Are Addictions Just Brains Gone Wild?

Sam Osherson and Marilyn Freimuth

What causes an addiction? Many media portrayals, such as last year's HBO series on addictions, emphasize addictions as a biological process, focusing on recent advances in neuroscience. The HBO series, along with commentaries it has spawned, raises our awareness of the prevalence of this problem in a non-sensationalistic fashion. The series moves beyond the shame and stigma often associated with addictions and invites us to explore the deeper roots of the problem.

 

However, The HBO series reinforces a portrait of addiction as a brain- driven “disease” despite evidence that difficulties in human relationships and personal identity are often at the root of addiction, and can influence both treatment effectiveness and the potential for relapse. Addiction can be a way of managing a sense of powerlessness and threat in interpersonal relationships. It can be a means of sedating feelings that are otherwise too powerful to endure, feelings of self- hatred, low self-worth, fears and anxieties about one’s place in the world.

 

This is not to say that biological factors are not involved in addiction and recovery; of course they are. Predispositions and vulnerabilities to the impact of psychoactive substances are very much a part of the picture. Yet, the human brain exists in a person and a person exists within a complex web of relationships, needs, and desires. The HBO series may feel that it de- stigmatizes addictions by focusing on brain and biology as the culprits, but it also dehumanizes people who struggle with addictions. As William Cope Moyers, author of Broken, a memoir of addiction, pointed out in a speech at an MIT research conference on the biology of addictions: after all is said and done, “I was born with a hole in my soul.”

 

There is a fault line in health care approaches to addictions. The fields of psychiatry and psychology are in the midst of an ongoing debate between “brain” versus “mind” approaches to mental illness. The biomedical, drug-oriented approach views problems like addiction as organically- driven syndromes in a disease model that is best controlled by drugs and other medical interventions. This approach appeals to the managed care industry and contrasts with “talk therapies” that view mental heath issues—such as addictions—as rooted in relationship problems, problematic life events, self-doubt, and distorted thinking.

 

So, it’s disturbing when watching the HBO series to hear people talk about some particularly difficult moment with their self- esteem or traumatic event in their personal history or difficult moment between parent and child and have the addiction counselor glide over that fact to focus on medications or have the screen fill up with a discourse on brain scans.

 

Solely viewing addictions as a brain disease minimizes the potential health benefits of early recognition of an addiction. Early on, addictions are more habit-like than disease- like—it only looks more and more biological once the body has adapted to the addictive jolt that organizes the brain’s limbic system. By ignoring the significance of the "the person," the program’s heavily biological, brained- oriented perspective does a disservice to the complexity of this problem and has the potential to undermine another of the program’s main points: addictions can be effectively treated and long term recovery is possible.

 

We have now in this country a health care system that emphasizes medication and a narrow view of illness, and all but ignores the doctor- patient relationship and a broad understanding of the role an illness plays in a person’s life. The “brain-centered” addiction paradigm is just one example of this tendency. Medications can be a useful part of treatment. However, studies indicate that compliance with a medical regimen depends on the quality of the alliance between doctor and patient. For the recovering person to develop new life skills requires a strong bond with the therapist or counselor. Preventing relapse requires that treatment providers attend to the kinds of self- deficits and relational brick walls that plague people with addictions both before and after addiction treatment.

 

Addictions happen to people, not just brains.