Molly J. Dingel

Addiction: Current Criticism of the Brain Disease Paradigm

To deepen understanding of efforts to consider addiction a “brain disease,” we review critical appraisals of the disease model in conjunction with responses from in-depth semistructured stakeholder interviews with (1) patients in treatment for addiction and (2) addiction scientists. Sixty-three patients (from five alcohol and/or nicotine treatment centers in the Midwest) and 20 addiction scientists (representing genetic, molecular, behavioral, and epidemiologic research) were asked to describe their understanding of addiction, including whether they considered addiction to be a disease. To examine the NIDA brain disease paradigm, our approach includes a review of current criticism from the literature, enhanced by the voices of key stakeholders. Many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma. We conclude that it is not necessary, and may be harmful, to frame addiction as a disease.

The experience of addiction as told by the addicted: incorporating biological understandings into self-story.

How do the addicted view addiction against the framework of formal theories that attempt to explain the condition? In this empirical paper, we report on the lived experience of addiction based on 63 semi-structured, open-ended interviews with individuals in treatment for alcohol and nicotine abuse at five sites in Minnesota. Using qualitative analysis, we identified four themes that provide insights into understanding how people who are addicted view their addiction, with particular emphasis on the biological model. More than half of our sample articulated a biological understanding of addiction as a disease. Themes did not cluster by addictive substance used; however, biological understandings of addiction did cluster by treatment center. Biological understandings have the potential to become dominant narratives of addiction in the current era. Though the desire for a “unified theory” of addiction seems curiously seductive to scholars, it lacks utility. Conceptual “disarray” may actually reflect a more accurate representation of the illness as told by those who live with it. For practitioners in the field of addiction, we suggest the practice of narrative medicine with its ethic of negative capability as a useful approach for interpreting and relating to diverse experiences of disease and illness.

Unwarranted Optimism in Media Portrayals of Genetic Research on Addiction Overshadows Critical Ethical and Social Concerns

The cost of addiction in the United States, in combination with a host of new tools and techniques, has fueled an explosion of genetic research on addiction. Because the media has the capacity to reflect and influence public perception, there is a need to examine how treatments and preventive approaches projected to emerge from addiction genetic research are presented to the public. The authors conducted a textual analysis of 145 news articles reporting on genetic research on addiction from popular print media in the United States and from popular news and medical internet sites. In articles that report on prevention, the media emphasize vaccine development and identifying individuals at genetic risk through population screening. Articles that emphasize treatment often promote current pharmaceutical solutions and highlight the possibility of tailoring treatments to specific genetic variants. The authors raise concerns about the tendency of this coverage to focus on the benefits of pharmaceutical treatments and genetic-based approaches to prevention while neglecting or downplaying potential risks and ethical issues. This analysis suggests a need for more balanced, evidence-based media reporting on the potential outcomes of genetic research.

The Media and Behavioral Genetics Alternatives Coexisting with Addiction Genetics

To understand public discourse in the United States on genetic causation of behavioral disorders, we analyzed media representations of genetic research on addiction published between 1990 and 2010. We conclude first that the media simplistically represent biological bases of addiction and willpower as being mutually exclusive: behaviors are either genetically determined, or they are a choice. Second, most articles provide only cursory or no treatment of the environmental contribution. A media focus on genetics directs attention away from environmental factors. Rhetorically, media neglect the complexity underlying the etiology the addiction and direct focus back toward individual causation and responsibility.

Influences on peer evaluation in a group project: an exploration of leadership, demographics and course performance

Collaborative learning strategies are widely used in higher education to deepen learning, promote team-building skills and achieve course learning objectives. Using peer evaluation is an important strategy to ensure that engaged and active students are rewarded for their efforts, and to discourage loafing within groups. However, less is known about what biases may influence students’ peer evaluations. In this paper, we investigate what variables students may (consciously or unconsciously) use to evaluate their peers. We explore the role of sex, race, course performance and group leadership on peer evaluation. We also investigate whether these variables correlate with students’ final course grade. We found that students who reported being leaders in groups were evaluated higher than peers who reported being followers, and that course performance positively correlated with peer evaluations. White students received higher peer evaluations than students of colour. This difference reflects trends in group leadership and course performance, with more white students than students of colour reporting being leaders in groups and receiving higher grades.

Integrating Genetic Studies of Nicotine Addiction into Public Health Practice: Stakeholder Views on Challenges, Barriers and Opportunities

Objective: Will emerging genetic research strengthen tobacco control programs? In this empirical study, we interview stakeholders in tobacco control to illuminate debates about the role of genomics in public health. Methods: The authors performed open-ended interviews with 86 stakeholders from 5 areas of tobacco control: basic scientists, clinicians, tobacco prevention specialists, health payers, and pharmaceutical industry employees. Interviews were qualitatively analyzed using standard techniques. Results: The central tension is between the hope that an expanding genomic knowledge base will improve prevention and smoking cessation therapies and the fear that genetic research might siphon resources away from traditional and proven public health programs. While showing strong support for traditional public health approaches to tobacco control, stakeholders recognize weaknesses, specifically the difficulty of countering the powerful voice of the tobacco industry when mounting public campaigns and the problem of individuals who are resistant to treatment and continue smoking. Conclusions: In order for genetic research to be effectively translated into efforts to minimize the harm of smoking-related disease, the views of key stakeholders must be voiced and disagreements reconciled. Effective translation requires honest evaluation of both the strengths and limitations of genetic approaches.

Chronic Addiction, Compulsion, and the Empirical Evidence

Pickard (2012) provides a strong critique of the definition of addiction as a “chronic, relapsing, neurobiological disease characterized by compulsive use of drugs or alcohol.” We agree with Pickard that framing addiction as a “disease of the brain” may have unintended consequences; for example, the model deemphasizes the influences of culture and environment, needlessly narrowing our understanding of addiction (Dingel, Karkazis, and Koenig 2011). However, we do not support her analysis fully. Pickard assumes that researchers and patients suffering from addictive disorders make literal use of the “disease of the brain” metaphor. She seriously overstates its influence. Based on five years of ethnographic fieldwork with addiction researchers, clinicians, and patients, we conclude that empirical realities are not consistent with Pickard’s position. The strong definition of compulsion Pickard refers to, and also associates with a neurobiological understanding of addiction—”an urge, impulse or desire that is irresistible: so strong that it is impossible for it not to lead to action”—implies that there is no choice (Pickard 2012). However, just because something is biological or a “disease” does not mean there is no choice or a loss of choosing capacity. Indeed, as noted by Ho and colleagues (2010), “The voluntary initiation and continuation of a behavior that is harmful to health is an important aspect of the etiology of many common diseases, including cardiovascular disease and metabolic syndrome” (779, emphasis added). Nora Volkow, the current head of the National Institute on Drug Abuse, has endorsed a theory in which addiction is thought to result from problems of motivation of choice—a framing that implies that “choosing,” though difficult, is still possible (Kalivas and Volkow 2005). While Pickard suggests that most scientists consider compulsion an all-or-none thing, we disagree. Data from our current study support what others have noted: Scientists are focused on enhancing our understanding of biological factors involved in addiction, which they hope will encourage policy changes that emphasize treatment; the basic assumption is that drug addicts have free will and can recover. As addiction researcher Griffith Edwards (2003) writes, alcoholism “is best approached through a framework of the

Research and reporting on the development of sex in fetuses: gendered from the start.

Research into human genetics has been expanding rapidly and most people learn about that research from mass media. Because prior research finds gender bias in aspects of both science and the media, we investigate the messages presented to the public concerning the relationship between biology and gender, taking as a case research on the genetic development of sexual difference before birth. We examine both the science that is getting media attention and the form that coverage takes. We find that gendered assumptions direct the science but also that scholarly discourse makes gender biases in method and interpretation accessible to scientific critique. On the other hand, mass media reporting ignores feminist critiques, marginalizes women and dramatically reinscribes gendered beliefs about the inherent superiority of men and the biological basis for gender differences in personality and behavior.

Student social self-efficacy, leadership status, and academic performance in collaborative learning environments

ABSTRACT Research confirms the positive effect of collaborative learning environments when students are considered as one homogeneous group. Little has been done to provide a detailed view of the performance of subgroups of students within collaborative settings. This quantitative and longitudinal study uses survey responses to explore differences in the variables of social self-efficacy (SSE) and leadership relative to each other, different academic performance levels, and across two academic years in a cohort of undergraduate students. Analysis showed no relationship between either sex or race and academic performance. However, results confirm that there is a positive relationship between SSE and grades, and that leaders have a higher SSE than followers. Results also show that SSE improves for leaders, but no evidence for such improvement for followers. We conclude that in collaborative learning environments, high SSE and leadership are important components in student achievement and should be considered when designing curricula.

“I don’t have to know why it snows, I just have to shovel it!”: Addiction recovery, genetic frameworks, and biological citizenship

The gene has infiltrated the way citizens perceive themselves and their health. However, there is scant research that explores the ways genetic conceptions infiltrate individuals’ understanding of their own health as it relates to a behavioral trait such as addiction. Do people seeking treatment for addiction ground their self-perception in biology in a way that shapes their experiences? We interviewed 63 participants in addiction treatment programs, asking how they make meaning of a genetic understanding of addiction in the context of their recovery, and in dealing with the stigma of addiction. About two-thirds of people in our sample did not find a genetic conception of addiction personally useful to them in treatment, instead believing that the cause was irrelevant to their daily struggle to remain abstinent. One-third of respondents believed that an individualized confirmation of a genetic predisposition to addiction would facilitate their dealing with feelings of shame and accept treatment. The vast majority of our sample believed that a genetic understanding of addiction would reduce the stigma associated with addiction, which demonstrates the perceived power of genetic explanations in U.S. society. Our results indicate that respondents (unevenly) ground their self-perception of themselves as an addicted individual in biology.