ABSTRACT
The brain-disease interpretation of addiction has won the allegiance of national and international health organizations, the media, and clinicians, yet it remains controversial among addiction researchers. This chapter tests three brain-disease claims: (1) drug use is involuntary in those who meet the criteria for dependence, (2) drug and alcohol dependence are chronic disorders, and (3) those dependent on drugs can maintain abstinence, but this requires sustained professional help in almost all cases. Each claim fails reasonable empirical tests. The correlates of quitting drugs are the correlates of choice, most addicts remit, and, overall, remission rates are about the same for those in treatment and those not in treatment. The chapter uses Kaplan-Meier survivor analysis to compare the rates of remission for those ever in treatment and those never in treatment, with separate analyses for those in Alcoholics Anonymous. There is little difference in the remission rates as a function of treatment, although there are interesting differences as a function of years of treatment. Relative to other treatments, Alcoholics Anonymous had significantly higher remission rates. Although the data fail to support the brain-disease interpretation, they do support the claim that those who meet the criteria for dependence remain voluntary drug users, drug-induced neural changes notwithstanding.
