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.

General practice is a critical setting for the identification, assessment, treatment, follow-up and onward referral of smokers. General practitioners (GPs) are in a unique position to play a part in reducing preventable morbidity and mortality attributable to tobacco use. During the past decade, numerous trials have been conducted in general practice and have shown that GP intervention with smokers has a variable degree of success depending on the intensity of contact. Although there are many positive reasons for GP involvement, there are also barriers to implementing smoking cessation strategies in general practice. In this paper we discuss some of these issues. The Stages of Change framework developed by Prochaska and DiClemente (1986) has been used to describe the stages a smoker goes through in the process of becoming a non-smoker. However, the incorporation of smoking cessation interventions in a GP's routine practice also involves a process of psychological change. In this paper, therefore, we apply the Stages of Change model to GPs' recognition, uptake and maintenance of smoking cessation interventions.

Excessive drinking is a global health problem which is responsible for a wide range of both chronic and acute illness, and which costs the UK National Health Service (NHS) £1.7 billion annually. Current health policy aims to reduce alcohol-related problems by promoting early identification of risk followed by brief intervention to facilitate positive changes in drinking level or patterns of consumption. However, practical and philosophical barriers concerning screening and brief alcohol intervention have so far impeded its uptake in routine primary care. This qualitative study aimed to simultaneously explore and compare health professionals’ and patients’ views on the acceptability and feasibility of screening and brief alcohol intervention in primary care. Focus groups were held with (a) four primary care teams, (b) two general practitioner (GP) and two nurse groups and (c) six patient groups in the north-east of England. A thematic framework approach was used to analyse audio-taped data via transcripts. Both health professionals and patients reported that raising and discussing alcohol-related risk was acceptable in primary care, when combined with other lifestyle issues or linked to relevant health conditions. Targeted rather than universal screening was the most acceptable method of identifying alcohol-related risk and would fit well with existing practice. However, there was uncertainty among health professionals about the effectiveness of brief alcohol interventions and some disagreement with patients concerning who was best placed to deliver them. Health professionals felt that nurses were best placed for such work whilst patients reported that they would initially raise the subject with GPs. There was broad acceptance of brief intervention approaches but a lack of support and specific incentives for this work impeded its delivery in routine practice.

Referrals for young males with drink-related offending behaviours were obtained from local courts. Following an assessment interview, young offenders completed either a talk-based Alcohol Education Course (AEC) or a behavioural AEC. At follow-up interviews, differences in dependent variables of offending and drinking behaviour were observed. The results are discussed in the context of their possible implications for practice.