From quackery to orthodoxy: history and the neuroscience of addiction

First published: 09/05/2019 | Last updated: May 20th, 2019

On 3 October, 1997, Alan Leshner, then director of the US National Institute on Drug Abuse (NIDA) wrote in the journal Science 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.’  Now known as the hijacked brain theory or the NIDA Paradigm, the theory informs addiction research and guides funding around the world.  But Leshner’s theory was not as novel as he said it was.  It is strikingly similar to that proposed in the 1880s by Dr. Leslie E. Keeley, who was among the world’s most famous physicians at the turn of the twentieth century.  But despite the testimony of tens of thousands of satisfied patients, the elite physicians of the British and American Medical Associations, and also the SSA’s precursor, the Society for the Study of Inebriety, rejected Keeley and described his practice as the epitome of quackery.

This paper offers 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?  Re-engaging Keeley’s forgotten story demands that we consider the importance of social and professional context for establishing the viability of even the latest, most technologically advanced attempts to understand Addiction.

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Dr Tim Hickman