Views about the disease and brain disease model of addiction: an international survey of addiction treatment providers in the USA, UK and Australia

Background

The disease model, and over the past few decades the brain disease model of addiction (BDMA), have received strong support from drug policy makers, especially in the USA. It is not clear how treatment providers view the disease model or BDMA and whether they view these models as clinically beneficial. This study reports an international survey of addiction treatment providers’ views in the USA, UK and Australia to examine: (a) differences in (and demographic factors predicting) support for the disease model and BDMA; and, (b) views about the potential clinical impact of framing addiction as a brain disease.

Methods

Addiction treatment providers in the USA (n=936), UK (n=165) and Australia (n=337) were surveyed about their beliefs on the disease model of addiction using the Short Understanding of Substance Abuse scale (SUSS). Their beliefs on the BDMA and its clinical impact were assessed using questions designed by the authors. Factor analysis of items on the SUSS revealed a similar factor structure in each country. Predictors of scores on the disease model factor subscale were analysed using multiple regression analyses. Descriptive statistics were used to summarise treatment providers’ views about the BDMA and its clinical impact.

Results

Support for the disease model of addiction was significantly higher among treatment providers in the USA than in the UK and Australia. In all three country samples, belief that addiction was a disease was higher among treatment providers who had a personal history of addiction, including those who had attended 12-step programmes. Compared to their UK and Australian counterparts, significantly more treatment providers in the USA: (a) had heard of the BDMA; (b) strongly agreed that addiction was a chronic, relapsing brain disease; (c) were more likely to use the term ‘brain disease’ when discussing addiction with clients; and, (d) believed that describing addiction as a ‘brain disease’ had a greater positive (e.g., reduces guilt; increases treatment seeking) and less negative impact (e.g., increased stigma; increased helplessness) for clients.

Conclusions

This is the largest study to explore treatment providers’ views about the disease model and BDMA in the USA, UK and Australia. Addiction treatment providers in the USA were more likely to support the disease model and BDMA than those in Australia and the UK and more likely to believe that it has a positive clinical impact on treatment. We discuss the implications of these findings for global drug policy, addiction treatment and addiction neuroscience research.