Negotiating the Relationship Between Addiction, Ethics, and Brain Science PMC
Negotiating the Relationship Between Addiction, Ethics, and Brain Science PMC

Notwithstanding evidence of influence of psychological and social factors on health and disease, there remains a tendency, possibly attributable to long-standing reductionist assumptions in the science, to roll everything up into the biological. There are several examples of this option in the theoretical psychiatry literature. Samuel Guze's highly influential paper over 30 years ago, ‘Biological psychiatry – is there any other kind? ’ (Guze, 1989) is an example, as indicated by the rhetorical nature of the title question. More recently, Peter White and colleagues proposed that mental disorders are brain disorders, without for a moment being unaware of the research showing the influence of psychosocial factors in the onset and course of many psychiatric conditions (White, Rickards, & Zeman, 2012). Likewise National Institute of Mental Health (NIMH's) Research Domains Criteria framework, which regards psychiatric conditions as disorders of brain circuitry (Insel et al., 2010).

Investigating psychological and social impacts on health

  • Realizing a neurobiological or genetic susceptibility to addiction could empower life planning and the avoidance of high-risk scenarios.
  • Although a brain disease model legitimizes addiction as a medical condition, it promotes neuro-essentialist thinking, categorical ideas of responsibility and free choice, and undermines the complexity involved in its emergence.
  • This helped them stay sober and maintain contact with other people, making them feel normal and part of society.
  • Thus it is the limited option for choice that is one prevailing variable, not only the reduced ability to choose alternatively.
  • One example is drug craving that may be experienced as strong, intense urges for immediate gratification that may impair rational thought about future planning (Elster and Skog 1999).

For instance, despite its cost-effectiveness and ease on burden of disease, the supervised injection site (SIS) in the Downtown Eastside area of Vancouver, Canada has been repeatedly threatened with closure by politicians. The threats are based on emotional and moral attitudes towards the existence of the SIS and drug addicts generally, as opposed to empirical evidence (Des Jarlais, Arasteh, and Hagan 2008). Social norms, availability, Top 5 Advantages of Staying in a Sober Living House accessibility, legality, modeling, expectancies, societal approval, visibility, targeting practices, and cultural beliefs all influence the experience of addiction. An individual exposed to drug use at an early age can be influenced by social modeling (or learning via observation). Additionally, certain environments have specific social norms related to drug use (e.g., “Everyone experiments a little with drugs in college”).

  • Some individuals may be more affected by the rewarding effects of drugs of abuse because they are trying their best to regulate painful emotions.
  • Mind once was the place of mediation between person and situation, between the biological and the social.
  • Invoking the BPSM and writings of Paolo Freire, they argue that gun violence disease can be attributed to an underlying “disease of oppression” embedded in “our violent society.” “Public health,” they write, “has a role to address the disease of oppression” (Kohlbeck and Nelson 2020, 3).
  • The degrees in which self-control is exerted, free choice is realized and desired outcomes achieved are dependent on these complex interacting biopsychosocial systems.

Consent for publication

This kind of “neuro-essentialism” (Racine, Bar-Ilan, and Illes 2005) may bring about unintentional consequences on a person’s sense of identity, responsibility, notions of agency and autonomy, illness, and treatment preference. This article presents a qualitative study based on the paradigm of the social construction of the philosophy of science, understanding people’s meaning-making as a personal process which is negotiated with other people and provided by culture [3, 13, 24]. They had completed all the surveys and tests in the Tyrili cohort 2016, which will give us the opportunity to compare results from both quantitative and qualitative data in future. The informant group represented the average age of the patients, and were between 25 and 45 years old, and included both men and women. Fifteen of the 25 former patients responded to our application to participate in the study.

  • Thus, although the BPSM tells us we can list a huge array of factors as disease causes (see Fig. 1), the model itself does not tell us how to determine which factors play a causal role in any given case.
  • Several theories and models have been developed to understand the concept of substance use disorder (SUD), focusing on, for example, self-medication, behaviour, self-regulation, neurobiology or social living conditions [25, 33, 47].
  • Both types of ‘reduction’ are relevant to the relation between the BMM and the BPSM and both are in play in Engel's 1977 paper.
  • In other cases (e.g., CFS, IBS, fibromyalgia, and alcoholism), it has played a supporting role.
  • Immediate findings are typically of correlations or associations, and control conditions of varying levels of stringency increase confidence in inference to causation.

Heroin-Assisted Treatment: An Applied Case Example

Empirical findings, new research paradigms, and theories developed in the last few decades effectively update and revitalize the BPSM. For many people, the process includes stable periods and periods characterised by emotional, relational, and social pain and trouble [6]. Thus, recovery processes should be met with patience and adjusted and collaborative support.

the biopsychosocial model of addiction

The BPS model has been promoted by the field of psychosomatic medicine utilizing “mind-body” approaches to health (22) that are common in “alternative therapies” (e.g., meditation, acupuncture, nutrition). A central theme with this approach is the use of seemingly divergent conceptual models to emphasize multicausality in understanding disease, rather than a reductionist approach. An example of a similar approach known as Ecosocial Theory was introduced by Krieger (23). The interactive BPS model proposes an integrated vision of health and disease that does not focus on a single root cause which is seen in a traditional biomedical approach (24). The integration of social and biological processes (25) may be critical for OUD treatment since the reductionist biological model has not been productive (and arguably harmful) and capitalized on by the pharmaceutical industry (26). A BPS framework not only helps guide addiction treatment, but also influences public perception of addiction (27).

The biopsychosocial model: Its use and abuse

the biopsychosocial model of addiction

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