How the Brain Disease Paradigm Remoralizes Addictive Behaviour

Abstract

In recent decades, addiction has been medicalized anew through the rise of an influential ‘brain disease paradigm’. This questions the equivalence of addiction to drug dependence by re-emphasizing loss of self-control over unhealthy impulses as the disease locus. While showing continuities with the nineteenth-century vision of addictions as ‘diseases of the will’, neurobiology objectifies disease as disrupted neurochemical transmission and lasting neuroadaptation. The brain disease paradigm emerged together with rapid advances in neuroimaging technology as well as intensified research efforts to confirm cigarette smoking as nicotine addiction. After smoking achieved such recognition in the late 1980s, numerous other unhealthy impulses and appetites have likewise come under neurobiological investigation as prospective cases of addiction. Despite its technoscientific sophistication, neurobiology's biomedicalization of addiction remains as partial and ambiguous as past medicalizations. By confirming moral self-transformation anew as an indispensable component of treatment and recovery, neurobiology revives addiction as a moral disease in the process of its objectification. Furthermore, through its rediscovery of a classic nineteenth-century ‘liberal disease’ at the molecular level, the neurobiology of addiction is acting as a vital moralizing resource in the biomedicalization of health and illness more generally today.

Key Words:

• addiction
• biomedicalization
• moral responsibility
• public health
• neurobiology
• nicotine

Acknowledgements

This work arises out of research supported by the Swedish Research Council (Contract number: 90197701). Thanks to Les Levidow and Kean Birch for their valuable comments and editorial assistance.