ABSTRACT
This chapter offers a perspective on the significance and the truth of the proposition that substance addiction is a brain disease, based on the conception of substance addiction offered in the foundational text of Alcoholics Anonymous (AA). It is proposed that substance addiction is primarily characterized by a sensitization to drugs whereby their ingestion causes cravings for more, by persistent urges to use and by denial. Severe addiction causes serious impairments in subjects’ motivational and decision-making systems. It is argued that these features justify the claim that addiction is a mental disorder and are what should matter to public perception, social and health policy, and treatment of addicts and their addictions, regardless of whether addiction is a brain disease. It is shown how the AA conception of addiction is underwritten by the incentive-sensitization theory of Robinson and Berridge. ‘Brain disease’ is open to a variety of different legitimate interpretations and it is concluded that addiction is a brain disease under all of them.
