Brain-disease model Flashcards
What is the Brain Disease Model?
“addiction is a chronic, relapsing, brain disease, that is characterized by compulsive drug seeking, despite harmful consequences”
overview of points
- fronto-striatal circuitries
- brain dysfunction
- correlational evidence
- other factors
- genetics
- chronic, relapsing nature
- stigmatization
- “Addiction is a disorder of the fronto-striatal circuitries”
✓ all substances of abuse have in common that they affect dopamine pathways involved in craving and habits (mesolimbic and nigrostriatal pathways)
✓ alcohol and substance abuse are associated with altered function and gray matter losses in prefrontal cortex, insula and cingulate cortex
> regions involved in top-down cognitive control over behavior
✓ in line with notion of a chronic disease, these changes in brain function and structure are long-lasting and persist after the individual stops taking the drug
X some brain functions do show recovery, after a period of abstinence
- Brain dysfunctions
X brain dysfunction/lesions are not sufficiently specific to support a diagnosis of S.U.
✓ neuroimaging as the ultimate diagnostic tool is not a realistic demand; other neuropsychiatric disorders can also not be diagnosed on the basis of brain scans
> e.g. ALS & Alzehimer’s also cannot be diagnosed based on brain scans
✓ neuroimaging helps to reveal underlying mechanisms, and these insights can identify targets for behavioral and pharmacological treatment and personalized medicine strategies
- Correlational evidence
X neuroimaging studies just offer correlational (not causal) evidence
✓ true, that’s why the convergence with findings from experimental studies in animal models is so important
- other factors
X availability, costs, social influences (ethnic, racial disparities), policies and socioeconomic factors also play an important role in (the risk for) addiction
✓ that is not an argument against the brain disease model, as these factors ultimately exert their influences on behavior by impacting neural processes
(the brain disease model does not erase these factors, it provides a framework for understanding those factors in the context of brain function)
- Genetics
X a genetic predisposition is not a recipe for compulsion
✓ that’s correct, but that’s because genetic risk is probabilistic, not deterministic
✓ meta-analyses of twin and adoption studies has estimated heritability at ~50% in alcohol addiction, indicating that DNA sequence variation accounts for 50% of the risk for this condition
✓ polygenic risk factors are shared across different substances
- Chronic, relapsing nature
✓ total abstinence for the rest of one’s life is a relatively rare treatment outcome
X there are many cases of spontaneous remission
> large proportions of individuals achieve natural recovery in the absence of any formal treatment
> majority of young people with substance use problems just age out of them later in life (without formal treatment)
✓ test-retest reliability is likely to be low in people with only mild SUD; people at severe end of the spectrum do tend to show a chronic relapsing course
- Stigmatization
✓ “chronic illness sufferer view” as opposed to moralistic “bad person” view helps people to get the treatment they deserve
> stigma continues to affect public perception of addiction, policy makers, and health professionals
> caused a lot of stress, isolation and obstacles for seeking treatment
✓ this biology-based definition of addiction aims to alleviate the moral judgement, discrimination and stigma associated with drug use
> should be treated in evidence-based manner
X some recent studies suggest that the brain disease model does not alleviate stigma associated with addiction, and sometimes even worsens it
> wether participants believed that addicts should receive free treatment was better predicted by one’s political affiliation, and not by whether participant believed in brain disease model
> increased stereotype that people with mental disorders are dangerous (brain suffers and person has no control over it)
X there are other alternatives ot the moral model than just the brain disease model
> e.g. addiction as a “disorder of choice”
overall point of debate
- strong arguments on both sides
- important debate to have as it shows some of the gaps in our understanding of addiction
! nevertheless, “brain-centric” account of addiction should be avoided
> the brain disease model does not negate that social and environmental factors play an important role in addiction, and deserve careful investigation (we need more research)
> addiction requires multidisciplinary research approach
what disciplines should be taken into consideration?
- neurobiological science
> understanding biology of addiction
> designing biological interventions - behavioral science
> understanding psychology of addiction
> designing psychological interventions
> can benefit from underlying neurobiology - economics and public administrations
> designing policies (taxation and regulation of access)
> can benefit from underlying neurobiology and behavioral insights
final notes
- offer arguments pro and con the brain disease model for exam
