Skip to main content Accessibility help

Indeed, not really a brain disorder: Implications for reductionist accounts of addiction

  • Matt Field (a1), Nick Heather (a2) and Reinout W. Wiers (a3)


Borsboom et al.’s formulation provides an opportunity for a fundamental rethink about the “brain disease model” of addiction that dominates research, treatment, policy, and lay understanding of addiction. We also demonstrate how the American opioid crisis provides a contemporary example of how “brain disease” is not moderated by the environmental context but is instead crucially dependent upon it.



Hide All
Berkman, E. T., Hutcherson, C. A., Livingston, J. L., Kahn, L. E. & Inzlicht, M. (2017) Self-control as value-based choice. Current Directions in Psychological Science 26(5):422
Case, A. & Deaton, A. (2015) Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences USA 112(49):15078
Davies, J. (2018) Addiction is not a brain disease. (Editorial). Addiction Research and Theory 26(1):12.
Dennett, D. C. (1995) Darwin's dangerous idea: Evolution and the meanings of life. Penguin.
Eiser, J. R. & Van der Pligt, J. (1986) “Sick” or “hooked”: Smokers’ perceptions of their addiction. Addictive Behaviors 11(1):1115.
Eiser, J. R., van der Pligt, J., Raw, M. & Sutton, S. R. (1985) Trying to stop smoking: Effects of perceived addiction, attributions for failure, and expectancy of success. Journal of Behavioral Medicine 8(4):321–41.
Hart, C. (2013) High price: Drugs, neuroscience and discovering myself. Penguin.
Heather, N. (2018) Rethinking addiction. The Psychologist 31(1):2428.
Heather, N., Best, D., Kawalek, A., Field, M., Lewis, M., Rotgers, F., Reinout, W. & Heim, D. (2018) Challenging the brain disease model of addiction: European launch of the addiction theory network. (Editorial). Addiction Research and Theory 26(4):249–55. doi:10.1080/16066359.2017.1399659.
Heyman, G. M. (1996) Resolving the contradictions of addiction. Behavioral and Brain Sciences 19(4):561610.
Heyman, G. M. (2013) Quitting drugs: Quantitative and qualitative features. Annual Review of Clinical Psychology 9:2959.
Hollingsworth, A., Ruhm, C. & Simon, K. (2017) Macroeconomic conditions and opioid abuse. NBER Working Paper No. 23192. NBER Working Paper Series. National Bureau of Economic Research. Available at:
Leshner, A. (1997) Addiction is a brain disease, and it matters. Science 278(5335):4547.
Levy, N. (2013) Addiction is not a brain disease (and it matters). Frontiers in Psychiatry 4: article 24. (Online publication). doi: 10.3389/fpsyt.2013.00024 Available at:
Lewis, M. (2017) Addiction and the brain: Development, not disease. Neuroethics 10:718.
Mattick, R. P., Breen, C., Kimber, J. & Davoli, M. (2009) Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews 3:CD002209. doi: 10.1002/14651858.CD002209.pub2.
Miller, W. R., Westerberg, V. S., Harris, R. J. & Tonigan, J. S. (1996) What predicts relapse? Prospective testing of antecedent models. Addiction 91(Suppl.):S15572.
Quinones, S. (2016) Dreamland: The true tale of America's opiate epidemic. Bloomsbury Press.
Satel, S. & Lilienfeld, S. (2014) Addiction and the brain-disease fallacy. Frontiers in Psychiatry 4: article 141. (Online publication). doi: 10.3389/fpsyt.2013.00141. Available at:
Satel, S. & Lilienfeld, S. (2017) Calling it “brain disease” makes addiction harder to treat. Boston Globe, June 22, 2017. Available at:
Stead, L. F., Perera, R., Bullen, C., Mant, D., Hartmann-Boyce, J., Cahill, K. & Lancaster, T. (2012) Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 12:CD000146. doi: 10.1002/14651858.CD000146.pub4.
Volkow, N. D., Koob, G. F. & McLellan, A. T. (2016) Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine 374(4):363–71.
Zoorob, M. & Salemi, J. (2017) Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States. Drug and Alcohol Dependence 173:19.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed