The Compulsive Brain Disease Model of Addiction Lowers Problematic Alcohol Drinkers’ Confidence to Reduce their Addictive Behaviour

Abstract Critical addiction theorists have proposed that public dissemination of the compulsive brain disease model of addiction (cBDMA), as opposed to choice-based theories, might be iatrogenic in reducing problematic substance users’ confidence to limit their consumption, but only two preliminary experimental studies have tested this claim. In this online between-subjects framing design, 1204 UK-based weekly alcohol drinkers (stratified into three severity levels by AUDIT: low-risk, hazardous and dependent) watched either a short video of Dr. Nora Volkow describing addiction as a compulsive brain disease or Prof. Marc Lewis describing addiction as a value-based choice (clipped from public lectures) or a neutral video describing UK geography. Participants then reported their agreement with and unpleasantness of the videos and their number of previous attempts, desire and confidence to reduce their addictive behaviour. Participants agreed more with the compulsion video but also rated it as more unpleasant. Low-risk drinkers reported greater desire to reduce addictive behaviour following the choice and compulsion than neutral video. Both hazardous and dependent drinkers reported lower confidence to reduce addictive behaviour following the compulsion than choice video. Effect sizes were small. The study corroborated two previous studies in suggesting that public dissemination of the cBDMA, compared to choice-based theories of addiction, appears to be iatrogenic for hazardous and dependent drinkers in lowering their confidence to reduce addictive behaviour. The study strengthens demand for research testing whether dissemination of the cBDMA in the natural environment unintentionally promotes addictive behaviour, directly contradicting its purpose.