Open Peer Commentaries Singing the Brain Disease Blues

Well over a decade ago, the National Institute on Drug Abuse began advancing the idea that addiction is a “brain disease. ” Over the years, the concept has become orthodoxy—a dubious achievement that has justifiably prompted Buchman and his colleagues (2010) to call for a more nuanced perspective on addiction. In this peer com-mentary we challenge the validity of the brain disease model of addiction and discuss its adverse implications for treatment. Let us begin with the concept of brain disease. “That addiction is tied to changes in brain structure and function is what makes it, fundamentally, a brain disease, ” wrote a former director of the National Institute of Drug Abuse in a seminal 1997 Science article (Leshner 1997). What does this statement really mean? Surely, drugs operate at th