The brain disease model of addiction and epistemic injustice

The brain disease model of addiction (BDMA) is a dominant, if highly contested, model of drug addiction globally. Over many decades, researchers have marshalled evidence from animal studies, neuroimaging scans, and genome wide association studies to argue that addiction is a brain disease. However, critics have argued that the model de-emphasises social and economic contexts, downplays the phenomenon of spontaneous or natural recovery, and over-interprets neuroscientific findings. Building on this critical tradition, the current paper asks a related question: Has the claim that addiction is a brain disease helped or harmed those experiencing drug-related harm epistemically? While no definitive answer to this question is offered, the current paper argues that overall, the claim that addiction is a brain disease advanced by proponents of the BDMA has harmed substance users already experiencing multiple disadvantages epistemically. Drawing on the concept of epistemic injustice, the current paper argues that the category 'drugs' creates an artificial and harmful dichotomy between those who use licit medicines and experience harm and those who use illicit substances and experience harm. Furthermore, this artificial dichotomy is compounded by racist and colonial discourses central to the war on drugs, and a rigid biological reductionism that de-emphasises social, economic, and cultural harm. The paper concludes by sketching an alternative approach rooted in epistemic justice, and a discussion of the implications of this concept for research and theory.