Over the last couple decades, a general progressive consensus on how people should think about drug addiction and drug addicts has emerged. Struggling with addiction isn’t some sort of personal moral failing, the argument goes — rather, addiction is an illness in the brain. It’s something people don’t have much control over. The idea is that viewing addiction in this light will engender sympathy toward those who struggle with it, perhaps leading to more humane policies.
But in an article in Nature, Carl Hart, a professor of psychology and psychiatry at Columbia University and leading addiction expert, argues that things haven’t quite worked out this way:
The notion that drug addiction is a brain disease is catchy but empty: there are virtually no data in humans indicating that addiction is a disease of the brain, in the way that, for instance, Huntington’s or Parkinson’s are diseases of the brain. With these illnesses, one can look at the brains of affected individuals and make accurate predictions about the disease involved and their symptoms.
We are nowhere near being able to distinguish the brains of addicted persons from those of non-addicted individuals. Despite this, the ‘diseased brain’ perspective has outsize influence on research funding and direction, as well as on how drug use and addiction are viewed in society. For example, the recently initiated multi-million-dollar Adolescent Brain Cognitive Development longitudinal study (https://addictionresearch.nih.gov/abcd-study) primarily seeks to gather neuroimaging data to better understand drug use and addiction among adolescents. It collects genetic information and measures drug use and academic achievement but lacks careful consideration of important social factors. Notably, there has never been such an ambitious funding effort focused on psychosocial determinants or consequences (for example, employment status, racial discrimination, neighborhood characteristics, policing) of drug use or addiction.
As Hart goes on to explain, in the 1980s there was a great deal of pseudo-neuroscience about the dangers of crack cocaine. Drug warriors favoring harsh laws would appeal to trendy arguments about the human brain’s vulnerability to crack. “‘Neuro’ remarks made about drugs with no foundation in evidence were pernicious: they helped to shape an environment in which there was an unwarranted and unrealistic goal of eliminating certain types of drug use at any cost to marginalized citizens,” writes Hart. This led to bad lawmaking, including the infamous disparity in sentencing for those convicted of possessing crack versus powdered cocaine.
Hart’s arguments are similar to the ones Maia Szalavitz makes in her wonderful book from last year, Unbroken Brain: A Revolutionary New Way of Understanding Addiction. Addiction, she writes, is “learned and has a history rooted in [individuals’] individual, social, and cultural developments.” This is much more complicated than a “disease.”
Of course, at a certain point it doesn’t really matter exactly how we describe addiction: Either society provides humane, evidence-based treatments to those who need them, or it doesn’t, and at the moment the United States is falling very short on this front. Still, Hart’s article is a useful reminder that giving up one mythology — addicts are morally suspect — is no reason to embrace another.