Treatment and Prevention

Addiction as "Brain Disease"

The HBO Addiction Project

HBO Addiction

Earlier in the course, we focused on the "medicalization" of alcohol- and drug-related deviance as a central concern of the social constructionist perspective on alcohol and drug problems. Examples of constructionist research on medicalization include Schneider's (1978) historical analysis of how the founders of Alcoholics Anonymous popularized the disease conception of "alcoholism" during the 1930s and Conrad and Potter's (2000) more recent study of the expansion of the medical diagnosis of ADHD to the troublesome behavior of adults as well as children. Other constructionist researchers have examined how the pharmaceutical industry has "discovered" and promoted a variety of medicalized conditions, such as "restless leg syndrome," to create new markets for prescription drugs.

However, there may be no better example of how claimsmaking by powerful groups in government, the media, and private enterprise has advanced the process of medicalization than the HBO Addiction Project. This unique effort to document and promote a conception of addiction as a "brain disease" involved an unprecedented collaboration between the cable network giant, HBO, one of the wealthiest philanthropic organizations in the U.S., the Robert Wood Johnson Foundation, and the major federal agencies dealing with substance use problems, the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The producers at HBO assembled a large team of filmmakers, medical professionals, and government scientists who participated in the construction of a fourteen-part television documentary "aimed at educating America about addiction as a brain disease and its treatment as such" (HBO Introduction to Addiction DVD). Various segments of this documentary present authentic and painful stories of people struggling with dependency on drugs or alcohol and its tragic consequences. A question running through these stories—"why can't they just stop?"—sends a clear message that addiction is not a matter of personal choice but a disease that is beyond the control of the substance abuser. When it first aired in March 2007, this documentary attracted an audience of over 13 million viewers and received two Emmy awards (NIDA press release, Sept. 16, 2007). The entire documentary can be viewed online at the project website, HBO: Addiction, which also contains a wealth of material and resources on the nature, diagnosis, and treatment of this "chronic relapsing brain disease."

Advocate for the Disease Model of Addiction: Dr. Nora Volkow

If one could speak of a "star" of this documentary, it would be Dr. Nora Volkow, Director of NIDA, who is prominently featured in several episodes of Addiction. The Resources link for this unit will take you directlyto a video in which Dr. Volkow presents a detailed account of her views about the neurochemical foundations of the brain disease of addiction. Prior to taking the top position at NIDA, Volkow had a distinguished career as a neuroscientist specializing in the use of brain imaging to examine the mechanisms of drug arousal and addiction. In her appearances in Addiction, she stresses themes like those in the following statement she prepared for a NIDA publication titled, "The Science of Addiction." Note the sharply contrasting images of a "healthy" brain and the brain of a drug user that were included in Volkow's statement—here, you can literally see the damage done by "brain disease":

How Science Has Revolutionized the Understanding of Drug Addiction

Throughout much of the last century, scientists studying drug abuse labored in the shadows of powerful myths and misconceptions about the nature of addiction. When science began to study addictive behavior in the 1930s, people addicted to drugs were thought to be morally flawed and lacking in willpower. Those views shaped society's responses to drug abuse, treating it as a moral failing rather than a health problem, which led to an emphasis on punitive rather than preventative and therapeutic actions. Today, thanks to science, our views and our responses to drug abuse have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of drug addiction, enabling us to respond effectively to the problem.

As a result of scientific research, we know that addiction is a disease that affects both brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities.

Drug User Brain Activity image
"Drug addiction is a brain disease that can be treated."
Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse


Despite these advances, many people today do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse.... At the National Institute on Drug Abuse (NIDA), we believe that increased understanding of the basics of addiction will empower people to make informed choices in their own lives, adopt science-based policies and programs that reduce drug abuse and addiction in their communities, and support scientific research that improves the Nation's well-being.

Nora D. Volkow, M.D.

By virtue of her powerful position in government, her impressive scientific credentials, and her persuasive use of imaging technology to picture the addicted brain, Volkow has become an influential claimsmaker on behalf of the disease model of drug problems. Whereas Conrad and Potter (2000) characterized opiate addiction as only "partially medicalized" just a decade ago, Volkow and other advocates of the brain disease conception appear to be making rapid progress toward a more thoroughly medicalized understanding of addiction to drugs, alcohol, and other "pathological" habits.

The medicalized conception of brain disease has important political implications as well as potentially far-ranging consequences for the way we define and control alcohol and drug problems. This all-encompassing model of addiction has served as a scientific justification for merging NIDA and NIAAA. As Volkow stated in an interview with the New York Times (June 13, 2001), the current separation of NIDA and NIAAA is "artificial" because alcohol and drug "(a)ddictions tend to move together...sharing many triggers and a great deal of biology." However, critics such as the psychiatrist Sally Satel (The Human Factor, 2007; Medical Misnomer, 2007) have challenged this political initiative by raising serious questions about the validity and the therapeutic usefulness of the brain disease model of addiction. It still remains to be seen whether Volkow's highly medicalized conception of individual deviance will eventually replace more traditional moral, social, and psychological views of alcohol and drug dependence.

    Index Page