Addiction and the Meaning of Disease

Abstract

Is addiction a brain disease? Cards on the table: I don’t know. My best guess is that in some cases it may be, in others not. But the fundamental aim of this chapter is not to argue for this admittedly weak conclusion. It is to do some conceptual spadework, so the ground is prepared for consideration of the question, whether the answer is ultimately yes, no, or, as I suspect, sometimes. This conceptual spadework is often missing from addiction research. On the one hand, the question of whether addiction is a brain disease is not reliably distinguished from the question of whether labeling it thus has beneficial consequences. On the other, the question of what a disease is – let alone what a disease of the brain is – is rarely addressed. Consider any general question of the form: Is X a Y? How could we know the answer unless we know not only facts about X, but also what it is to be a Y? Yet few advocates or critics alike of the view that addiction is a brain disease have provided an account of what a brain disease is. Here, I hope to make a start.