Silver School of Social Work, Department of Psychiatry, and Center for Bioethics, New York University, 1 Washington Square North, New York, NY 10025, United States.
Behav Brain Res. 2020 Jul 1;389:112665. doi: 10.1016/j.bbr.2020.112665. Epub 2020 Apr 26.
Is addiction a medical disorder, and if so, what kind of disorder is it? Addiction is considered a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Critics argue that the brain changes result instead from normal neuroplasticity and learning in response to the intense rewards provided by addictive substances, thus addiction is not a disorder but rather a series of normal-range if problematic choices. Relying on the harmful dysfunction analysis of medical disorder to evaluate disorder versus nondisorder status, I argue that even if one accepts the critics' reinterpretation of NIDA's brain evidence and rejects the brain disease account, the critics' conclusion that addiction is not a medical disorder but is rather a matter of problematic nondisordered choice does not follow. This is because there is a further possible account of addiction, the evolutionary "hijack" view, that holds that addiction is due to the availability of substances and stimuli that were unavailable during human species evolution and that coopt certain brain areas concerned with human motivation, creating biologically undesigned peremptory desires. I argue that if the hijack theory is correct, then it opens up the possibility that addiction could be a true motivational medical disorder for which there is no underlying neurological-level dysfunction. Finally, I explore the implications of this account for how we see the social responsibility for addiction and how we attempt to control it.
成瘾是一种医学障碍吗？如果是，它属于哪种障碍？美国国家药物滥用研究所（NIDA）认为成瘾是一种大脑疾病，依据是观察到成瘾者大脑发生了变化，这些变化被解读为大脑损伤。批评者则认为，这些大脑变化是由正常的神经可塑性和对成瘾物质提供的强烈奖励的学习反应引起的，因此成瘾不是一种障碍，而是一系列正常范围内但有问题的选择。我依据医学障碍的有害功能障碍分析来评估障碍与非障碍状态，认为即使人们接受批评者对 NIDA 的大脑证据的重新解释并拒绝大脑疾病的说法，批评者关于成瘾不是一种医学障碍而是一系列有问题的非障碍性选择的结论也站不住脚。这是因为，还有一种可能的成瘾解释，即进化“劫持”观点，认为成瘾是由于物质和刺激的可用性造成的，这些物质和刺激在人类物种进化过程中是不存在的，它们会劫持某些与人类动机有关的大脑区域，从而产生非生物设计的强制性欲望。我认为，如果劫持理论是正确的，那么它就为成瘾可能是一种真正的动机性医学障碍打开了可能性，而这种障碍没有潜在的神经水平功能障碍。最后，我探讨了这一观点对我们如何看待成瘾的社会责任以及我们试图控制成瘾的影响。
