Ochterbeck D & Forberger S. Drug and Alcohol Review. 2022;41(7):1630-1641.
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This qualitative study explored 190 international addiction researchers’ perspectives on: (1) brain-based explanations of addiction; (2) the perceived dominance of the concept in science, society, treatment, and among those affected, and; (3) their general conception of addiction.

60% of the respondents shared the classification of substance use disorders (SUDs) as brain diseases/disorders. Around 80% considered it the dominant view in science, but fewer in treatment, society, and affected individuals. There was broad criticism of an exclusively brain-based disease model of addiction, with about 60% of respondents agreeing that neuroscientific findings are better explained by the normal neuroplasticity of the brain. The majority of respondents (around 75%) regarded the brain-based model as helpful for understanding SUDs but found it an oversimplification. There was relatively broad agreement on various causal factors, reflecting a complex bio-psycho-social conception of addiction by researchers.

Commentary:

What is addiction? Despite being a very difficult question to answer, it is one I have come back to time and time again throughout my career. Whilst this study doesn’t really set out to answer this question, it is an interesting and worthwhile read because, of course, the way we think about addiction is informed by the research we read; and the way research is prioritised, designed, conducted, and reported is informed by the researchers’ views on addiction. So how they conceptualise addiction is important. It filters down into the academic papers they write, the media that report those papers, the guidelines that are based on those papers, and ultimately our clinical practice.

The way we talk about addiction with patients can hinder or foster a therapeutic relationship. How do you continue a conversation with a patient who does not see themselves as addicted, dependent, disordered, or diseased? At the risk of going all the way back to basics, seeing the whole person and trying to understand how their substance use and behaviour fits into their lives is a good start. Understanding how the patient conceptualises their problems is vital to forming a shared understanding, so you can then start working on solutions together. Whilst diagnosis is important for clinicians to inform therapeutic approaches, diagnostic terms can be vague, disempowering, and even stigmatising for patients. Diagnosis can feel also like an over-simplification. As this article shows, addiction means many things to many people. Sometimes, before we can really help an individual, we need to understand what it means to them.

Article taken from our latest Clinical Update, edited by Tom Jones. To read the full Clinical Update please become a Premium CPD Member.

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