Arguments For/Against The Brain Disease Model

Question 1

Name 3 arguments in favor of the BDM and their counter-arguments

Answer 1

1. Addiction is a disorder of fronto-striatal circuitries; changes happen due to substances, they are long-lasting and persist after cessation of use
   Counter: Some brain areas do show recovery after periods of abstinence
2. Total abstinence for the rest of one’s life is a relatively rare treatment outcome —> its a relapsing disorder for most people
   Counter: Many cases of spontaneous remission; large amounts of people achieve natural recovery in the absence of formal treatment
   Re-Counter: Spontaneous remission only happens in mild SUD, in severe cases there’s usually relapsing
3. ”Chronic illness sufferer view” as opposed to “bad person view” helps people get their deserved treatment —> alleviates moral judgment, stigma and discrimination
   Counter: Some recent studies suggest that the BDM doesn’t alleviate stigma associated with addiction and sometimes even worsens it —> there are also alternatives to the moral model than just the BDM

Question 2

Name 4 arguments against the BDM and their counter-arguments

Answer 2

1. Brain dysfunction/lesions are not sufficiently specific to support diagnosis
   Counter: Neuroimaging as ultimate diagnostic tool is unrealistic everywhere; other diseases (eg. Alzheimer’s) can also not be diagnosed on the basis of just brain scans
2. Neuroimaging studies just offer correlational (not causal) evidence
   Counter: True, this is why experimental animal models are so important
3. There is more to addiction than just neuroimaging —> eg. availability, costs, social influences, policies and socioeconomic factors also play a role
   Counter: BDM in no way implies that we should ignore those social/environmental factors but rather it it offers a framework for understanding these factors in the context of brain function
4. A “genetic predisposition is not a recipe for compulsion”
   Counter: Correct, but that’s because genetic risk is probabilistic, not deterministic —> 50% heritability in alcohol addiction