Putting the brain in its place Arguments from ethics and philosophy of science October 24-26, 2017, Lisbon addictions 2017

We declare no conflict of interest. Susanne Uusitalo, University of Helsinki, Finland  Jaakko Kuorikoski, University of Tampere, Finland 

The worry The brain disease model of addiction (BDMA) locates the problems in addiction to the brain and its relation to a psychoactive subtance.     Koob & Volkow (2016) on BDMA in Lancet Psychiatry:  ”One of the main goals of neurobiological research is to understand the changes at the molecular, cellular and neurocircuitry levels that mediate the transition from occasional, controlled substance use to loss of control in drug intake and chronic addiction.”

Reflection from ethics Presumably, the mediation is between the drug (use) and loss of control. This seems to suggest that the research tries to find the loci of vulnerability that undermines and threatens the individual’s ability to govern herself regarding the drug use.

The object of the study in BDMA "the study of chronic drug administration-induced brain changes" Aims to study the transition of drug taking to addiction                Aims to account for individual differences: this transition takes place only in some users

Key concept: control In BDMA, addiction is characterised by loss of control in drug use ("compulsion to seek and take the drug, loss of control in limiting intake - - " Koob & Volkow 2016, 760, emphasis added) Distinction between merely heavy use (controlled) and addictive use (use characterised by loss of control) This loss of control is by definition harmful (cf. skills) Harmfulness (e.g., "disturbances in three major neurocircuits" that result in addictive behaviour) is a normative notion. Its (harm) relation to lack of control

...and vulnerability In BDMA 'vulnerability' in and to addiction mainly refers to changes in the brains (e.g., neurocircuitry, molecular genetic mediation, epigenetic changes) Even environmental risk factors are seen as the individual's susceptibility to them. Human brain and its vulnerability, the human condition: Not by itself problematic If we maintain the distinction between heavy use and addictive use, we need to be able to say why are the addicted users vulnerable: this may well be partly illustrated by the brain changes, but is it a sufficient way of characterising the vulnerabilities addicted individuals may come across? N.B. The control in substance use is also inherently characterised by the social circumstances. The social environment is not merely the external setting for the individual's drug use, but constitutive of the ways in which the use is considered as in or out of control.

Koob & Volkow (2016): Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry 3:760-73 Molecular genetic studies have identified transduction and transcription factors that act in neurocircuitry associated with the development and maintenance of addiction that might mediate initial vulnerability, maintenance, and relapse associated with addiction. (760) Recently developed animal models  -- allowing the investigation of neuro biological processes that underlie the risk for addiction and environmental factors that provide resilience against vulnerability. (761) to better understand the greater vulnerability to substance use disorders (761) those changes persist in the vulnerability to relapse. (761) influence vulnerability to the development and perpetuation of addiction. (764) The capacity to inhibit prepotent responses is a major contributor to an individual’s vulnerability to addiction (766) also interact with genetic and environmental vulnerability to addiction. (766) new insights into the molecular basis of vulnerability to relapse. (767) Genes have been identified that convey vulnerability at all three stages -- (767) in the vulnerability to nicotine dependence (767) Some of the polymorphisms associated with vulnerability for the binge/intoxication stage (767) These genes convey vulnerability in the human population, (768) a key component of vulnerability for drug and alcohol use disorders (768) increases in vulnerability to drug use and relapse (768) Identification of these molecular and neurochemical loads on the circuitry provides key information about vulnerability, resilience, treatment, and recovery from addiction, as well as information on how different drugs of abuse enter the overall addiction cycle. (769) Vain esimerkki! Poimin kaikki vulnerability sanat artikkelista.

Vulnerability of the individual and the social brain Compromised executive control "in the brain" "Loss of control" as a directly measurable phenomenon? Decreases in frontal cortex activation Physiological changes in animal models Social constitution of agency and control Limitations of animal models The way in which the use of the substance within a particular social context affects brain functioning (short and long term) E.g., comparing heroin addicts with patients in opioid assisted treatment

Concluding remarks Even though loss of control may be beneficial way of diagnosing addiction (e.g., acknowledging the distinction), Limiting the idea of vulnerability in (to) addiction to the brain's susceptibility to effects of psychoactive substances is likely to turn out to be too narrow a scope when considering the challenges addiction presents to individuals Learning the changes and transition in drug use to addiction gives us valuable information, at the same time if we maintain that vulnerability of addicted individuals is normative, the scope of 'vulnerability' must extend to the social world in which the behaviour takes place.