This article is part of the Research Topic Alternative Models of Addiction


Front. Psychiatry, 03 March 2014 | doi: 10.3389/fpsyt.2013.00141

Addiction and the brain-disease fallacy

  • 1Yale University School of Medicine, New Haven, CT, USA
  • 2Department of Psychology, Emory University, Atlanta, GA, USA

From Brainwashed: The Seductive Appeal of Mindless Neuroscience by Sally Satel and Scott Lilienfeld, copyright © 2013. Reprinted by permission of Basic Books, a member of The Perseus Books Group.

The notion that addiction is a “brain disease” has become widespread and rarely challenged. The brain-disease model implies erroneously that the brain is necessarily the most important and useful level of analysis for understanding and treating addiction. This paper will explain the limits of over-medicalizing – while acknowledging a legitimate place for medication in the therapeutic repertoire – and why a broader perspective on the problems of the addicted person is essential to understanding addiction and to providing optimal care. In short, the brain-disease model obscures the dimension of choice in addiction, the capacity to respond to incentives, and also the essential fact people use drugs for reasons (as consistent with a self-medication hypothesis). The latter becomes obvious when patients become abstinent yet still struggle to assume rewarding lives in the realm of work and relationships. Thankfully, addicts can choose to recover and are not helpless victims of their own “hijacked brains.”

Keywords: brain-disease fallacy, addiction, fMRI, Project HOPE, brain-disease model

Citation: Satel S and Lilienfeld SO (2014) Addiction and the brain-disease fallacy. Front. Psychiatry 4:141. doi: 10.3389/fpsyt.2013.00141

Received: 26 June 2013; Accepted: 08 October 2013;
Published online: 03 March 2014.

Edited by:

Hanna Pickard, University of Oxford, UK

Reviewed by:

Serge H. Ahmed, Centre National de la Recherche Scientifique, France
Bennett Foddy, University of Oxford, UK

Copyright: © 2014 Satel and Lilienfeld. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Scott O. Lilienfeld, Department of Psychology, Emory University, 473 Psychology Building, 36 Eagle Row, Atlanta, GA 30322, USA e-mail:

Back to top