The Brain Disease Model of Addiction: is it Supported by the Evidence and has it Delivered on its Promises?

Dr. Allwissend 01

The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises?

Prof Wayne Hall, PhD
Adrian Carter, PhD
Cynthia Forlini, PhD

Sign up for Lancet Psychiatry to read the full article. An overview is below.

We need a similar critique of the American Society of Addiction Medicine (ASAM)  and its affiliates on this side of the Atlantic as “addiction medicine” is slated to be approved  by the  American Board of Medical Specialties in 2016 even though the discipline falls far short of the educational and professional standards for quality practice developed and implemented by all other ABMS member boards.    According to the ABMS these 24 boards are:

“committed to the principle of examining doctors based on six general competencies designed to encompass quality care: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.”

These areas have been collectively identified by the ABMS, the American College of Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) in order to standardize graduate medical education.

Any critique of the ASAM would find a number of issues antithetical to the six general competencies which stress “learning and improvement.”   In contrast the ASAM rests on the conviction that their views are absolutely certain and patently rejects open-minded inquiry.  An academic analysis of addiction medicine  from the vantage point of the ASAM would reveal false assumptions, bias, dogmatism, and data-dredging.  It would also reveal that those claiming expertise are in fact illegitimate and irrational authority who believe in an ends-justifies-the-means approach to push forth the chronic relapsing brain disease with lifelong abstinence an d imposed 12-step recovery. These are false experts who rationalize unethical, unprofessional and even criminal behavior as zeal for the faith if it aligns with the brain disease model of addiction (BDMA)   Their viewpoints are fixed and final.

They have not been held to truly objective judging, analysis, evaluation or outside critique.  The purpose of critique is the same as the purpose of critical thinking: to appreciate strengths as well as weaknesses, virtues as well as failings. Critical thinkers critique in order to redesign, remodel, and make better. This direly needs to be done.  The evidence-base for both the BDMA and the drug and alcohol testing, assessment and treatment is poor.     They are claiming physician health programs are the crown jewel of addiction treatment– a replicable model to be replicated in other populations.  It is all hyperbole and propaganda.  In reality they are using medical assessment and treatment as tools to repress and punish doctors.  Those running the state physician health programs are typically morally disengaged bullies with Machiavellian egocentricity.   And all the congratulatory backslapping is based on a singe poorly designed opinion piece.

Science and medicine need to be predicated on competence, thoughtfulness, good faith, civility, honesty, and integrity. This is universally applicable.  What they are doing betrays the trust of society and breaches the most basic ethical obligations of not only doctors but human beings.

But no one seems to be challenging them. Why is no one questioning this self-appointed authority. If people do not start talking, writing, discussing and debating the current paradigm then what Robert Dupont describes in the ASAM White Paper on Drug Testing will be ushered in.  As with doctors you won’t know it until it hits you.    If the ASAM becomes an ABMS medical specialty then it will be too late. They will impose their authority on you as a patient and their won’t be a damn thing you will be able to do about it.

Once illegitimate and irrational authority are sanctified by the American Board of Medical Specialties there will be nothing left to do except watch the profession of medicine go up in flames.

Right now it’s just doctors and pilots.   What you need to see is that you are next.  I base that prediction on past public-policy, regulatory, administrative and medical practice tinkering as well as the documented paper trail of “research” and opinion. And even though all of this can be explained using documentary evidence, fact and critical analysis no one seems alarmed.

If you map it out you will see the trajectory is aimed at the transportation industry,  students with federal loans,  high school athletes, schools, gun owners, and eventually schools.

If you have something to lose that is affiliated with a state or federal agency they will hold it hostage if you get a positive hair, nail, sweat blood, or urine test at your doctors visit.    The positive test is the golden ticket for them and a ticket to an assessment facility in Kansas, Arkansas, Mississippi and some other places for you on your dime.    And these are one-way tickets. No return to normality available.  One way ticket.    No return flight.

See full article through the following link:

Screen Shot 2014-12-30 at 2.10.24 AM

Proponents of the brain disease model of addiction (BDMA) have been very influential in setting the funding priorities of NIDA, and by extension the bulk of publicly supported research on addiction. In 1998, Leshner testified that NIDA supports more than 85% of the world’s research on drug abuse and addiction.3 The American Society of Addiction Medicine has defined addiction as a “primary, chronic disease of brain reward, motivation, memory, and related circuitry”.4 In July, 2014, newly appointed Acting Director of US National Drug Control Policy, Michael Botticelli, launched a reformist strategy nationally, claiming decades of research have demonstrated that addiction is a brain disorder—one that can be prevented and treated.5 The BDMA has also been widely discussed in leading scientific research journals3, 6 and most recently in a positive editorial in Nature.7

In the USA, proponents of the BDMA have argued that it will help to deliver more effective medical treatments for addiction with the cost covered by health insurance, making treatment more accessible for people with addictions.1, 2, 6 An increased acceptance of the BDMA is also predicted to reduce the stigma associated with drug addiction by replacing the commonly held notion that people with drug addiction are weak or bad with a more scientific viewpoint that depicts them as having a brain disease that needs medical treatment.

In this Personal View, we critically assess the scientific evidence for the BDMA reported in leading general scientific journals and the extent of the social benefits that advocates of the BDMA claim it has produced, or is likely to produce, with its widespread acceptance among clinicians, policy makers, and the public. The BDMA is not co-extensive with neuroscience-based explanations of addiction. This review is not intended as a critique of all neuroscience research on addiction. We focus instead on the popular simplification of work in this specialty that has had a major influence on popular discourse on addiction in scientific journals and mainstream media.


Considerable scientific value exists in the research into the neurobiology and genetics of addiction, but this research does not justify the simplified BDMA that dominates discourse about addiction in the USA and, increasingly, elsewhere. Editors of Nature were mistaken in their assumption that the BDMA represents the consensus view in the addictions specialty,7 as shown by a letter signed by 94 addiction researchers and clinicians (including one of the authors of this Personal View).74Understanding of addiction, and the policies adopted to treat and prevent problem drug use, should give biology its due, but no more than it is due. Chronic drug use can affect brain systems in ways that might make cessation more difficult for some people. Economic, epidemiological, and social scientific evidence shows that the neurobiology of addiction should not be the over-riding factor when formulating policies toward drug use and addiction.

The BDMA has not helped to deliver the effective treatments for addiction that were originally promised by Leshner and its effect on public health policies toward drug addiction has been modest. Arguably, the advocacy of the BDMA led to overinvestment by US research agencies in biological interventions to cure addiction that will have little effect on drug addiction as a public health issue. Increased access to more effective treatment for addiction is a worthy aim that we support but this aim should not be pursued at the expense of simple, cost effective, and efficient population-based policies to discourage the whole population from smoking tobacco and drinking heavily. Nor should the pursuit of high technology cures distract from the task of increasing access to available psychosocial and drug treatments for addiction, which most people with addictive disorder are still unable to access.

Our rejection of the BDMA is not intended as a defence of the moral model of addiction.65 We share many of the aspirations of those who advocate the BDMA, especially the delivery of more effective treatment and less punitive responses to people with addiction issues. Addiction is a complex biological, psychological, and social disorder that needs to be addressed by various clinical and public health approaches.65 Research into the neuroscience of addiction has provided insights into the neurobiology of decision-making, motivation, and behavioural control in addiction. Chronic use of addictive drugs can impair cognitive and motivational processes and might partly explain why some people are more susceptible than others to developing an addiction. The challenge for all addiction researchers—including neurobiologists—is to integrate emerging insights from neuroscience research with those from economics, epidemiology, sociology, psychology, and political science to decrease the harms caused by drug misuse and all forms of addiction.46



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14 thoughts on “The Brain Disease Model of Addiction: is it Supported by the Evidence and has it Delivered on its Promises?

  1. I’m starting to realize that most disease-model critics still believe that addiction is a disorder (e.g. Peele and Svalavitz), and so they think my view (‘addiction is a lie’) is ‘extreme’ even if they don’t say it publicly. So I can expect little more than criticism of AA and NIDA (disease model proponents). That’s ok. If my claim that the ‘disorder delusion’ is maintained by AA and NIDA brainwashing (and their arms in media and law enforcement) then we will be disabused of it by their destruction.

    Liked by 1 person

    • Well I think your viewpoint coincides with my belief that the majority of those coerced into this Hell don’t have what they claim. I’m enjoying my “disease” right now in the form of an Old-fashioned that I will drink over the next hour and then go home. I’m sure these dimwits would call for a 3 month incarceration for doing so. If you look at these doctors they are notable for being control- freaks and lack of imagination. These bitter dregs have simply come together under the common theme of “recovery” and for the first time in their lives felt a sense of power and control and they enjoy it. Bargain basement fussbuckets who think they have secret knowledge and now want to mandate it on all of us. I know they are following my blog as most of them used their own names when doing so. Cheers Like-Minded Docs and that includes the Prohibitionist dinosaurs, the sociopathic profiteers and the plain dumb dumbs who buy into the remedial level pseudo psychology and readers digest logic and are being used by the psychopathic profiteers one PBR away from another malpractice suit. A toast to you – doctors who are living proof that you can be too smart to understand AA but you can’t be too dumb.

      Liked by 1 person

      • Oh you bet they are reading your blog. However their industrial strength machinery for monumental self-deception reassures them that ‘this too shall pass’. LOL. But the worst is when they pull this shit on children. I’m not much for ‘government solutions’ but seriously that should be illegal!


        • It won’t pass ! We need to force them to answer the questions and show the rest of the world their silence is not taking the “higher ground.” They are silent because when faced with a direct clear question they cannot answer it and crawl back under the bottom barrel simple-minded rock from whence they came. Our job is to shine a light on the whole charade. We need to throw a bucket of water on these quacks and shoe the world they are nothing but a band of snake oil carnies pulling a three cars montee and pretend experts.


        • Jeepers, it is illegal. My shrink said to me, actually admitted her “hospital” demanded that she drug me with anything that would stop me from writing. She then changed my diagnosis mid-sentence, then changed it again. I would assume to forcibly drug someone with no valid “illness” is certainly illegal. I fired her. But it got worse. To threaten me repeatedly, accuse me of whatever fiction they could dream up, abuse…anything. I escaped by the skin of my teeth. My place was illegally searched, I was given drugs that the other Julie Greene (spelled differently) in Watertown took, with no apology (I refused them) even though the shrink admitted he was were wrong. That was Patrick Aquino at Mount Auburn. Why not just ask me? About eight months after that, I went to CVS Pharmacy in Watertown, spoke to the mgr and told her “Please check date of birth and address next time.” Never mind the shrink should have. They also handed me a single dose of 600 mgs Lamictal. I didn’t take Lamictal, hadn’t for years. You know what that does to someone who has just had kidney failure and weighs under 80 pounds? Spat ’em out just in time. In the end, even the nephrologist was doing it. He threatened based on a nonexistent “abnormal” blood level. Maybe he had the wrong chart in front of him. Who knows? That was Adam Segal at Harvard Vanguard. Dang, I got out just in time. I think my foot might be broken, by the way. Good thing I am not in the USA.


      • Yeah, I used to wish for breast cancer. Know what that gets you? About 500 brand new female friends who love you no matter what (unless you get to stage 4, of course). Know what anorexia gets you? Every single friend you ever had runs away, refuses to allow their kids near you, won´t return your calls, and will avoid you on the street, too. Unless you start talking recovery talk and praise some shrink or “treatment center” that saved you. Well, then, as long as you keep singing their praises, you can collect your regular checks from said “treatment” center i.e. prison for kids. Still, if you are skinny you are hated anyway, treated like a criminal. We need to stop discussing human rights with anyone or we will get automatically called “paranoid.” Every time you say “right” you get docked. Can you imagine what would have happened to Thom Jefferson and Ben Franklin? Wow, a whole damn war based on paranoia. Let’s shoot up some fireworks, eh? “They” follow my blog, too. I love it, love ruining their reputations cuz they sure ruined mine. Do you get bullies? My friend says one of mine is undoubtedly a former provider. I badmouth ’em all, I name names, really don’t give a poop now, I’m outa there. Hope you are, too, far away like me.


  2. I am not an alcoholic, decidedly, though I’ve actually tried to become one. It’s hard to believe anyone would want more after about two tablespoons of the stuff. I get either turned off by the taste, or I lose interest. My friend was a gutter drunk and died 35 years sober at the age of 72. We often discussed alcoholism at length. I had attended AA many times with various buddies of mine over the years. One day, I heard if a person is truly alcoholic, the difference between that person and a tea-totaler like me is not in the brain at all, but in the way that the liver deals with alcohol. It sounded plausible, that the liver did something to the level in the blood to make the person crave more. This debunks the brain theory but at the same time explains why it runs in families and runs rampant among groups such as Northern Europeans and American Natives. I would suppose that too much alcohol, whether one is “addicted” or not, damages the liver either way. I used to cry and cry and hope I could be an alcoholic instead of having an eating disorder. That way, I’d be allowed into AA, get free coffee, tell lots of jokes, and enjoy the club till I got tired of it.

    Liked by 2 people

  3. Hi Michael;As always,interesting reading. I’m pleased that so many industry types appear to read you materiel. After all,these are important issues,and our opinions should count. I can also agree with some of Julie’s experiences. Even though I only spent 2 days in the treatment part of the “like-minded” facility,reading the notes and diagnoses several months later was eyeopening. One thing was patient will learn to eat normally. Well,I went out of there with a bleeding duodenal ulcer(duh). Revisionest history. Beth


  4. Reblogged this on Disrupted Physician and commented:

    An academic analysis of addiction medicine from the vantage point of the ASAM would reveal false assumptions, bias, dogmatism, and data-dredging. It would also reveal that those claiming expertise are in fact illegitimate and irrational authority who believe in an ends-justifies-the-means approach to push forth the chronic relapsing brain disease with lifelong abstinence an d imposed 12-step recovery. These are false experts who rationalize unethical, unprofessional and even criminal behavior as zeal for the faith if it aligns with the brain disease model of addiction (BDMA) Their viewpoints are fixed and final.

    They have not been held to truly objective judging, analysis, evaluation or outside critique.


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