Hastings Cent Rep. 2020 Jul;50(4):37-46. doi: 10.1002/hast.1172.
The landscape of addiction is dominated by two rival models: a moral model and a model that characterizes addiction as a neurobiological disease of compulsion. Against both, I offer a scientifically and clinically informed alternative. Addiction is a highly heterogenous condition that is ill-characterized as involving compulsive use. On the whole, drug consumption in addiction remains goal directed: people take drugs because drugs have tremendous value. This view has potential implications for the claim that addiction is, in all cases, a brain disease. But more importantly, it has implications for clinical and policy interventions. To help someone overcome addiction, you need to understand and address why they persist in using drugs despite negative consequences. If they are not compelled, then the explanation must advert to the value of drugs for them as an individual. What blocks us from acknowledging this reality is not science but fear: that it will ignite moralism about drugs and condemnation of drug users. The solution is not to cleave to the concept of compulsion but to fight moralism directly.
一种是道德模式，另一种是将成瘾描述为一种强迫性的神经生物学疾病的模式。针对这两种模式，我提供了一种基于科学和临床知识的替代方案。成瘾是一种高度异质的疾病，其强迫性使用的特征描述并不准确。总的来说，成瘾者的药物消费仍然是有目的的：人们使用药物是因为药物具有巨大的价值。这种观点可能对成瘾在所有情况下都是一种脑部疾病的说法提出质疑。但更重要的是，它对临床和政策干预具有影响。要帮助某人克服成瘾，你需要了解并解决他们为什么尽管有负面后果仍坚持使用药物的原因。如果他们不是被迫的，那么解释必须涉及药物对他们个人的价值。阻止我们承认这一现实的不是科学，而是恐惧：这将引发对毒品的道德主义和对吸毒者的谴责。解决方案不是坚持强迫性的概念，而是直接对抗道德主义。
