You must judge for yourself.
I think that Prof Hart may be trying to remind us that science, at its best, sets forth falsifiable propositions that then can be evaluated through observation and experiment (i.e., made subject to falsification).
The proposition that something is a brain disease is not a case of science setting forth a falsifiable proposition.
It is a metaphorical statement. Brain disease is being used as a metaphor in a social construction that is engaging because it focuses our attention on what can be learned through advanced brain imaging technologies and those used in Nobel Prize-winning molecular biology research on fundamental processes of memory. By calling something a brain disease, we can place that something into the domain of dazzling 21st century public health research, and move it out of the cathedrals, churches, and prayer meetings into biomedical laboratories.
What's wrong with that?
Prof Hart reminds us of the reductionistic fallacy, a kind of synecdoche, in which we characterize and name the whole thing by mentioning one (perhaps tiny) part, as in "Seeing the sails, we braced for battle." The battle is not with the sails. Here, using synecdoche, we make the sails stand for the armada of an opposing navy, and prepare for what is to happen next.
If the fight were truly with the sails, we might prepare catapults to throw flaming liquids that would burn the sails. But doing so, we would neglect to load the cannons or arm ourselves for close combat.
Here, Prof Hart does a great service by reminding us that the brain disease metaphor is overly reductionistic. It gained political currency in an post "Great Society" era. Current over-emphasis of that metaphor has produced, in some quarters, a point of view that the leaders who direct this country's drug research agenda are willing to give priority only to the kind of research that they themselves conduct in the brain research laboratories.
Knowing these leaders, I would say that they give some appearance of that willingness in their public utterances, and that they might do better by conveying to the public an appreciation that "brain disease" can be a useful metaphor, but that its utility has clear boundaries. The brain disease metaphor speaks to the tip of the epidemiological iceberg that Prof Hart mentions -- the most severe of the drug-involved casualties, and perhaps only a small subset of those casualties. It does not speak to the drug involvement of the vast majority of drug users, whose drug-taking is not a manifestation of any "brain disease," but rather is a behavioral and social choice made quite consciously and deliberately, akin to deciding whether to drink a brew after a hard day of being the "ama de casa" or doing other work.
The rest of this post meanders about this theme, and might not be worth reading or remembering.
In troubling times:
Great courage and good cheer!
J.
p.s.
To this stage, in the U.S.A., it's been neither science nor evidence driving the judgments.
You can choose your metaphor, and select the supporting "facts" while other details are ignored.
Some metaphors lead one to draw up tactics for re-shaping individuals via social control.
Some metaphors lead one to draw up tactics for re-shaping of human society.
Imagine a society that has replaced all current minimum wage jobs with automatons.
Now, extend the reach to elimination of virtually all jobs that previously could be performed without a GPA>2.95 and a four-year college degree.
Food, shelter, health care, etc.
Don't worry about it.
The productivity of the top 50% is enough to finance a society of artists, musicians, thinkers, goof-offs, ....
And no one in that top 50% is a wage slave.
At any time, they can turn on, tune in, and drop out (of going to work every day).
There is someone else happy to replace them, with a four year college degree and GPA=2.96.
Labor shortage is a thing of the past.
The drug experience is re-conceptualized one of a set of choices about how one occupies the waking hours.
To be sure, that experience might yield no new art, poetry, novels, music, etc.
Instead, the drugger's choice is to take an extended vacation from all that, and to plan for a return after the vacation.
Some, who have gold in the pockets, fly down to Mar-a-Lago and play golf for the weekend, eat a steak, play xBox,..., fly back, with a large carbon footprint.
Others, with less gold, drop something, turn on, and tune in for the weekend, eat a tofu burger and sprouts, play Frisbee in the neighborhood park, with a modest carbon footprint.
Who has the brain disease?
Who is the criminal?
We have to make judgments.
I have seen enough who truly do have a brain disease, acquired after onset of drug use, and before drug use, there had been no sign of any such affliction. (This is the tip of the epidemiological iceberg of drug involvement I have mentioned elsewhere, with a stretch from the first drug exposure opportunity onward toward the first use of the drug, most often a transient "honeymoon" with the drug, and then movement on to something else, with no enkindling of a brain disease process for the vast majority of users.)
I have seen many get into trouble with drugs, but it is hard to make a case for a brain disease, except perhaps a transient one, with underlying processes akin to those of a transient delirium secondary to an intoxication state. They used daily for years, several times a day, and then stopped cold turkey, and went on about their business. (Tobacco comes to mind in many examples.)
I can see the brain disease metaphor having some value in the first instance.
And I see little value in the second instance.
It's a complex problem with no simple solution, but it's not at all clear that the concept of a brain disease or the concept of "addiction" are making the problem any more soluble.
And isn't that the goal of the public health science?
To make health problems soluble?
For any heterogeneous and complex condition, the brain disease and addiction metaphors might well be examples of hopeless over-simplification.
Or maybe the current U.S. Congress can be convinced to spend more money on health, if we convert all complex health problems and behaviors to brain diseases and turn to the addiction metaphor to characterize them:
addiction to love
addiction to running
addiction to reading
addiction to ... reading blogposts?
addiction to writing.....
You must judge for yourself.
