Addiction is not a Disease

By now, most people have heard the trope, “addiction is a disease.” The American Society of Addiction Medicine (ASAM) is even more specific and calls is a “brain disease.” Though I ask you, where else would it be if not in the brain? In any case, the medical establishment is heavily invested in the medical model of addiction. As a natural result, if the problem is medical in nature, then you must need a doctor in order to deal with it.

That may have been the case in the mid-twentieth century, but since then we have had an explosion of treating personnel in the addiction field. Psychiatry is only a short throw from psychology, which has itself spawned a legion of mental health disciplines. Make no mistake, I have nothing against the mental health field. More, the less rigorously trained people are often a better fit for helping with the ordinary problems of life, than are the psychiatrists. Your mileage may vary.

The science of addiction

The Science of Addiction is the title of a recent article published in Chicago Health Online. Lorna Collier, the article’s author provides a nice summary of the current state of addiction and its treatment in the Fall of 2018. It hews to tracks the near-universal philosophy described above. Naturally, if the disease is in the brain, there must be structural component, right? If that’s true, wouldn’t it behoove us to attempt to demolish and erect in its place a better neural structure?

I’m not so sure.

Optimism, especially among scientists, is not only natural but it is essential. Remember Edison and all the failed lightbulb prototypes?  All those scientists who spent all those years trying to split the atom? If we weren’t optimistic we never would have figured out the iPhone, or the jumbo jet – or the wheel. But in the area of the squash (brain) I submit we’ve gotten ahead of ourselves.

The article recaps the dopamine brain hypothesis, summarized as dopamine-goes-up-with-things-humans-like. This is true whether the stimulus is alcohol, heroin, or chocolate chip cookies. Dopamine also spikes with gambling and sex, not just chemicals. Sounds like it may be the pleasure chemical, yes? The key clue in the puzzle of addiction, right? If only.

Dopamine spikes in the brain when we hear loud noises.  It’s an essential player in movement and depletion of dopamine in a specific part of the brain is a hallmark of Parkinson’s disease (a real brain disease to be sure). Dopamine squirts occur with every like and repost of your tweets, at least when you are notified. Same with Instagram and Facebook.

Dopamine is better described as the “this is important” molecule. Neuroscientists say it is involved in determining salience of a stimulus. In other words, dopamine is the why-should-I-care molecule. Oh yeah, it’s critical in executive function (thinking) and, oddly, kidney function. Don’t ask me why.

Not a disease

As you can see, we don’t even have a good handle on what the addiction establishment says is the most important molecule in the “brain disease.” They’re talking about demolishing structures and redirecting neural processes but they don’t really understand the normal brain – much less the diseased one.  Nobody does.

Humankind has survived unimaginable catastrophes.  From the Missoula floods to the bolide firestorms courtesy of the comet Encke, we made it. Famine, pestilence, real disease, throw as us what you will, Thou Universe,  and at least some of us will survive. Look at our pre-human ancestors and the story is mostly the same – all the way back to single-cell organisms. Our brains are the key to our dominance of the planet.

Addiction is too complex at this point for us to model. Far more likely than a disease, addiction represents the normal processes of brain function that become stuck in a repetitive (and to excess, self-destructive) routine.