Is addiction a failure of will or a disease of the brain? Su Wei Ng investigates.
Is addiction a failure of will or a chronic illness? This question has been the subject of much debate over the years. Addiction can become all-consuming regardless of the legal status of the drugs involved. Severe health deterioration, and emotional and psychological damage are just some of the effects associated with patterns of addictive drug use. Over time, addicts become less able to perform day-to-day activities, and their routines can be thrown into disarray. Nonetheless, some individuals still maintain their habit regardless of these effects. The reasons for this are of central importance to those trying to understand addiction.
Addiction was believed to be a failure of will back in the 1930s. In this model, it was viewed as a failure of morals on the part of the addict, simply a lack of self-control. By the comparatively enlightened 1980s, researcher William Willbanks had proposed three main models of addiction: the moral model, the learning model, and the medical model. These models differed mainly in the causes they attributed to drug use, and the degree to which they acknowledged the role of free will. The moral model of addiction posited that addiction is a choice based on poor values or a choice made by individuals with low moral standards. In contrast to this, the medical model interpreted addiction as a desire which is completely out of the addict’s control. The learning model viewed addiction as a result of choices made by individuals who was influenced by their surroundings and environmental factors.
“The scientific consensus surrounding the causes and maintaining factors of addiction changed mainly as a result of the medical profession’s growing knowledge of the physiological factors associated with addiction.”
“Addiction is a brain disease,” Alan Leshner declared in Science in 1997. This view heralded the new scientific consensus on the issue, and led to addiction being recognised as a chronic illness which alters the brain structure and functions, rather than a moral failing. This new outlook was supported by researchers who had critiqued the old model of addiction for not considering the issue of relapse, and for ignoring the physiological effects of drugs, and the sociological backgrounds of addicts. The scientific consensus surrounding the causes and maintaining factors of addiction changed mainly as a result of the medical profession’s growing knowledge of the physiological factors associated with addiction. Addiction was increasingly perceived as a disease, specifically, a brain disease which progressed over time.
More is being learned about the neurology of substance abuse, too. Neuroscientists have discovered significant changes in brain anatomy, chemistry, and cell-to-cell signalling in the brains of addicts. Within the brain there are a variety of different pathways of interconnected brain cells, different pathways are responsible for different functions. In addiction, the reward pathway is hijacked, in this pathway the chemical dopamine (known for inducing pleasure) is used by brain cells. When the addictive substance is taken, dopamine is released in the reward pathway, giving the user pleasure. But as a person is exposed to the addictive substance on a more regular basis, they develop a tolerance for it, and more and more of the addictive substance is needed to elicit the same pleasurable response i.e. release of dopamine.
“According to United Nations Office on Drugs and Crime, more than 200,000 people worldwide die every year from drug abuse and drug related diseases such as HIV and hepatitis. About 1/20 adults worldwide are addicted to alcohol.”
According to United Nations Office on Drugs and Crime, more than 200,000 people worldwide die every year from drug abuse and drug related diseases such as HIV and hepatitis. About 1/20 adults worldwide are addicted to alcohol. While substance abuse is relatively easy to track, there is less numerical data available for other compulsive activities, such as gambling. Neuroscientists hope that by studying the brain mechanisms underlying addictive behaviour, effective treatments may eventually emerge for all kinds of addictions, drug-induced and otherwise. The shift from old ‘moral’ model of addiction, to the new neurological model is the result of a greater understanding of these mechanisms. It marks a new era in the dispassionate treatment of addictions, and the compassionate treatment of addicts.