[Scientific theory and drug abuse research]

Scientific medicine has for years been faced with the classical philosophical dilemma between ontological realism and epistemological empiricism. The impact of this dilemma is especially important in scientific psychiatry and, not least, in the study of substance use disorders. Much controversy exists concerning the question of what psychiatric diseases "really are" and how disease should be separated from non-disease. The anti-psychiatric movement claimed that the disease model in psychiatry should be totally abandoned, and the impact of this movement on our daily thinking may have been greater than we have generally recognized. As for the substance use disorders there is no doubt that the disease model is generally considered no use. But giving up the disease model--or one of the disease models--has serious consequences for the scientific study of these disorders. The interpretation of data from eg a long-term follow-up study of substance users is impossible except in a disease-model frame-of-reference. So is any search for causes or search for effects of a certain treatment. Usually an explicit discussion of the philosophical frame-of-reference in such studies is not given with the consequence that scientific discussions of substance use or substance use disorders are often waste of time.