Is Addiction a Pathology of Choice?

By Sarah Beller 05/22/13

New research suggests that drug cravings and decision-making are linked in the brain.

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To use or not to use? Photo via

People often dispute whether addiction is a disease or a choice; new research says it may be both. McGill University researcher Dr. Alain Dagher says that cravings for nicotine and other drugs can be viewed in specific brain regions that are also responsible for decision making. The research, which was presented at the 2013 Canadian Neuroscience Meeting, builds on previous investigations into how people who are addicted to a substance make the choice to use. Previous studies have suggested addicted individuals place greater value on immediate rewards (like the pleasure of cigarette smoking) over delayed rewards (like health benefits). Dagher's research suggests that the "value" of the drug to an individual at a given time (i.e. the intensity of the craving) can be visualized in the brain using Magnetic Resonance Imaging (fMRIs), and that these images can be used to predict subsequent drug use. A specific brain region called the dorsolateral prefrontal cortex (DLPFC) regulates cigarette craving in response to drug cues like seeing people smoke, or smelling cigarettes; and the study suggests that addiction may result from a connection between the DLFPC and other parts of the brain. This information could lead to new treatments for cravings in people who are trying to quit, such as artificially stimulating the DLFPC. "Policy debates have often centred on whether addictive behaviour is a choice or a brain disease," said Dagher, "This research allows us to view addiction as a pathology of choice. Dysfunction in brain regions that assign value to possible options may lead to choosing harmful behaviours."

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Sarah Beller is a writer and the Executive Director at Filter. She has written about drug policy with a focus on harm reduction for Substance.comThe Fix and Salon. She has worked as a social worker with formerly incarcerated people in New York for a number of years. Her writing has also appeared in McSweeney’sThe HairpinThe ToastReductressThe Rumpus and other publications. You can find Sarah on Linkedin and Twitter.