New work on the brain and addiction

Abstract

The brain has become an important part of how we understand ourselves as human beings. Almost everything is nowadays explained by references to the mechanisms of the brain: consumption behaviour, political activity, career choice and marital status. In fact, it is difficult to come up with a single social phenomenon that has not yet been connected to the brain. It is a central and exciting part of the human biopsychosocial essence. This also applies to addiction. In the field of addiction studies, the neurosciences have been provided enormous space in the form of expectations and financial grants. According to the so-called brain disease model of addiction (BDMA), addiction is a chronic brain disease and it is thought that in the future it will be possible to medicate or manipulate the disease with various concrete tools. The evidence seems to be unequivocal: imaging of brains has shown how “kicks” of dopamine and serotonin light up in people who are addicted to alcohol or gambling even when only thinking about drinking or playing, not even engaging in the behaviour. In recent years, however, a rapidly growing group of scientific authorities – including several well-known neuroscientists – have pointed out how weak and relative the evidence for brain research really is. They believe that neither the brain nor addiction problems are as easily programmed as the BDMA suggests. The same activity in the brain has shown to take place in other contexts: in everyday situations such as when we watch sports competitions or exciting movies, or when we feel great nervousness and it then releases. Because of brain plasticity, it is almost impossible to diagnose a person's bad habits solely on the basis of brain imaging. Does the image of the brain from last year still represent the brain as it looks today? How do you “tie” the appearance of the brain to the person and their life situation? Here, psychology has become the helper of the brain disease model in that it provides the neurosciences with concepts and phenomena to search for in the chemical processes of the brain. Two new titles This spring there are at least two brand new titles worth checking out for anybody interested in how evidence on the brain can support knowledge production in the addiction field. The first is the Routledge anthology volume edited by Nick Heather, Matt Field, Antony C. Moss and Sally Satel, with both new and re-printed contributions concerning the BDMA (Heather et al. 2022). Chapters are ordered into sections representing texts that are “For the BDMA”, “Against the BDMA”, “Unsure of the BDMA” and “Alternatives to the BDMA”. The result is a massive collection of 44 chapters that together have been described as a “landmark volume” with tens of contributors, many of whom are world renowned names in the addiction field. The second book is a Palgrave Macmillan-published monography by an international author group of social scientists from Finland, Canada and Germany, including myself as first author (Hellman et al., 2022). The focus of research is here how understandings of the brain affect our view of reality. We examine this aspect among experts and professionals in addiction care, in media material about new neuroscientific findings, in various prevention campaigns and among clients of one of the world's largest addiction care units (CAMH) in Toronto, Canada. We have mapped and explained how brain-related understandings and concepts affect how we view addiction as a phenomenon. Our research shows that brain-related understandings, including our knowledge of what is possible to prove and comprehend through brain research, have enormous significance for how we perceive addictions and the people who live with addiction. Diagnosing addictions as brain diseases can make people feel that their problems are taken seriously and they feel themselves that it alleviates the great burden of stigma that they are exposed to in everyday life. At the same time, the diagnosis removes agency, and can give unrealistic hopes for easy medical solutions to complex social and cultural problems. The experts in our research do not deny that the brain plays a crucial role as a place where the creation and materialisation of problems takes place. But they do not support the disease model as a dominating basis for individual or societal efforts. The disease model was also not a very commonly occurring or particularly important concept for clients in addiction care. 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