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Out of our heads: Addiction and psychiatric externalism.

Shane N Glackin, Tom Roberts, Joel Krueger

Behavioural Brain Research February 1, 2021 DOI: 10.1016/j.bbr.2020.112936 (opens in new tab)

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Characteristics Theoretical or philosophical paper Peer reviewed
Topics Addiction
Keywords 4e cognition Extended mind Integrative framework Psychiatric externalism Recovery
Citations 28
Key points Proposes that 4E cognition theory offers an integrative framework for understanding addiction across multiple levels, dissolving the choice-versus-disease-model dichotomy and clarifying brain-environment interactions.

Abstract

In addiction, apparently causally significant phenomena occur at a huge number of levels; addiction is affected by biomedical, neurological, pharmacological, clinical, social, and politico-legal factors, among many others. In such a complex, multifaceted field of inquiry, it seems very unlikely that all the many layers of explanation will prove amenable to any simple or straightforward, reductive analysis; if we are to unify the many different sciences of addiction while respecting their causal autonomy, then, what we are likely to need is an integrative framework. In this paper, we propose the theory of "Externalist" or "4E" - for extended, embodied, embedded, and enactive - cognition, which focuses on the empirical and conceptual centrality of the wider extra-neural environment to cognitive and mental processes, as a candidate for such a framework. We begin in Section 2 by outlining how such a perspective might apply to psychiatry more generally, before turning to some of the ways it can illuminate addiction in particular: Section 3 points to a way of dissolving the classic dichotomy between the "choice model" and "disease model" in the addiction literature; Section 4 shows how 4E concepts can clarify the interplay between the addict's brain and her environment; and Section 5 considers how these insights help to explain the success of some recovery strategies, and may help to inform the development of new ones.

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Psychedelics as Medicines: An Emerging New Paradigm General population 2016 Theoretical or philosophical paper
Restructuring reward processing with Mindfulness-Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. 2016 Theoretical or philosophical paper
Ayahuasca’s entwined efficacy: An ethnographic study of ritual healing from ‘addiction’ 2017 Theoretical or philosophical paper
Hypotheses Regarding the Mechanisms of Ayahuasca in the Treatment of Addictions 2012 Theoretical or philosophical paper
Biosynthesis of an Anti-Addiction Agent from the Iboga Plant. 2019 Theoretical or philosophical paper

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