Plenary session 1 ‘Back to the future: Addiction and the scientific method’
David Nutt is a psychiatrist and Professor of Neuropsychopharmacology in the Division of Brain Science, Imperial College London. His presentation explored the brain mechanisms of addiction and the actions of current treatments, highlighting the need to understand the former in order to tailor the latter for optimum effect. He described his research team’s use of multimodal imaging with PET and fMRI in people with heroin and alcohol addiction and also those with gambling disorder (to control for the effects of drug use). In doing so he challenged the evidence base for the prevailing dopamine hypothesis of addiction, showing that dopamine appears not to be a major mediator of heroin addiction in humans, unlike cocaine and other stimulants. Brain research offers a powerful way to study the mechanisms of addiction and hopefully will lead to the development of new treatments targeted to the underlying brain systems that underpin addiction. You can hear his full presentation here
David Nutt – Addiction: from brain research to new treatments?
Dr Timothy A Hickman is a senior lecturer in the History Department at Lancaster University, and his work is in the cultural history of addiction. In his presentation he told the story of Dr Leslie E. Keeley, who was among the world’s most famous physicians at the turn of the twentieth century due to his assertion that alcoholism was a disease that he could cure. His treatment was based on a secret formula that he said contained gold, and by selling franchises he had created nearly 100 Keeley institutes in the USA by 1893. However, despite the testimony of tens of thousands of satisfied patients, his practice was rejected as quackery by the elite physicians of the British and American Medical Associations, as well as the SSA’s precursor the Society for the Study of Inebriety. His method quietly disappeared along with his reputation.
When the director of NIDA reported in 1997 that ‘dramatic advances’ in neuroscientific and behavioral views of addiction prove that addiction is ‘a chronic, relapsing brain disorder characterized by compulsive drug seeking and use,’ the hijacked brain theory or the NIDA Paradigm was born. However, this supposedly novel theory was strikingly similar to that proposed in the 1880s by Keeley, and Dr Hickman’s presentation offered an opportunity to discuss the ironic re-emergence of yesterday’s quackery as today’s orthodoxy. Was this transformation a product of results, evidence or procedures? How did codes of professional practice and/or ethics constitute the properly medical? Who gained, who lost, and how have those relations of power changed over time? In telling the story he reminded us of the need to consider the importance of social and professional context for establishing the viability of even the latest, most technologically advanced attempts to understand addiction. You can hear his full presentation here
Tim Hickman – From quackery to orthodoxy: history and the neuroscience of addiction
Robert West is Professor of Health Psychology and Director of Tobacco Studies at the Cancer Research UK Health Behaviour Research Centre, University College London, as well as the Editor-in-Chief of the SSA journal Addiction.He began his presentation by introducing the concept of a ‘namespace’, a term crucial for understanding the an extension of the World Wide Web called the semantic web, and one that he believes will be central to science in years to come. Terms such as addiction, stress and craving are currently used imprecisely, and the discipline of psychology requires greater precision in order to make progress. Therefore Professor West described the use of a namespace to help create controlled vocabularies to clearly define the processes involved in addiction and its resolution. Individuals from a range of different perspectives can each build their own constructs for addiction, which will then ultimately be brought together through a natural process of consensus forming and building. Making models explicit using a common language, and creating and maintaining a database of measures, methods and results in a standard form, will allow models and theories to be regularly revised in the light of new findings.
He went on to define his own view of addiction as something that develops when psychological processes combine with opportunities to lead to dispositions to experience strong automatic and reflective motivation to engage in behaviours despite harmful consequences. It is maintained by similar processes and opportunities, and resolves when psychological processes and/or opportunities lead to a reduction in these addictive dispositions. The PRIME Theory of motivation is an evolving attempt to integrate these and other key constructs into a coherent model that can provide a basis for reducing the prevalence of, and harm from, addictive behaviours, and to achieve behaviour change more generally. Its roots are in psychology but it aims for integration with other behavioural and social science types of model. The presentation outlined the current version of PRIME Theory and how it accounts for major observations in the study of addiction, where it sits within the broader model of behaviour (COM-B: capability, opportunity, motivation, behaviour), and the implications for individual- and population-level strategies for combating addiction. You can hear his full presentation here
Robert West – A psychological perspective on addiction
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.