1
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John YJ, Caldwell L, McCoy DE, Braganza O. Dead rats, dopamine, performance metrics, and peacock tails: Proxy failure is an inherent risk in goal-oriented systems. Behav Brain Sci 2023; 47:e67. [PMID: 37357710 DOI: 10.1017/s0140525x23002753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
When a measure becomes a target, it ceases to be a good measure. For example, when standardized test scores in education become targets, teachers may start "teaching to the test," leading to breakdown of the relationship between the measure - test performance - and the underlying goal - quality education. Similar phenomena have been named and described across a broad range of contexts, such as economics, academia, machine learning, and ecology. Yet it remains unclear whether these phenomena bear only superficial similarities, or if they derive from some fundamental unifying mechanism. Here, we propose such a unifying mechanism, which we label proxy failure. We first review illustrative examples and their labels, such as the "cobra effect," "Goodhart's law," and "Campbell's law." Second, we identify central prerequisites and constraints of proxy failure, noting that it is often only a partial failure or divergence. We argue that whenever incentivization or selection is based on an imperfect proxy measure of the underlying goal, a pressure arises that tends to make the proxy a worse approximation of the goal. Third, we develop this perspective for three concrete contexts, namely neuroscience, economics, and ecology, highlighting similarities and differences. Fourth, we outline consequences of proxy failure, suggesting it is key to understanding the structure and evolution of goal-oriented systems. Our account draws on a broad range of disciplines, but we can only scratch the surface within each. We thus hope the present account elicits a collaborative enterprise, entailing both critical discussion as well as extensions in contexts we have missed.
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Affiliation(s)
- Yohan J John
- Neural Systems Laboratory, Department of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | | | - Dakota E McCoy
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, USA
- Department of Biology, Duke University, Durham, NC, USA
| | - Oliver Braganza
- Institute for Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany
- Institute for Socioeconomics, University of Duisburg-Essen, Duisburg, Germany
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2
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Morris J, Boness CL, Witkiewitz K. Should we promote alcohol problems as a continuum? Implications for policy and practice. DRUGS (ABINGDON, ENGLAND) 2023; 31:271-281. [PMID: 38682086 PMCID: PMC11052541 DOI: 10.1080/09687637.2023.2187681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - C L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
| | - K Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
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3
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Boness CL, Votaw VR, Francis MW, Watts AL, Sperry SH, Kleva CS, Nellis L, McDowell Y, Douaihy AB, Sher KJ, Witkiewitz K. Alcohol use disorder conceptualizations and diagnoses reflect their sociopolitical context. ADDICTION RESEARCH & THEORY 2022; 31:307-312. [PMID: 37981984 PMCID: PMC10656047 DOI: 10.1080/16066359.2022.2150935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2023]
Abstract
The present paper highlights how alcohol use disorder (AUD) conceptualizations and resulting diagnostic criteria have evolved over time in correspondence with interconnected sociopolitical influences in the United States. We highlight four illustrative examples of how DSM-defined alcoholism, abuse/dependence, and AUD have been influenced by sociopolitical factors. In doing so, we emphasize the importance of recognizing and understanding such sociopolitical factors in the application of AUD diagnoses. Last, we offer a roadmap to direct the process of future efforts toward the improved diagnosis of AUD, with an emphasis on pursuing falsifiability, acknowledging researchers' assumptions about human behavior, and collaborating across subfields. Such efforts that center the numerous mechanisms and functions of behavior, rather than signs or symptoms, have the potential to minimize sociopolitical influences in the development of diagnostic criteria and maximize the treatment utility of diagnoses.
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Affiliation(s)
- Cassandra L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
| | - Victoria R Votaw
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
- Department of Psychology, University of New Mexico, Albuquerque, NM
| | - Meredith W Francis
- The Brown School of Social Work and the Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - Ashley L Watts
- Department of Psychological Sciences, University of Missouri, Columbia, MO
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | | | - Linda Nellis
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of New Mexico, Albuquerque, NM
- The Brown School of Social Work and the Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- Department of Psychology, University of Michigan, Ann Arbor, MI
- Department of Psychological Sciences, University of Missouri, Columbia, MO
- VA Puget Sound Health Care System, Seattle, WA
- Center for Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA
| | - Yoanna McDowell
- VA Puget Sound Health Care System, Seattle, WA
- Center for Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA
| | | | - Kenneth J Sher
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
- Department of Psychology, University of New Mexico, Albuquerque, NM
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4
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Ekendahl M, Karlsson P, Månsson J, Heimdahl Vepsä K. Self-interpellation in narratives about craving: Multiple and unitary selves. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1391-1407. [PMID: 36031748 PMCID: PMC9804802 DOI: 10.1111/1467-9566.13534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
The concept of addiction seeks to explain why people act contrary to their own best interest. At the centre stage of addiction discourse is craving, conceptualised as a strong urge to use substances. This article analyses how talk therapies such as relapse prevention and self-help groups shape identity constructions and understandings of craving among clients. Drawing upon interviews with individuals who have engaged in talk therapies in Sweden, we analyse how craving is made up through 'self-interpellation', that is, personal narratives about past, present or future thoughts, feelings and actions. The main 'self-interpellation' included multiple selves, where craving was elided by the true self and only felt by the inauthentic self. Less dominant were narratives which drew on a unitary self that remained stable over time and had to fight craving. The notion of multiple selves appeared as a master narrative that the participants were positioned by in their identity constructions. We conclude that this multiplicity seems ontologically demanding for people who try to recover from substance use problems. A demystification of craving, in which neither substance effects nor malfunctioning brains are blamed for seemingly irrational thoughts and actions, may reduce the stigmatisation of those who have developed habitual substance use.
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Affiliation(s)
- Mats Ekendahl
- Department of Social WorkStockholm UniversityStockholmSweden
| | - Patrik Karlsson
- Department of Social WorkStockholm UniversityStockholmSweden
| | - Josefin Månsson
- Department of Social WorkStockholm UniversityStockholmSweden
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5
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Wyler H, Maisch A, Berger T, Kieser U, Schleifer R, Liebrenz M. Alcohol use disorder and disability insurance in Switzerland: the attitudes and views of lawyers, insurance medical experts, and addiction-specialist therapists. Subst Abuse Treat Prev Policy 2022; 17:69. [PMID: 36303216 PMCID: PMC9615404 DOI: 10.1186/s13011-022-00495-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND According to a landmark decision by the Swiss Federal Supreme Court, people with a substance use disorder (SUD) are now eligible for disability benefits if their disorder impairs their ability to work. Alcohol use disorder (AUD) is one of the most common SUDs in Switzerland and is associated with high societal and economic costs. This study aimed to gain an in-depth understanding of the views of professional stakeholder groups regarding AUD and their opinions on the new legal precedent. METHODS Swiss social insurance lawyers, insurance medical experts, and addiction-specialist therapists (N = 79) answered an online questionnaire. Due to violations of the assumption of normality, non-parametric tests are reported in most cases. RESULTS Therapists held significantly higher regard for patients with AUD than both lawyers and insurance medical experts. All three groups strongly supported a disease view of AUD but agreed significantly less that it was a disease like cancer, suggesting that AUDs might be seen as at least partially self-inflicted. Overall, moralist views of AUD received considerably less support than the disease view, with lawyers agreeing with moralist views more than therapists. All groups were well-informed and largely supportive about the new legal precedent. When asked about stipulating participation in medical treatment to mitigate damages associated with a claim, attending therapy was supported the most amongst the groups (80% of participants felt this was somewhat or fully appropriate), followed by a reduction in drinking quantity (58%), and abstinence (18%). In all three groups, we identified associations between certain views and opinions on AUD and support for the new legal precedent. CONCLUSIONS Whilst there were differences between the stakeholder groups in their regard for and views of AUD, all three adopted a clear harm-reduction approach with respect to measures to mitigate damages associated with the insurance disability claim. A possible connection of this stance with the Swiss national drug policy in recent years is discussed together with limitations of the study and practical implications of the findings.
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Affiliation(s)
- Helen Wyler
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Anja Maisch
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Thomas Berger
- grid.5734.50000 0001 0726 5157Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ueli Kieser
- grid.15775.310000 0001 2156 6618Institute for Legal Studies and Legal Practice, University of St. Gallen, St. Gallen, Switzerland
| | - Roman Schleifer
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Michael Liebrenz
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
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6
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Moe FD, Berg H. Treating equivalent cases differently: A comparative analysis of substance use disorder and type 2 diabetes in Norwegian treatment guidelines. J Eval Clin Pract 2022; 28:721-728. [PMID: 35484825 PMCID: PMC9790317 DOI: 10.1111/jep.13693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Substance use disorder (SUD) is often understood as a chronic illness. AIMS This paper investigates whether SUD is treated as a chronic illness. METHOD To this aim, we have used World Health Organizations (WHO's) definition of chronic illness to conduct a comparative analysis of SUD and type 2 diabetes (T2D), which is another chronic illness. RESULTS When analysing Norwegian treatment guidelines, we found that only the T2D guideline reflects the WHO's conceptualization of chronic illnesses. We argue that this discrepancy implies that SUD is understood as a moral and legal problem, while T2D is conceptualized as a somatic illness. We discuss how social, political and historical conditions of the possibility for understanding SUD are interwoven with normative presumptions about the clinician, patient, treatment guidelines and drug policies in a way that may impede the development of continuing care. CONCLUSION The paper concludes that the delivery of treatment services is inequitable as SUD is not treated as a chronic illness.
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Affiliation(s)
- Fredrik D Moe
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.,Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Henrik Berg
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway.,Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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7
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From concepts to treatment: a dialog between a preclinical researcher and a clinician in addiction medicine. Transl Psychiatry 2022; 12:401. [PMID: 36130939 PMCID: PMC9492712 DOI: 10.1038/s41398-022-02177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/08/2022] Open
Abstract
The debate surrounding the brain disease model and the associated questioning of the relevance of animal models is polarizing the field of addiction, and tends to widen the gap between preclinical research and addiction medicine. Here, we aimed at bridging this gap by establishing a dialog between a preclinical researcher and a clinician in addiction medicine. Our objective was to evaluate animal models and the neuroscientific conceptualization of addiction in light of alcohol or drug dependence and treatment in patients struggling with an addiction. We sought to determine how preclinical research influenced addiction medicine over past decades, and reciprocally, what can preclinical researchers learn from addiction medicine that could lead to more effective approaches. In this dialog, we talk about the co-evolution of addiction concepts and treatments from neuroscientific and medical perspectives. This dialog illustrates the reciprocal influences and mutual enrichment between the two disciplines and reveals that, although preclinical research might not produce new pharmacotherapies, it does shape the theoretical conceptualization of addiction and could thereby contribute to the implementation of therapeutic approaches.
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8
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Extending the two-component model of delusion to substance use disorder etiology and recovery. NEW IDEAS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.newideapsych.2022.100935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Loyal D, Sutter AL, Auriacombe M, Serre F, Rascle N. The Pregnant Smoker Stigma Scale – Public Stigma (P3S-PS): development and validation in general French population. Women Health 2022; 62:157-167. [DOI: 10.1080/03630242.2022.2030449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Deborah Loyal
- INSERM U1219, Bordeaux University, Bordeaux, France
- CRPMS EA 3522, Paris University, Paris, France
| | - Anne-Laure Sutter
- INSERM U1219, Bordeaux University, Bordeaux, France
- Perinatal Psychiatry Unit, Charles Perrens Hospital, Bordeaux, France
| | - Marc Auriacombe
- CNRS USR 3413, SANPSY, Bordeaux University, Bordeaux, France
- Addictology Unit, Charles Perrens Hospital, Bordeaux, France
| | - Fuschia Serre
- CNRS USR 3413, SANPSY, Bordeaux University, Bordeaux, France
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10
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Hall P. The moral maze of sex & porn addiction. Addict Behav 2021; 123:107054. [PMID: 34320446 DOI: 10.1016/j.addbeh.2021.107054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/30/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
Sex addiction, a term first coined in the early 80s, has always been met with controversy. Some say the label of addiction is an excuse used by those who have lost their moral compass or refuse to accept responsibility for their sexual choices. Others claim the label is used to pass moral judgement on those whose sex lives or internet viewing habits do not fit societally prescribed norms. The acceptance by WHO of CSBD (Compulsive Sexual Behaviour Disorder) into ICD11 was heralded as a moral victory by the sex addiction naysayers who claimed WHO's position 'proved' it wasn't an addiction; conversely sex addiction professionals claimed victory saying that finally this was a step in the right direction. This paper will explore the divide and provide insight on how using a pure medical model of addiction has contributed and fueled the debate. An alternative model for conceptualization from a biopsychosocial perspective will be provided to suggest ways of moving forward that could ease the controversies as well as opening new areas for research and most importantly, greater understanding and empathy for clients.
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Affiliation(s)
- Paula Hall
- Sexual & Relationship Psychotherapist UKCP Reg, Acc COSRT(Snr), MBACP Accred, The Laurel Centre, London, UK.
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11
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Murphy J, Russell B. Police Officers' addiction frameworks and policy attitudes. Addict Behav 2021; 122:107007. [PMID: 34146796 DOI: 10.1016/j.addbeh.2021.107007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/08/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023]
Abstract
Police officers have frequent encounters with people who use drugs, either by making an arrest for a drug-related offense or responding to a drug overdose call. Yet, little is known about how police officers view drug addiction - as a disease, a moral failure, or something else - and how their frameworks for conceptualizing addiction impact their attitudes toward drug policies, including the use of naloxone. This research examined police officers' adherence to a moralistic addiction framework in relation to their support for treatment-oriented drug policies. Officers (N = 618) were surveyed about their beliefs on drug policy and the extent to which drug addiction was a product of one's morals or related to social or biological reasons. Results found that approximately 22% of the variance in drug policy attitudes could be explained by addiction frameworks and control variables. Officers who embraced a biological perspective of addiction were more supportive of policies that expanded treatment, including access to naloxone, and less punitive sanctions. Those with stronger moralistic views were less supportive of expanding treatment initiatives and endorsed expanding punitive sanctions. Officer age and education was positively related with expanding treatment and naloxone use while exposure to overdoses was negatively related to policy support. These results demonstrate that officers' frameworks about drug addiction play an important role in drug policy attitudes and, by extension, how they might interact with people who use drugs.
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12
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Addiction as a brain disease revised: why it still matters, and the need for consilience. Neuropsychopharmacology 2021; 46:1715-1723. [PMID: 33619327 PMCID: PMC8357831 DOI: 10.1038/s41386-020-00950-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
The view that substance addiction is a brain disease, although widely accepted in the neuroscience community, has become subject to acerbic criticism in recent years. These criticisms state that the brain disease view is deterministic, fails to account for heterogeneity in remission and recovery, places too much emphasis on a compulsive dimension of addiction, and that a specific neural signature of addiction has not been identified. We acknowledge that some of these criticisms have merit, but assert that the foundational premise that addiction has a neurobiological basis is fundamentally sound. We also emphasize that denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing access to healthcare and treatment, the consequences of which are catastrophic. Here, we therefore address these criticisms, and in doing so provide a contemporary update of the brain disease view of addiction. We provide arguments to support this view, discuss why apparently spontaneous remission does not negate it, and how seemingly compulsive behaviors can co-exist with the sensitivity to alternative reinforcement in addiction. Most importantly, we argue that the brain is the biological substrate from which both addiction and the capacity for behavior change arise, arguing for an intensified neuroscientific study of recovery. More broadly, we propose that these disagreements reveal the need for multidisciplinary research that integrates neuroscientific, behavioral, clinical, and sociocultural perspectives.
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13
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Shuster R. Monitoring Programs for Nurses With Substance Use Disorders: One Nurse's Journey and Recommendations. J Psychosoc Nurs Ment Health Serv 2021; 59:13-17. [PMID: 33647158 DOI: 10.3928/02793695-20210212-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Estimates of nurses with substance use disorders (SUDs) are approximately equal to those of the general public. Historically, nurses with SUDs faced public disciplinary action for any violations of the nurse practice act in their respective states, but now many states have alternative-to-discipline (ATD) programs available. Although the consent agreement for disciplinary and non-disciplinary programs are often similar, ATD programs are, in contrast, confidential and assist nurses to safely return to practice. As a RN and person in long-term recovery, I have first-hand experience with an ATD program. I credit the program with saving my career; however, it is not without criticism. Recommendations for improvements include increased education about ATD programs, research to evaluate efficacy of mandated interventions, including nurses in recovery within shared governance of these programs, implementing true peer support with nurses in long-term recovery, defraying the costs of the program to participants, and ensuring all staff within the programs receive standardized onboarding training followed by ongoing education. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 13-17.].
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14
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Montemarano V, Cassin SE. The effect of a food addiction explanatory model of eating behaviours on weight-based stigma: An experimental investigation. Eat Behav 2021; 41:101507. [PMID: 33862467 DOI: 10.1016/j.eatbeh.2021.101507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/24/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Weight stigmatization and discrimination are pervasive issues that have numerous adverse consequences for those with excess weight. It has been proposed that some individuals may be addicted to hyperpalatable processed foods, resulting in weight promoting eating behaviours. The current study replicated and extended a study examining the effect of a food addiction explanation for eating behaviours on weight-based stigma and weight-controllability beliefs. Undergraduate students (N = 757) were randomly assigned to one of four conditions where they read a newspaper article accompanied by a photo of a woman 1) who was either of a higher body mass index (BMI) or a lower BMI, and 2) that attributed her eating behaviours to either food addiction or poor dietary and lifestyle choices. Stigma towards the woman and individuals with a higher BMI in general were assessed. Results indicated that the woman with a higher BMI elicited greater weight stigma. Attributing weight to food addiction increased perceptions of psychopathology towards the woman, whereas attributing weight to poor dietary and lifestyle choices elicited judgment towards the woman. Neither explanation about eating behaviours elicited stigma towards individuals with a higher BMI in general. Findings suggest that a food addiction explanation alone may not be sufficient to reduce weight stigma.
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Affiliation(s)
- Vanessa Montemarano
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto M5B 2K3, Ontario, Canada.
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto M5B 2K3, Ontario, Canada
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15
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Rundle SM, Cunningham JA, Hendershot CS. Implications of addiction diagnosis and addiction beliefs for public stigma: A cross-national experimental study. Drug Alcohol Rev 2021; 40:842-846. [PMID: 33493359 DOI: 10.1111/dar.13244] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Stigmatisation of alcohol and other drug (AOD) use disorders poses a significant barrier to treatment access. A review by the World Health Organization concluded that addictive disorders were the most stigmatised health condition. Few studies have examined whether different etiological models of addiction (MOA) have implications for public stigma toward AOD disorders. The current study examined whether beliefs representative of five MOA predict public stigma levels and whether stigma differs for AOD use disorders relative to other health conditions. METHODS Survey data were collected from Canada, the USA and Australia using an online data collection platform. Participants were randomised to one of four vignette manipulations describing an individual with an alcohol use disorder and/or other disorder. Participants' stigma toward the vignette character and beliefs related to five MOA (disease, moral, psychological, sociological, nature) were measured. RESULTS Stigma ratings were significantly higher in the alcohol use disorder condition compared to other conditions. Two MOA accounted for significant variance in stigma ratings, where greater beliefs in the nature and psychological MOA predicted significantly lower levels of stigma toward alcohol use disorder. Contrary to predictions, beliefs in the disease MOA did not relate to lower stigma. Lastly, beliefs in the moral MOA partly accounted for geographical region differences (the USA vs. Canada) in public stigma. DISCUSSION AND CONCLUSIONS The current study provides further experimental support that AOD disorders are more stigmatised than others. Additionally, the findings suggest that MOA may relate differentially to perceived stigma, and that regional variability in such beliefs exists.
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Affiliation(s)
- Samantha M Rundle
- Department of Psychology, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - John A Cunningham
- Department of Psychology, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Christian S Hendershot
- Department of Psychology, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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16
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Ekhtiari H, Verdejo-Garcia A, Moeller SJ, Zare-Bidoky M, Baldacchino AM, Paulus M. Editorial: Brain and Cognition for Addiction Medicine: From Prevention to Recovery. Front Psychiatry 2020; 11:590030. [PMID: 33329140 PMCID: PMC7732613 DOI: 10.3389/fpsyt.2020.590030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Scott J. Moeller
- Department of Psychiatry, Stony Brook Medicine, Stony Brook, NY, United States
| | - Mehran Zare-Bidoky
- School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States
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Heather N. The concept of akrasia as the foundation for a dual systems theory of addiction. Behav Brain Res 2020; 390:112666. [PMID: 32437886 DOI: 10.1016/j.bbr.2020.112666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022]
Abstract
The aim of this article is to argue that the ancient concept of akrasia can serve as the conceptual foundation and theoretical justification for a dual systems theory of addiction. Akrasia refers to acting against one's better judgement and thus to behaviour that agents know is bad for them and have previously resolved to abjure, addiction being seen as an extreme form of akrasia. In this way akrasia can provide the basis for accounts of addictive behaviour that stress its inconsistency over time and the great difficulty addicts experience in changing it. A definition of addiction consistent with this view is offered and defended, and some of its general advantages for understanding and responding to addiction described. A consequence of defining addiction in this way is that it should be seen as a disorder of choice or, alternatively, of self-regulation, and reasons are given why the latter term should be preferred. It is then proposed that the concept of akrasia and the perspective on addiction that follows from it lead logically to the need for a dual systems theory of addiction. Although no such theory is presented here, terminological issues are clarified, criticisms of dual systems theories are noted, and a rudimentary description of what an integrated dual systems theory of addiction might look like is provided.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Northumbria University, 8 Roseworth Terrace, NE3 1LU, Newcastle upon Tyne, UK.
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18
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Abstract
The concept of addiction as a brain disease has been challenged by the public for a long time. Addiction has been considered a moral defect for centuries. Recently, neurobiological studies have shown that addiction can change certain brain circuits, which impairs its functions in a way that makes the addicted individual vulnerable for relapse. This commentary will discuss the evolution of opioid addiction and how it progressed into what it is now. It will provide the scientific evidence that supports the concept of opioid addiction as a brain disease.
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Affiliation(s)
- Ayman Fareed
- Mount Sinai Wellness Center, Dahlonega, Georgia, USA
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19
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Nicotine addiction as a moral problem: Barriers to e-cigarette use for smoking cessation in two working-class areas in Northern England. Soc Sci Med 2019; 238:112498. [PMID: 31446371 PMCID: PMC6857429 DOI: 10.1016/j.socscimed.2019.112498] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022]
Abstract
Tobacco use in high-income countries correlates with socio-economic disadvantage, but although switching to electronic cigarettes could be a safer alternative, little is known about barriers to use. Drawing on eighteen months of data collection in two areas of Northern England in 2017/18 including ethnography and interviews with 59 smokers and e-cigarette users, I show that concern about continued nicotine addiction either deterred working-class smokers from switching to e-cigarettes or dictated the conditions of their use. Research participants were unhappy about addiction both as loss of control experienced as moral failure and as neglect of financial responsibilities i.e. role performance failure in relation to family responsibilities, or what I call ‘thrift as care’. They reduced the moral burden of addiction by lowering nicotine content, rejecting pleasure and minimising expenditure. They chose the cheapest possible tobacco, switched from combusted tobacco to cheaper e-cigarettes and bought cheap e-cigarettes and liquids. For working-class smokers, minimising spend on what they perceive negatively as addiction may be a greater moral concern than reducing health risk. I conclude that ensuring that vaping is significantly cheaper than smoking may be key to addressing health inequalities linked to tobacco use. Working-class smokers avoided e-cigarettes because of concern about addiction. Those who did switch preferred a medical to a recreational model of use. Users reduced nicotine content, minimised spending and avoided exotic flavours. Failure of willpower and role performance (thrift as care) created addiction shame. Ensuring that vaping is cheaper than smoking is key to harm reduction.
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Rise J, Halkjelsvik T. Conceptualizations of Addiction and Moral Responsibility. Front Psychol 2019; 10:1483. [PMID: 31316438 PMCID: PMC6610207 DOI: 10.3389/fpsyg.2019.01483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
The present study explored the connection between conceptualizations of addiction and lay people's inferences about moral responsibility. In Study 1, we investigated how natural variations in people's views of addiction were related to judgments of responsibility in a nationwide sample of Norwegian adults. In Study 2, respondents recruited from Mechanical Turk were asked to consider different conceptualizations of addiction and report on how these would affect their judgments of moral responsibility. In Study 3, we tested whether manipulating conceptualizations through textual information and through the framing of addiction in terms of states versus behavior could influence participants' judgments of moral responsibility. We found that attributions of moral responsibility were lower when addiction was connected to diseases and disorders, such as dysfunctional processes in the brain, and greater when addiction was associated with agency and addictive behaviors. In conclusion, different conceptualizations of addiction imply different moral judgments, and conceptualizations are malleable.
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Affiliation(s)
- Jostein Rise
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Torleif Halkjelsvik
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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Kinnard EN, Netherland J, Marshall T, Arnold A. Finding common ground: Academics at the intersection of addiction and criminal justice. Addict Behav 2019; 90:452-453. [PMID: 30611575 DOI: 10.1016/j.addbeh.2018.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Elizabeth N Kinnard
- Department of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States.
| | - Julie Netherland
- Office of Academic Engagement, Drug Policy Alliance, New York, NY, United States
| | - Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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22
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Kelly JF. E. M. Jellinek's Disease Concept of Alcoholism. Addiction 2019; 114:555-559. [PMID: 30064157 DOI: 10.1111/add.14400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 12/11/2022]
Affiliation(s)
- John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Baldassarri SR, Lee I, Latham SR, D’Onofrio G. Debating Medical Utility, Not Futility: Ethical Dilemmas in Treating Critically Ill People Who Use Injection Drugs. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:241-251. [PMID: 30146983 PMCID: PMC6530472 DOI: 10.1177/1073110518782925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Physicians who care for critically ill people with opioid use disorder frequently face medical, legal, and ethical questions related to the provision of life-saving medical care. We examine a complex medical case that illustrates these challenges in a person with relapsing injection drug use. We focus on a specific question: Is futility an appropriate and useful standard by which to determine provision of life-saving care to such individuals? If so, how should such determinations be made? If not, what alternative decisionmaking framework exists? We determine that although futility has been historically utilized as a justification for withholding care in certain settings, it is not a useful standard to apply in cases involving people who use injection drugs for non-medical purposes. Instead, we are welladvised to explore each patient's situation in a holistic approach that includes the patient, family members, and care providers in the decision-making process. The scope of the problem illustrated demonstrates the urgent need to definitively improve outcomes in people who use injection drugs. Increasing access to high quality medication-assisted treatment and psychiatric care for individuals with opioid use disorder will help our patients achieve a sustained remission and allow us to reach this goal.
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Affiliation(s)
- Stephen R. Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale School of Medicine
| | | | | | - Gail D’Onofrio
- Yale School of Medicine
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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Lewis M. A Morass of Musings on Moralization. Reply to Frank and Nagel. NEUROETHICS-NETH 2017. [DOI: 10.1007/s12152-017-9314-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lewis M. Self-Efficacy: Now You See It, Now You Don’t. Reply to Snoek. NEUROETHICS-NETH 2017. [DOI: 10.1007/s12152-017-9322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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No Need for the Disease Label: Choice is Complicated. Reply to Heather. NEUROETHICS-NETH 2017. [DOI: 10.1007/s12152-017-9320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Introduction: Testing and Refining Marc Lewis's Critique of the Brain Disease Model of Addiction. NEUROETHICS-NETH 2017; 10:1-6. [PMID: 28725281 PMCID: PMC5486510 DOI: 10.1007/s12152-017-9310-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 10/31/2022]
Abstract
In this introduction we set out some salient themes that will help structure understanding of a complex set of intersecting issues discussed in this special issue on the work of Marc Lewis: (1) conceptual foundations of the disease model, (2) tolerating the disease model given socio-political environments, and (3) A third wave: refining conceptualization of addiction in the light of Lewis's model.
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