The always excellent Maia Szalavitz has another good article: Most of Us Still Don’t Get It: Addiction Is a Learning Disorder
There’s a lot of misinformation pushed out there about addiction, and much of it is used to justify interventional drug policy – the whole notion that drugs enslave people against their will. And part of that is driven by “brain disease studies” showing that drug use “changes” the brain.
All experience changes the brain—it has to, in order to leave a mark on memory. If experience didn’t alter us, we couldn’t perceive, recall or react to it. So, simply changing the brain doesn’t make addiction a disease because not all changes are pathological. In order to use brain scans to prove addiction is a disease, you’d have to show changes that are only seen in addicted people, that occur in all cases of addiction and that predict relapse and recovery. No one has yet done this. [...]
Researchers long argued that the pharmacology of particular drugs is what makes them addictive—that, say, cocaine’s alterations in the dopamine system cause a worse addiction than sex or food do because the drug directly affects the way the brain handles that chemical. But since sex and food only affect these chemicals naturally—and can create compulsive behavior that’s just as hard for some people to quit—why should we see cocaine differently?
Of course, none of this is to say that addiction isn’t a medical disorder or that addicted people shouldn’t be treated with compassion. What it does show, I believe, is that addiction is a learning disorder, a condition where a system designed to motivate us to engage in activities helpful to survival and reproduction develops abnormally and goes awry. [...]
Addiction—whether to sex, drugs or rock & roll—is a disorder of learning. It’s not a disorder of hedonism or selfishness and it’s not a sign of “character defects.” This learning, of course, involves the brain—but because learning is involved, cultural, social and environmental factors are critical in shaping it. [...]
We’ve been doing the equivalent of trying to treat obsessive-compulsive disorder by banning hand sanitizer when what we really need to understand is why and how obsessions and compulsions develop in particular people.
Fascinating and useful stuff.