Myth of the brain disease model of addiction

images2The brain disease model of addiction is one of the most prevailing myths in our understanding of addiction. It is indubitable that addiction has a significant neurological component, but to reduce addition to neurophysiology is a gross error. The reason this way of thinking is so readily accepted is that it is congruent with the prevailing scientific materialistic worldview that dominates most analysis of addiction, and human behavior. Although many adherents of the brain disease model acknowledge the interplay of psychosocial factors with physiology, they nonetheless place primary emphasis on biology. Below is will briefly try and point out that viewing addiction as a brain disease is making an error in assigning addiction an ontological status, that is not befitting of its true complexity.

Integral scholar Sean Esbjörn-Hargens (2010) describes that the ontic status of a phenomena can be understood as having three potential orders of complexity, “the first order is characterized by phenomena that we can more or less ‘see’ with our own senses. The second order is the result of using various extensions of our senses (instruments, computer programs, charts) to see the phenomena … The third order cannot be seen with our senses nor indirectly by our instruments, but only by indications” (p. 159). Certain phenomena can be adequate accounted for when viewed as a first or second order ontological complexity, but certain phenomena has to be understood as a third order complexity, to avoid running the risk of developing over-simplified and reductionist understanding of the phenomenon.

At the highest level of abstraction lies the notion of an individual’s addiction-in-the-world, which is a staggeringly complex phenomenon beyond our senses or instruments. So addiction “is two steps removed from our direct experience (the first order) and our perception of it relies on many abstract indicators (the second order), which are epistemologically distant and ontologically complex” (Esbjörn-Hargens, 2010, p. 159). Therefore is best viewed as a “probability continuum” of ontological complexity, co-arising and enacted through different methodologies and worldviews. For example, a first order ontology could be the experience of being high on the drug. It is available to our senses. A second order ontology could be the pharmacological effect of a drug on neurotransmitter levels or unconscious psychological drives as risk factors to substance abuse. This we can understand only through measurement and calculations, and through a metapsychological perspective. Both these approaches can grasp only partial aspects of human existence.

When understanding addiction as a third order ontology, we begin to understand why certain models of addictions, especially the single-factor models, give rise to such partial and reductionist explanations. They are good at explaining certain “archaic features” of addiction in the realm of its enacted first or second order ontology, but methodologically and epistemologically, they are incapable of enacting addiction on a third order ontology. Technically, a third order ontology is actually the level of ontological complexity where the notion of addiction exists (a first or second order ontology cannot articulate a complex phenomenon like addiction, and can only enact “archaic-addiction” probabilities).
Most of the models of addiction have as their foundation a worldview of scientific materialism and positivistic methodology that are typically adequate for exploring phenomena existing on the first and second order of ontological complexity. However, such models are hopelessly inadequate in explaining complex phenomena such as addiction (or any human behaviour) which “exist” on the third order of ontological complexity. For example, reward deficiency syndrome (Blum, 1995) can only be understood as one of many possible physiological risks that interact with other aspects of being human, without having to reduce human behaviour and motivation to neurotransmitter levels. Simply put, even though an addict has abnormal neurotransmitter levels, at the molecular realm of brain physiology concepts such as addiction are meaningless. To talk at molecular level about addiction is like saying that an amoeba, which only primarily exists in a primitive level of ontological complexity, has abandonment issues originating from poor object relations.

Medard Boss (1983) points out that the natural scientific method has its limitations in explaining the human realm, as it originated from and is only sovereign in the non-human realm (natural sciences). Boss’s approach of Daseinsanalysis, based on Heidegger’s (1962/1927) ontology, could be described as an ontic “articulation of Heidegger’s” ontology. In our current context we could say that by using Heidegger’s method in exploring psychology and psychiatry, Boss echoes the dangers of explaining higher-order complex phenomenon (which includes any aspect of human-being-in-the-world) by using methodology (i.e. empirical observation) and epistemology (i.e. positivistic) dominant in lower orders of complexity. He believes that in Freud’s metapsychology (and most other theory of human existence) there is inevitably an abstraction and tapering from our lived engagement in-the-world (human-being-in-the-world reduced to first and second order ontology).

In summary: the phenomenon of addiction is best understood as a third order ontology, which can only be co-enacted (“brought-forth-in-the-world”) when juxtaposed with associated “methodological variety” and “epistemological depth” (Esbjörn-Hargens, 2010). The notion of epistemological distance highlights that some facts of addiction “speak louder” than others and some elements of addiction facts are only enacted within certain worldviews. Methodological variety refers to the fact that “the more epistemological distance and ontological complexity increase, the more methodological variety will increase. Thus, the more multiple an object becomes (the What), the more methods and disciplines you will need to study and make sense of it (the How), and the more perspectives there will be on what is or is not the nature of that object (the Who)” (Esbjörn-Hargens, 2010, p. 162). In short, trying to reduce any human’s being-in-the-world to a first or second order ontology, as the “brain disease” model tries to do, is fundamentally flawed. Addiction is caused by, affects and manifests in all areas of our being-in-the-world, and only paradigms (or rather meta-paradigms) that function on this level of ontological complexity may suffice, if we are ever to understand, and successfully treat this colossal nemesis.

References to this blog post can be found in my articles as indicated on my Publications and Research page of my website