Effects of environmental enrichment on recovery from addiction: no disease, no chronic and no relapse

Abstract

This paper critically analyses the axioms on which the brain disease model of addiction rests: i) it is a disease, ii) it is genetically determined, iii) it is irretrievably developed by drugs, iv) it is explained by the value placed on reward, and v) it is maintained by abstinence avoidance. It is argued that, in the light of scientific findings and under the prism of common sense, each of its axioms is falsifiable. The commonly held idea that self-administering drugs, eating an excess of palatable foods or persistently playing video games produces an incurable disease in people because their brains undergo irreversible changes after repeated performance of the habit is discussed. Subsequently, the classical definition of addiction as a chronic and relapsing disease is deconstructed by analysing the epidemiological data on the supposed chronicity and relapse, providing evidence of recovery as, in fact, the most probable spontaneous course. Finally, and as a common thread throughout the paper, environmental enrichment is proposed as a therapeutic approach and a precursor of the paradigm shift. It concludes with ideas on the need to build a better biopsychosocial model that substantially optimises the care response offered to people who have developed an addiction.