Student Cover Sheet and Reflection on Feedback Form

University of Birmingham – School of Philosophy, Theology and Religion

Module Title: LI Philosophy of Mental Health (30841)

Module Level: LI
Student ID (SRN) 2041626
Essay/assignment title: Explain and critically discuss the view that addiction is
a brain disease of some kind.
Confirmed Word Count: 1737
Have you had an extension agreed? Yes No
If Yes, what is your extension deadline? N/A
What feedback have you received on earlier assessments, or while preparing this assessment?
 To include fewer arguments in more depth
 To include more of my own examples
 To explain scholar’s views in more depth

How have you responded to that feedback in this assessment?

 I have tried to use a narrow focus to explain arguments in more detail
 I have attempted to include more critical evaluation
 I have tried to explain the Leshner’s and Lewis’s views very clearly

What feedback on this assessment would best help you think about your next one?
 Feedback on whether I have used enough critical evaluation
 Feedback on whether my focus was narrow enough
 Feedback on whether the referencing was correct
In his 1997 paper entitled ‘Addiction is a Brain Disease, and It Matters’, Alan Leshner argues
that addiction is a brain disease. Leshner points to the empirical research which highlights
the fundamental differences between addicted and non-addicted brains. I will critically
discuss whether this is a successful solution to the ‘puzzle of addiction’. This essay will be
divided into five main sections. I will begin by outlining this ‘puzzle of addiction’. Secondly, I
will explain how the disease model, specifically that from Leshner, attempts to make sense
of this puzzle in terms of compulsion. Thirdly, I will introduce an objection to this model. I
will then suggest a proposed reply from those in favour of the disease model. However,
ultimately, I will demonstrate that this response is weak, thus concluding that addiction is
not a brain disease of some kind.

To begin with, it is essential to explain the ‘puzzle of addiction’. This is necessary in order to
fully understand the way in which the disease model attempts to solve it. The paradox can
be summarised as follows: why would an individual continuously use drugs despite directly
experiencing and having knowledge of the harmful effects (Pickard, 2018, 10). Take the
example of Sarah who jumped into a dangerous lake with extremely fast-moving water. Her
actions were clearly harmful and thus the following question can be asked: why might Sarah
do something that she knows to be harmful? Now suppose that her 4-year-old son fell into
the water five seconds before. This would be a good explanation to rationalise Sarah’s
actions. The same can be said for the case of addiction. In the same way that her child
provides a reason as to why Sarah jumped into the lake, the disease model attempts to
provide a reason as to why an addict continuously takes drugs despite knowing the negative
consequences. Admittedly, the explanation for addicts continuously seeking drugs is harder
to obtain than Sarah jumping into the lake, yet the analogy is still a helpful one.

The disease model offers one explanation of this initial puzzle by arguing that addiction is a
brain disease. On this account, the addiction causes neurobiological changes to the brain
and thus an addict has no control over the matter and is compelled to continue taking the
drug (Pickard, 2018, 12). The compulsion is thus a motive and cannot be controlled. This
model helps to explain this repeated engagement in harmful behaviour as the addicts
cannot exercise voluntary free choice (Pickard, 2018, 10). Therefore, this brain disease
model is providing an answer to the puzzle of addiction in terms of compulsion.

Alan Leshner supports this biological model of addiction and defines it as a “chronic,
relapsing illness, characterized by compulsive drug seeking and use” (Leshner, 1997, 45). He
reaches this conclusion by observing that the brain undergoes various neurobiological
changes due to repeated use of drugs (Leshner, 1997, 46). Whilst specifically looking at the
mesolimbic pathway, he claims that the brain is clearly affected by persistent drug use
(Leshner, 1997, 46). This pathway is where the dopamine receptors are found and thus the
drug ingested gives rise to massive increases of dopamine which in turn leads to excessive
amounts of pleasure (Holton and Berridge, 2016, 6-7). Leshner thus compares the addicted
to the non-addicted brain and highlights their differences (Leshner, 1997, 46). This leads
Leshner to ultimately conclude that these “changes in brain structure and function is what
makes it, fundamentally, a brain disease” (Leshner, 1997, 46).

It is important to note that Leshner also looks at the social contexts on which the brain
disease is based upon (Leshner, 1997, 46). This could provide reason to support Leshner’s
disease model. He argues that it is too simplistic to label addiction as purely a brain disease,
we have to account for its social aspect as well. Nevertheless, Leshner focuses mainly on
addiction being biological and does not go into much detail surrounding these other factors.

However, I will now introduce an objection to Leshner’s argument. This being that there
exists a fundamental flaw in the disease model of addiction; the empirical evidence used to
support this model is mistaken. There are numerous emotions/experiences that cause a
change in our brain yet are not classified as addictions. This is the view of Marc Lewis, a
neuroscientist, who argues that classifying addiction as a disease is not only incorrect but
also harmful (Lewis, 2017, 8). Lewis specifically looks at the concept of neuroplasticity; the
brains ability to change upon new environments (Lewis, 2017, 10). He thus argues that it is
not abnormal for the brain to change due to drugs.

Lewis provides justification for this by comparing changes in the brain due to addiction and
changes caused by emotions such as love. There seem to be some striking parallels between
the two (Lewis, 2017, 12). In the same way that addicts take drugs whilst knowing the
harmful consequences, people do insane things for the people they love. We think
obsessively about our loved ones, even to the point that falling in love could result in
compulsive behaviour. A clear example of this is the well-known story of Romeo and Juliet.
Romeo kills himself because he believes his lover, Juliet, has died. Similarly, when Juliet
wakes up and sees that Romeo is dead, she also kills herself. It is thus clear that love causes
people to act erratically and in a manner they would not have done otherwise.
As a result, like an addiction, love alters the structural and functional makeup of the brain
(Lewis, 2017, 12). Thus, Lewis’s fundamental claim goes as follows: if addiction is a brain
disease, then love must be as well (Lewis, 2017, 12). Here, Lewis is attempting to show that
this is an absurd claim; it is common knowledge that love is not a brain disease, thus
addiction should not be categorised as one either.

I will now introduce a proposed reply from defenders of the brain disease model. I imagine
supporters of this model (and Leshner himself) would reply with the following argument: if
we fail to define addiction as a brain disease of some kind, addicts will not receive the
treatment they need. One effect of denying that addiction is a brain disease is that addicts
are viewed as immoral people who are responsible for their actions. This is because it is
believed that they are simply unwilling to change their behaviour. Therefore, if we agree
with Lewis that addiction is not a brain disease of some kind, this could be detrimental for
both the physical and mental health of the addicts.

Rather, we should look to treat addicts with medication as they are in a separate brain state
to non-addicts. This idea of giving treatment to addicts with a brain disease seems to also
explain why prison interventions have not been very effective (Leshner, 1997, 46). By simply
imprisoning an addicted criminal, the addict would not benefit in any way. However, if the
individual was treated with medication, not only will their drug use decrease but also their
crime levels (Leshner, 1997, 46). This account seems to contain merit as this shift in thinking
seems to have happened for other illnesses such as Schizophrenia. In the past
schizophrenics were seen as not worthy of treatment and thus were locked away. However,
it is now known that they need to be treated with medication (Leshner, 1997, 46).
Therefore, on this view, if we do not define addiction as a brain disease of some kind,
addicts will be viewed as responsible for their actions and thus be vilified and disparaged. As
a result, they will not be able to receive the treatment that they need.

However, I will now demonstrate that this proposed reply is unsuccessful. I would like to
pose the following question: is it really necessary to define addiction as a brain disease in
order to make sure addicts get the help that they deserve? I believe that the answer to this
question is fairly obvious; no, it is not. Simply labelling an addiction a brain disease does not
automatically provide the addict with the help they need. There are many societal
challenges that do not require the label of a disease in order to be solved. Take the example
of homelessness or poverty. In order to address these issues, we do not term them as
diseases. Rather than using medication as a way of treating those involved, we would
provide financial assistance or resources which would prove to be much more beneficial.
The same should be done for addiction. We do not need to provide the addicts with medical
treatment and interventions as addiction is clearly not a brain disease. Rather, it should be
treated with therapy, financial aid, support etc.

Furthermore, I would like to believe that society as a whole has become more accepting and
understanding when looking at different people’s struggles with addiction. Therefore, I
refuse to accept that by not labelling addiction as a brain disease, addicts would be seen as
self-serving, immoral individuals who are responsible for their actions. With the ongoing rise
of social media, we are able to gain an up-close and personal look into the struggles and
difficulties addicts have to face. This, in turn, has allowed us to become more compassionate
and understanding towards their situation. Therefore, I do not believe we have to define
addiction as a disease in order to remove this stigmatized view of addicts.

In conclusion, I have critically discussed the view that addiction is a brain disease of some
kind. I have looked at Leshner’s argument that the neurobiological changes in the brain
caused by consistent drug use prove that addiction is a brain disease. However, I have
shown that this argument is flawed. This is due to the examples of everyday experiences
such as love, which cause changes in the brain, yet we do not classify as a brain disease. I
have also shown that a proposed reply also fails. We do not need to define addiction as a
brain disease in order for addicts to get the correct treatment that they deserve.
Furthermore, it is more than possible that our perception of addicts can change in a positive
way without labelling addiction a brain disease. Therefore, due to the empirical evidence
being flawed and the proposed reply being unsuccessful, I conclude that addiction is not a
brain disease of some kind.
Bibliography:
- Holton, R and Berridge, K (2016) ‘Compulsion and choice in addiction’ in Addiction
and Choice: Rethinking the relationship, Chapter 9, pp 2-22. [Online] Available at:
https://oxford-universitypressscholarship-com.ezproxye.bham.ac.uk/view/10.1093/
acprof:oso/9780198727224.001.0001/acprof-9780198727224-chapter-9?print=pdf
- Leshner, A. (1997) ‘Addiction is a Brain Disease, and It Matters’ in Science, 278(5335),
pp 45-47. [Online] Available at:
https://science.sciencemag.org/content/sci/278/5335/45.full.pdf
- Lewis, M. (2017) ‘Addiction and the Brain: Development, Not Disease’ in
Neuroethics, 10(1), pp 7-18. [Online] Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486526/pdf/12152_2016_Article_
9293.pdf
- Pickard, H. (2018) ‘The Puzzle of Addiction’ in The Routledge Handbook of Philosophy
and Science of Addiction, edited by H. Pickard and Serge H. Ahmed, pp 9-22. [Online]
Available at: https://www.hannapickard.com/uploads/3/1/5/5/31550141/pickard_-
_the_puzzle_of_addiction.pdf