Blithikioti Chrysanthi, Fried Eiko I, Albanese Emiliano, Field Matt, Cristea Ioana A
Department of General Psychology, University of Padova, Padova, Italy.
Department of Clinical Psychology, University of Leiden, Leiden, Netherlands.
Lancet Psychiatry. 2025 Jun;12(6):469-474. doi: 10.1016/S2215-0366(25)00060-4. Epub 2025 Mar 25.
The brain disease model of addiction has dominated public and scientific discourse on addiction (termed substance use disorder [SUD] in the DSM-5) over the past 3 decades. The model framed addiction as a chronic and relapsing brain disease caused by structural and functional brain alterations. The purpose of this model was purportedly dual, as both an aetiological theory and a tool to reduce stigma. Weak empirical support and concerns about the model downplaying fundamental psychosocial causes of SUDs have led to stark disagreement as to whether addiction should be conceptualised as a brain disease. In this Personal View, we argue that the absence of an agreed, clear, and consistent definition of a brain disease-coupled with frequent recourse to concepts with divergent or shifting meaning-have obstructed productive debate and a coherent advance in knowledge and understanding of addiction. Borrowing from the philosophy of psychiatry, we show that both narrow and broad views of brain disease coexist and inform addiction research, though often implicitly and inconsistently. The narrow view of brain disease posits that a mental condition qualifies as a brain disease only if it manifests similarly to a paradigmatic brain disease, resulting from either known or unknown structural and functional damage. The broad view of brain disease suggests that brain disease status should be granted automatically to mental disorders, as all mental activity resides in the brain. We examine theoretical assumptions, empirical evidence, and treatment implications for each view and propose ways of moving beyond them.
在过去30年里，成瘾的脑部疾病模型主导了关于成瘾（在《精神疾病诊断与统计手册》第5版[DSM - 5]中称为物质使用障碍[SUD]）的公众和科学讨论。该模型将成瘾界定为由大脑结构和功能改变所导致的一种慢性复发性脑部疾病。据称，此模型有双重目的，既是一种病因理论，也是一种减少污名化的工具。由于实证支持薄弱，且有人担心该模型淡化了物质使用障碍的基本社会心理成因，导致对于成瘾是否应被概念化为脑部疾病存在严重分歧。在这篇个人观点文章中，我们认为，缺乏一个商定的、清晰且一致的脑部疾病定义，再加上频繁诉诸含义不同或不断变化的概念，阻碍了富有成效的辩论以及在成瘾知识和理解方面的连贯进展。借鉴精神病学哲学，我们表明，脑部疾病的狭义和广义观点并存并影响着成瘾研究，尽管往往是隐含且不一致的。脑部疾病的狭义观点认为，一种精神状况只有在其表现与典型脑部疾病相似，且由已知或未知的结构和功能损害导致时，才符合脑部疾病的标准。脑部疾病的广义观点则表明，脑部疾病的状态应自动赋予精神障碍，因为所有精神活动都存在于大脑中。我们审视了每种观点的理论假设、实证证据和治疗意义，并提出了超越这些观点的方法。
