The neuro-fiction of addiction immunizations

Animal studies demonstrating "proof of concept" for addiction immunizations were first published in the 1970s. As originally theorized, immunization could block the brain's absorption of a drug, eliminate its pleasurable effects, and reduce or extinguish future drug-seeking behavior. Since the publication of this foundational animal research, addiction vaccines for humans have been heralded as potential "game changers" in the treatment of substance use disorders (SUD). Labeled as "novel" and "promising" for fifty years, addiction immunizations are still an imaginary. Drawing on the sociology of expectations framework, we analyze the ongoing failure, novelty and promise of immunizations for SUD. Through an interpretive systematic review of the international peer-reviewed medical literature related to addiction immunization from the 1970s forward, we reveal how this body of R&D is simultaneously riddled with failure, on the verge of game-changing breakthroughs, and guardian of the brain disease model of addiction. We investigate how, why and with what consequences addiction vaccines have remained novel and promising in the context of ongoing failure. Our analysis foregrounds three interrelated promissory dynamics that have animated the hunt for addiction immunizations and the neuro-pharmaceuticalization of addiction for fifty years. We argue that the past, present and future support of the idea of addiction vaccines is in service of the dominant but unsettled understanding of addiction as a brain disease. Addiction immunizations are a neuro-fiction: an imaginary neuro-technological solution to a pressing problem. Although imaginary, they espouse an actuality about addiction with significant real-world implications.