Curing addiction: twelve steps or fixing the brain?

Tuesday, December 4th, 2012

Alcoholics Anonymous provides a non-medical intervention for problem drinking. It’s based on a Twelve Steps program of spiritual and character development, and tends to polarise the medical field, largely because of its emphasis on spirituality.

AA is arguably one of the only treatments effective for alcoholics wishing to become sober. And few, if any, support groups or organisations can claim the widespread acceptance and awareness of Alcoholics Anonymous. But AA’s approach to curing addiction is not medical at all.

Why is it that an organisation founded on the idea of a spiritual awakening has been able to cement itself firmly in the history of addiction research and treatment? Has this been a help or a hindrance to understanding the condition?

In the nineteenth century, physicians considered all forms of addiction to be a sign of akrasia, or weakness of will. This developed into a view that addiction is a consequence of an individual’s psychological development interacting with their social environment.

Alcoholics Anonymous was founded by Bill Wilson and Dr Bob Smith in 1935. It was largely after 1956, when the American Medical Association recognised alcoholics as legitimate patients requiring medical care, that the idea that alcoholism was a disease took hold. But physicians were not able to come up with a medical cure that worked.

The now familiar concept that the cause of addiction is to be found in the brain appeared after this. Advancements in technology allowed researchers to pinpoint some of the pathways of addiction.

In 1979 Avram Goldstein argued that heroin and all narcotics work on our brain’s reward system. These drugs hijack the regular pathways of dopamine, wreaking havoc on the brain’s ability to regulate it and endorphins. This havoc, he argued, leads to addiction.

This “brain-based” model of addiction directed research until the 1980s and 1990s, when Dr Stanton Peele and Dr Bruce Alexander independently began to question the isolation of addiction research from cultural contexts.

Both Peele and Alexander wrote that addiction is more than just the effect of a drug on the brain. The context in which an individual engages in drug taking is equally important as the drug itself. Alexander went as far as to argue that the idea of drug-induced addiction was a myth. Continue reading

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