A debate is about to be ignited in the addiction science community when Dutch researcher Reinout Wiers’ book, A New Approach to Addiction and Choice, comes out in August. We requested a review copy here at AddictionNews and we can’t wait to read what Dr. Wiers has to say about addiction and the brain.

In a preview article provided to News-Medical.Net by Wiers’ publisher, Taylor & Francis Group, Wiers argues that addiction is in most cases “a biased choice,” and not a chronic brain condition. He questions whether changes in the brain attributed to addiction might, in fact, be the accumulation of other life incidents that change the normal human brain.

As if on cue, the journal Molecular Psychiatry dropped a major piece of brain research on June 26 with brain scans of 17 people with cocaine use disorder (CUD) and 17 “healthy control” (HC) subjects. Functional MRI scans of the subjects when presented with cues demonstrated substantial differences between the HC group and the CUD group: “cocaine cues only affect inhibitory control in individuals with CUD and not in HC.” These effects were muted, however, when another person was present in the room.

The researchers, led by Damiano Terenzi of the Aix-Marseille Université, Marseille, France, conclude their “findings highlight the impact of social context and drug cues on inhibitory control…emphasizing the importance of considering the social context in addiction research.” The researchers say that:

[I]n humans with psychostimulant use disorder, similar beneficial effects of the peer presence were observed in a cross-sectional survey assessing the social environment at the moment of stimulant use.

The researchers point out that the presence of peers (“second-person neuroscience”) impacts substance use in different ways, causing greater nicotine use, for example, but usually lower cocaine use. Their method for judging this seems a little duplicitous:

[W}e chose here to enact a second-person neuroscience situation by pretending a direct interaction with the experimenter who observes participants’ performance in real-time in half of the scanning sessions, while unbeknown to the participants presence of the experimenter was fake and controlled throughout the experiment.

However, the results they got were unambiguous: The HC group showed no reaction to the presence of another person and the CUD group showed a significant reduction in the response to cocaine-related cues. In many ways, this research echoes the findings of heroin use by United States soldiers during the Vietnam war. In that difficult social situation, half of the thousand veterans tracked by the U.S. Army tested positive for opiates in a urine test upon leaving Vietnam. In follow-up urine tests, contrary to expectations, “less than 1% had shown signs of opiate dependence.”

The researchers concluded that “the occasional use of narcotics without becoming addicted appears possible even for men who have previously been dependent on narcotics.” Which brings us all the way back to the forthcoming book by Dr. Reinout W. Wiers, Professor of Developmental Psychopathology at the University of Amsterdam, who argues that “the fact that there are changes [to the brain] associated with addiction does not in itself prove that addiction is a brain disease.”

Unlike other chronic diseases such as dementia and Parkinson’s disease, Dr. Wiers argues, people can recover from addiction without professional assistance. The article provided by his publisher to News-Medical.Net states: “The chronic brain disease perspective has been shown to diminish hope of recovery, both among people struggling with addiction themselves and those around them, including their treatment providers.”

Dr. Wiers recommends “therapy and varieties of cognitive training, either computerized or in the form of mindfulness meditation,” a therapy we recently looked at on AddictionNews. We look forward to reviewing Dr. Wier’s new book in the near future.

Written by Steve O’Keefe. First published July 03, 2024.

Sources:

“Challenging the chronic brain disease model of addiction,” News-Medical.Net, July 1, 2024.

A New Approach to Addiction and Choice: Akrasia and the Nature of Free Will, by Reinout W. Wiers, Taylor & Francis Group, 2025.

“Social context and drug cues modulate inhibitory control in cocaine addiction: involvement of the STN evidenced through functional MRI,” Molecular Psychiatry, June 26, 2024.

Image courtesy Wikimedia Commons, used under Creative Commons license.