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Well over a decade ago, the National Institute on Drug Abuse began advancing the idea that addiction is a "brain disease." Over the years, the concept has become orthodoxy--a dubious achievement that has justifiably prompted Buchman and his colleagues (2010) to call for a more nuanced perspective on addiction. In this peer commentary we challenge the validity of the brain disease model of addiction and discuss its adverse implications for treatment.

Let us begin with the concept of brain disease. "That addiction is tied to changes in brain structure and function is what makes it, fundamentally, a brain disease," wrote a former director of the National Institute of Drug Abuse in a seminal 1997 Science article (Leshner 1997). What does this statement really mean? Surely, drugs operate at the level of the brain (Hyman 2007). No dispute there. Regular, heavy use of alcohol, nicotine, heroin, cocaine, and other substances produces brain changes (reward centers are "hijacked," as it is commonly put) that, in turn, influence the urge to use drugs and the struggle to quit. Brain-related differences among users influence the rapidity with which they develop addiction, their subjective experience of the drug, the potency of their craving, and the severity of their withdrawal symptoms.

That said, why should this make addiction a brain disease as opposed to, say, a molecular disease, a psychological disease, or a sociocultural disease? All are equally valid perspectives for different purposes. As psychologist Nick Heather wisely asserted, "Addiction can be defined in any way the definer thinks fit. . . . The crucial issue is how useful the definition is for specific purposes" (Heather 1998). So, for example, if one's purpose is to investigate dopamine circuitry, then viewing addiction as as brain-based phenomenon makes sense. But if one's purpose is providing psychosocial treatment and devising policy, then the "neurocentric" view doesn't help much.

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Sally Satel, M.D., is a resident scholar at AEI. Scott O. Lilienfeld is a professor of psychology at Emory University.

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