Understanding Addiction: A Series of Four Salons

Psychologist and neuroscientist Marc Lewis, along with drug policy reformer Shaun Shelly, will host a four-part salon series on the nature of addiction and new approaches to treatment and care. These salons will challenge the dominant but misguided disease model of addiction and replace it with progressive approaches that integrate emotional learning, environmental factors (family, culture, etc.), and evidence for brain change.  

Most of us know someone with a drug or alcohol problem. Or perhaps we are the ones with the problem. Drug use is not necessarily harmful. But “addiction,” referring to persistent substance use, despite urgent efforts to stop or cut down, can hurt us in many ways. Beyond the emotional and social costs of living with addiction, drug-related deaths are at an all-time high. Is addiction a disease? Does the brain really change with addiction? Are people who are considered addicts mentally ill? Or are they adapting as well as they can to personal or social challenges? Can they be helped? Or is that the wrong question? Is it their environment rather than their behaviour that needs to change? In the meantime, what changes to policy and public health systems can minimize drug-related illnesses and the oppression of people who use drugs, while improving their general health and wellbeing?

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Save the dates (parts 2-4):

March 21st, April 18th, May 16th

1-4pm EST

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In the first salon in the series, Marc Lewis and Shaun Shelly challenge the idea that addiction is a disease and introduce alternative models that better make sense of the data.

The US National Institute on Drug Abuse (NIDA) defines addiction as a chronic, relapsing brain disease. (Note that NIDA has very recently changed “disease” to “disorder” in some of their communications — perhaps in response to criticisms like ours!) The head of NIDA goes even further and calls addiction a “disease of free will.”

Does this make sense when we look at the data? Are there alternatives to the brain disease model? Can we avoid deterministic ideas like pathology, maladaptation (“mal-” being the problem), and genetic or cultural set-points? Is there such a thing as free will? What about the benefits of drugs?

What if addiction was logical in certain circumstances? Perhaps humans have evolved to have “addictive” relationships? Are we creating patients and “bad people” with our ideas about drug use?

Can we maintain some concept of personal responsibility consistent with the assumption that people (even “addicts”) make choices…without resorting to the idea of some absolute moral code?

Suggested Viewing:

• Nora Volkow and Marc Lewis debate on-stage in Amsterdam
• In-depth interview on TV-Ontario

Suggested Reading:

• Lewis, M. (2017). Addiction and the brain: Development, not disease. Neuroethics, 10, 7-18. DOI: 10.1007/s12152-016-9293-4.
• Kriegler, A. (2020). Interview with Shaun Shelly, Researcher at the University of Pretoria and the Policy, Advocacy and Human Rights lead at TB HIV Care, South Africa. SA Crime Quarterly, (69), 7-15.

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