the piece.
Addiction Neuroscience & Volition: Character Flaw or Bona Fide Brain Disease?

Perhaps one of the most interesting features of the neuroscientific literature on addiction is the explicit attempts to use the research for political purposes.  Rather than isolate themselves behind a wall of scientific objectivity and neutrality, a surprising number of prominent addiction researchers use the brain disease model to argue for changes in both public perception and policy. The use of neuroscience for projects of destigmatization is not unique to addiction.  Vidal (2009), in speaking more broadly about neuroscience, suggests that brain images have contributed to the destigmatization of illness.  Abi-R (2010) argues that we are in a third wave of brain research that brings together a diverse hybrid of perspectives and researchers that are held together by “some common institutional projects…a common reductionist approach to the explanation of complex phenomena pertaining to the brain, behavior and the nervous system (p.12).”  The common project of neuroscientific addiction researchers appears to be the reframing of addiction as a brain disease for the explicit purpose of destigmatizing and decriminalizing drug use and bringing it more fully into the purview of the medical, rather than the criminal justice, system.

Dackis (2005), for instance, claims that neuroimaging will “substantiate the biological basis of addiction and…ultimately erode entrenched societal attitudes that prevent addiction from being evaluated, treated, and insured as a medical disorder (p.1431).”  In his view, neuroscience will eventually end the discrimination and criminalization of addiction (2005, p.1431).  Others characterize the failure of the public to adopt the brain disease model as “a public relations problem (Nature, 2005, p.1413)” for science and medicine.  But by highlighting and disseminating “select advances in addiction research,” scientists can and should reverse the public’s “misconceptions” and “facilitate changes in policy (Dackis, 2005, p.1431).

These researchers believe that promoting a biological basis for addiction will undermine competing notions that addiction is “a character flaw rather than a bona fide brain disease (Chou, 2005, p.1427).”  At stake for the researchers is nothing less the definition and source of volition and free will.  Their argument hinges on the notion that addiction undermines volition because, if addicts’ behavior is involuntary, they cannot be culpable for their ‘disease.’  Volkow (2005), for instance says:

We have learned how some drugs and alcohol can disrupt volitional mechanisms by hijacking the brain mechanisms…  However, despite 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 voluntary behavior.  The loss of behavioral control in the addicted individual should spur a renewed discussion of what constitutes volition (p.1436).

This tension between medically- and character-based paradigms of pathology is not new and has existed for decades in conversations about addiction – as well as a host of other ‘diseases.’  What is new is the attempt to pinpoint a biological basis for the loss of volition and to locate it in the addict’s brain.  This is critical because as along as addiction is seen as having an element of choice, it remains difficult to characterize as a disease in which those afflicted are free from blame.  Historically, there has been confusion whether the pathology is the behavior or whether the pathology causes the behavior (Pickersgill 2009).  The neuroscience of addiction claims to have solved that dilemma by isolating the brain mechanisms that cause the undesirable behavior – compulsive use of drugs or alcohol. While the project of neuroscientists appears to be relieving drug users of the stigma and blame associated with addiction, such rhetoric can also be used to justify the “suspension of their personal autonomy, installing an imperative that they be governed by others (Brook, 2005, p.319.”  For if they cannot control their behavior – if they have a ‘defect of the will (Bull, 2008, p.154)”-- they must be controlled by someone else.  However, recently, neuroscientists have developed a number of interventions (most still experimental) that they claim can correct defects in the will of addicts.