A time of reason… –  

Nov. 27, 2020 – Pickard then writes about neuroscientist Marc Lewis’ learning model, which considers both the disease and choice model problematic. While the choice model demonizes the addict, the disease model disempowers them and minimizes their agency. Lewis maintains that the brain changes seen in addicts are a result of neuroplasticity, rather than the underlying cause of addiction and that the empowerment and agency of the patient are essential to recovery.

Pickard mostly agrees with Lewis but insists that the choice model cannot be easily rejected. First, there is a growing evidence base suggesting that drug use is not simply compulsive, and addicts have a degree of control and choice. Studies show that most people age out of addiction without treatment because they get preoccupied with life changes. Others quit cold turkey despite years of dependence. Both people and animal studies have shown that people with dependence will often choose rewards other than drugs (like money, small gifts) when provided alternatives; rats addicted to cocaine even chose snuggling over cocaine.

Second, if, as Lewis maintains, we are to use empowerment, agency, and self-awareness to help people, then this means that a person has some level of agency, some control over their behavior, and some power over their addiction.

Pickard writes that we can accept drug use to be a choice, but unlike the moral model, we must not consider it to be a shameful or a selfish one. Thus, we as a society also have a choice in seeing the addict not as someone who is lazy or bad, but as someone who is suffering and in pain.

Pickard’s responsibility without blame framework is about exploring and challenging our own attitudes about addiction. The model emerges from her work as a clinician in a Therapeutic Community. These communities are less hierarchical than hospitals. They require a deep and even a personal connection between experts and patients, and within the patient group. She writes:

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