Is brain-disease addiction the exception?
Fenton and Wiers argue that Korsakoff-level brain disease is a black swan; most addiction sits on a gradual continuum of impaired control that can recover.
Source
Free Will, Black Swans and Addiction
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Is brain-disease addiction the exception?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
Dominant biomedical view?
best described as a brain disease, the current dominant perspective in biomedical sciences, clearly stated by the influential scientist and president of th
Delay-discounting?
delay-discounting []. However, association does not imply causation, and indeed there is both evidence that impulsive traits can become more pronounced thr
What they did
They accept that addiction involves delay-discounting and staged brain changes (reward, habit, dark-side stress) but deny that those changes automatically equal a brain disease. A gradual model moves from motivated choice toward compulsion. Extreme damage with little recovery (e.g. Korsakoff’s) may warrant the disease term.
What they found
Epidemiology shows most cases remit, so disease-as-rule is the wrong default. A continuous view of executive abilities is more accurate and may be a better engine for change.
The limits
What it doesn't show
This is a commentary on Lewis, not a new cohort. It does not quantify how often KS-like states occur among people labelled addicted.
Key terms
- Black swan
- A rare, extreme case (here: addiction as irreversible brain disease) mistaken for the typical case.
- Delay-discounting
- Preferring smaller sooner rewards over larger later ones; a facet of impulsivity.
- Korsakoff’s syndrome
- Severe alcohol-related brain damage with poor recovery of memory and control.
- Gradual model
- Addiction as a continuum from choice toward compulsion, not a binary diseased/healthy brain.
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Brain disease is usually?
Common questions
When may ‘brain disease’ fit?
Extreme damage with little chance of recovery, e.g. some KS patients.
What is the usual picture?
Individual differences in control that addiction can impair and that can recover.
Why ‘black swan’?
If you start from KS, disease looks like the rule; epidemiology says it is not.
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