Variations in Addiction: The molecular and the molar in neuroscience and pain medicine

This article critically examines two versions of addiction, the neuroscientific model of addiction as a brain disease and the behavioural model of addiction developed by pain medicine. By juxtaposing these different ways of seeing and acting on addiction, the article challenges the assumption that addiction is a constant and singular entity that can be identified outside a particular context. It also highlights the uses, limitations and tensions of each approach. The molecular gaze of the chronic relapsing brain disease model has the potential to undermine the stigmatization of addicts, while the therapeutic gaze of pain medicine recognizes that changes in the brain produced by long-term drug use are not in themselves pathological. The article suggests that the brain disease model is limited in its scope because it removes addiction from the social context in which it is experienced. On the other hand, the molecular knowledge produced by brain-based research is likely to challenge the ability of pain medicine to maintain clear-cut distinctions between dependence, the drug-seeking behaviour of pain patients and addiction.