HJAR May/Jun 2022

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2022 31 needed nor held by a contemporary ver- sion of this view. Common themes are that viewing addiction as a brain disease is criti- cized for being both too narrow (addiction is only a brain disease; no other perspec- tives or factors are important) or too far reaching (it purports to discover the final causes of addiction). With regard to disease course, we propose that viewing addiction as a chronic relapsing disease is appropri- ate for some populations, and much less so for others, simply necessitating better ways of delineating the populations being discussed. We argue that when considering addiction as a disease, the lens of neurobi- ology is valuable to use. It is not the only lens, and it does not have supremacy over other scientific approaches. We agree that critiques of neuroscience are warranted [108] and that critical thinking is essential to avoid deterministic language and scientific overreach. Beyond making the case for a view of addiction as a brain disease, perhaps the more important question is when a specific level of analysis is most useful. For under- standing the biology of addiction and designing biological interventions, a neuro- biological view is almost certainly the most appropriate level of analysis, in particular when informed by an understanding of the behavioral manifestations. In contrast, for understanding the psychology of addiction and designing psychological interventions, behavioral science is the natural realm, but one that can often benefit from an under- standing of the underlying neurobiology. For designing policies, such as taxation and regulation of access, economics and public administration provide the most pertinent perspectives, but these also benefit from biological and behavioral science insights. Finally, we argue that progress would come from integration of these scientific perspectives and traditions. E.O. Wilson has argued more broadly for greater consil- ience [109], unity of knowledge, in science. We believe that addiction is among the areas where consilience is most needed. Aplural- ity of disciplines brings important and tren- chant insights to bear on this condition; it is the exclusive remit of no single perspective or field. Addiction inherently and necessar- ily requires multidisciplinary examination. Moreover, those who suffer from addiction will benefit most from the application of the full armamentarium of scientific perspec- tives. n REFERENCES 1. Leshner AI. Addiction is a brain disease, and it matters. Science.1997;278:45–7. 2. McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284:1689–95. 3.SchomerusG,LuchtM,HolzingerA,MatschingerH,Carta MG, Angermeyer MC. The stigma of alcohol dependence compared with other mental disorders: a review of population studies.AlcoholAlcohol.2011;46:105–12. 4.HeymanGM.Addictionandchoice:theoryandnewdata. Front Psychiatry.2013;4:31. 5. Heather N, Best D, Kawalek A, Field M, Lewis M, Rotgers F, et al. Challenging the brain disease model of addiction: European launch of the addiction theory network. Addict ResTheory.2018;26:249–55. 6. Pickard H, Ahmed SH, Foddy B. Alternative models of addiction.Front Psychiatr.y 2015;6:20. 7. Hall W, Carter A, Forlini C. The brain disease model of addiction: is itsupportedbytheevidenceandhas itdelivered on its promises? Lancet Psychiatr.2015;2:105–10. 8. Hart CL.Viewing addiction as a brain disease promotes social injustice.Nat HumBehav.2017;1:0055. 9. Heilig M, Epstein DH, Nader MA, Shaham Y. Time to connect:bringingsocialcontext intoaddictionneuroscience. Nat Rev Neurosc.i 2016;17:592–9. 10.JellinekEM.Thediseaseconceptofalcoholism.Hillhouse Press on behalf of the ChristopherJ.Smithers Foundation: NewHaven,CT; 1960. 11.StevensonA.OxforddictionaryofEnglish.3ed.NewYork, NY: Oxford University Press; 2010. 12. Fan J, May SJ, Zhou Y, Barrett-Connor E. Bimodality of 2-h plasma glucose dis- tributions in whites: the Rancho Bernardo study.Diabetes Care 2005;28:1451–6. 13. King AC, Vena A, Hasin D, De Wit D, O’Connor CJ, Cao D.Subjective responses to alcohol in the development and maintenanceofalcoholusedisorder(AUD).AmJPsychiatry. 2021. https://doi.org/10.1176/appi.ajp.2020.20030247. 14. GBD. 2016 Alcohol and Drug Use Collaborators. The global burden of disease attributable to alcohol and drug use in195countriesandterritories,1990-2016:asystematic analysisfortheGlobalBurdenofDiseaseStudy2016.Lancet Psychiatry.2018;5:987–1012. 15.EdwardsG,GrossMM.Alcoholdependence:provisional descriptionofaclinicalsyndrome.BrMedJ.1976;1:1058–61. 16.EpsteinDH,HeiligM,ShahamY.Science-based actions can help address the opioid crisis. Trends Pharm Sci. 2018;39:911–16. 17.AmatoL,DavoliM,PerucciCA,FerriM,FaggianoF,Mattick RP.An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abus Treat. 2005;28:321–9. 18. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Datab SystemRev.2013;5:CD009329. 19.Jonas DE,Amick HR,Feltner C,Bobashev G,Thomas K, Wines R, et al. Phar- macotherapy for adults with alcohol usedisorders inoutpatientsettingsasystematicreviewand meta-analysis.JAMA.2014;311:1889–900. 20. Mark TL, Kranzler HR, Song X. Understanding US addiction physicians’ low rate of naltrexone prescription. DrugAlcohol Depend.2003;71:219–28. 21. Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteriadecisionanalysis.Lancet.2010;376:1558–65. 22. Wilk AI, Jensen NM, Havighurst TC. Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers.J Gen InternMed.1997;12:274–83. 23.LaingRD.Thedividedself;astudyofsanityandmadness. London:Tavistock Publications; 1960. 24. Foucault M, Khalfa J. History of madness. New York: Routledge; 2006. 25.RegierDA,FarmerME,RaeDS,LockeBZ,KeithSJ,Judd LL. et al.Comorbidity of mental disorders with alcohol and other drug abuse. Results Epidemiologic Catchment Area (ECA) study.JAMA.1990;264:2511–8. 26. Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al. Prevalence and co-occurrence of substanceusedisordersand independentmoodandanxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61:807–16. 27. Lopez-Quintero C, Hasin DS, de Los Cobos JP, Pines A, Wang S, Grant BF, et al. Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addiction.2011;106:657–69. 28. Humphreys K. Addiction treatment professionals are not the gatekeepers of recovery. Subst Use Misuse. 2015;50:1024–7. 29.CohenE,FeinnR,AriasA,KranzlerHR.Alcoholtreatment utilization:findingsfromtheNationalEpidemiologicSurvey on Alcohol and Related Conditions. Drug Alcohol Depend. 2007;86:214–21. 30. Sobell LC, Cunningham JA, Sobell MB. Recovery from alcohol problems with and without treatment: prevalence in two population surveys.Am J Public Health. 1996;86:966–72. 31. Culverhouse R, Bucholz KK, Crowe RR, Hesselbrock V, Nurnberger JI Jr, Porjesz B, et al. Long-term stability of alcohol and other substance dependence diagnoses and habitual smoking: an evaluation after 5 years. Arch Gen Psychiatry.2005;62:753–60. 32. Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey onAlcohol and Related Con- ditions.Arch Gen Psychiatry.2007;64:830–42. 33. Skolnick P. The opioid epidemic: crisis and solutions. Annu Rev PharmToxicol.2018;58:143–59. 34. Hser YI, Evans E, Grella C, Ling W, Anglin D. Long- term course of opioid addiction. Harv Rev Psychiatry. 2015;23:76–89. 35.MathersBM,DegenhardtL,BucelloC,LemonJ,Wiessing L, Hickman M. Mor- tality among people who inject drugs: a systematic review and meta-analysis. Bull World Health Organ.2013;91:102–23. 36.GrantBF,GoldsteinRB,SahaTD,ChouSP,JungJ,Zhang H,etal.EpidemiologyofDSM-5alcoholusedisorder:results from the National Epidemiologic Survey on Alcohol and Related Conditions III.JAMAPsychiatry.2015;72:757–66. 37. Lee MR, Sher KJ.“Maturing Out”of binge and problem drinking.Alcohol Res: Curr Rev.2018;39:31–42. 38. Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ. Recovery from DSM- IV alcohol dependence: United States,2001–2002.Addiction.2005;100:281–92. 39. Berridge V.The rise, fall, and revival of recovery in drug policy.Lancet.2012;379:22–23. 40. Parvaz MA, Moeller SJ, d’Oleire Uquillas F, Pflumm A, MaloneyT,Alia-KleinN,etal.Prefrontalgraymattervolume recovery intreatment-seekingcocaine-addicted individuals: a longitudinal study.Addict Biol.2017;22:1391–401. 41.Korponay C,Kosson DS,DecetyJ,Kiehl KA,Koenigs M. Brain volume correlates with duration of abstinence from substanceabuse inaregion-specificandsubstance-specific manner. Biol Psychiatry Cogn Neurosci Neuroimaging. 2017;2:626–35. 42. Janes AC, Datko M, Roy A, Barton B, Druker S, Neal C, et al. Quitting starts in the brain: a randomized controlled trial of app-based mindfulness shows decreases in neural responses to smoking cues that predict reductions in smoking.Neu- ropsychopharmacology.2019;44:1631–38. 43. Humphreys K, Bickel WK. Toward a neuroscience of long-term recovery from addiction. JAMA Psychiatry. 2018;75:875–76. 44. Verhulst B, Neale MC, Kendler KS. The heritability of alcoholusedisorders:ameta-analysisoftwinandadoption studies.Psychol Med.2015;45:1061–72. 45.GoldmanD,OrosziG,DucciF.Thegeneticsofaddictions: uncovering the genes.Nat Rev Genet.2005;6:521–32. 46. Kendler KS, Jacobson KC, Prescott CA, Neale MC. Specificity of genetic and environmental risk factors for use and abuse/dependence of cannabis, cocaine, hallucinogens, sedatives, stimulants, and opiates in male twins.AJ Psychiatry.2003;160:687–95. 47. Schizophrenia Working Group of the Psychiatric Genomics C. Biological insights from 108 schizophrenia- associated genetic loci.Nature.2014;511:421–7. 48.Wray NR,Ripke S,MattheisenM,Trzaskowski M,Byrne EM,AbdellaouiA,etal.Genome-wideassociationanalyses identify 44 risk variants and refine the genetic architecture of major depression.Nat Genet.2018;50:668–81. 49.WrayNR,LinT,AustinJ,McGrathJJ,Hickie IB,MurrayGK, et al.Frombasic science to clinical application of polygenic risk scores: a primer.JAMAPsy- chiatry.2021;78:101–9. 50. Walters RK, Polimanti R, Johnson EC, McClintick JN, AdamsMJ,AdkinsAE,etal.TransancestralGWASofalcohol dependencerevealscommongeneticunder-pinningswith psychiatric disorders.Nat Neurosci.2018;21:1656–69. 51. Visscher PM, Wray NR. Concepts and misconceptions aboutthepolygenicadditivemodelappliedtodisease.Hum Hered.2015;80:165–70. 52.HeiligM,LeggioL.Whatthealcoholdoctororderedfrom theneuroscientist:theragnosticbiomarkersforpersonalized treatments.Prog Brain Res.2016;224:401–18.