IYCRC SUMMER RESEARCH PROJECT 2026
Prepared By: Afsah butt
Email: buttafsah@gmail.com
Submission Date: 27 July 2026.
Introduction
Throughout most of the twentieth century, addiction was considered to be a result of moral failure. People with substance use disorder (SUD) were considered to be “bad,” and they were harshly criticized due to the belief that drug addiction was a conscious decision to misbehave (Leshner, 1997). Despite the fact that healthcare providers have recognized addiction as a medical condition several decades ago, it is still questionable whether or not the problem in question should be regarded as a disease. Neurobiological paradigm assumes that substance addiction is a chronic, non-accidental brain disease caused by the intake of psychoactive substances. This paper seeks to analyze the effects of changing the approach from the “moral model” to “chronic brain disease” on the field of health care and law enforcement.
Key Terms: Substance Use Disorder, Neuroplasticity, Stigma, Public Health Policy.
Case Description
In this paper, Subject X is a 34-year-old male patient diagnosed with severe opioid use disorder (see DSM-5, American Psychiatric Association, 2013).
Initial (Voluntary) Phase
When Subject X was 26 years old, he had an injury while playing sports. His doctor prescribed him opioids to relieve pain. Subject X took them voluntarily and was able to control his intake of the medicine. It means that he used opioids for recreation and not because of treatment needs.
In the first period of the study, Subject X was not addicted to the substance. The patient did not have any cravings and experienced no harmful effects when he stopped using the medication. There were no signs of dependence on opioids and seeking the substance.
Intermediate (Neuroadaptation) Phase
Due to the constant use of the opioid medication, Subject X developed tolerance to the substance, meaning that the initial dose was ineffective, and he had to increase the dosage in order to achieve the same effect. As a consequence of the increasing doses, the patients experienced severe withdrawal symptoms every time they stopped taking the medication. This issue had a negative impact on Subject X's life negatively. Therefore, the patient used opioids in order to avoid these symptoms. Consequently, at the certain stage, Subject X became addicted to the substance as he could not stop taking it despite all the adverse effects of opioids.
Compulsive (Brain Disease) Phase
At the age of 30, Subject X was diagnosed with Severe Opioid Use Disorder because he exhibited maladaptive patterns of use in accordance with the DSM-5 criteria (American Psychiatric Association, 2013). It is important to note that the patient could not control his use of the substance despite the negative consequences of it for his career, finances, and relationships. At this stage, Subject X was addicted to opioids and had impaired brain circuitries.
The neurobiological changes caused by chronic opioid use affected the patient in a way that he lost control over substance use. Diagnostic tests showed that Subject X's dopamine receptors in the striatum and the volume of the prefrontal cortex changed due to the substance use. In spite of the fact that he chose to use the substance voluntarily, subject x developed addiction to the substance. Thus, Subject X's case is a good example of how people can become addicted to a substance that they used initially voluntarily. Chronic substance use leads to changes in the brain of people that use opioids.
Research Question
How the neurobiological changes do caused by substance addiction challenge the traditional notion of 'moral failure,' and what are the implications of this understanding for contemporary public health policy?
Objectives
For determination of the neurobiological mechanisms put forward in the article which underlie substance abuse;
To examine how intentional use of substances differs from addiction;
To examine the impact of the ‘moral failure’ concept on patients’ well-being;
To appraise the efficiency of public health policies based on medical and criminal approaches.
Literature Review
Neurobiology of Reward System
The brain disease theory is predicated on neurobiological changes in the reward mechanism of the individual affected. Studies have revealed that dopamine release as a consequence of taking drugs in the nucleus accumbency occurs several times more often than in the case of natural reward triggers (Koob & Volkow, 2016). As a result, this increases the salience of drug-related cues in the dopamine pathway which disrupts the reward process making substance use the most attractive option.
Due to the hyper activation of the reward pathway, the prefrontal cortex reduces the production of dopamine in order to protect neurons from excitotoxicity. The reduction in dopamine transporters makes it difficult for individuals to enjoy activities and, therefore, leads to anhedonia, the core characteristic of substance addiction (Volkow et al., 2016).
Prefrontal Cortex Dysfunction and Executive Control
Those who advocate for the “moral model” of addiction may claim that the inability to fight against the urge to take drugs or alcohol is associated with weak executive control skills that need to be strengthened through greater efforts to abstain from substance use. However, the detrimental effects of chronic substance abuse on cognitive functioning, particularly the prefrontal cortex (PFC), have been firmly established by now (Goldstein & Volkow, 2011). PFC hypo activity is the core mechanism underlying addiction that prevents self-regulation and leads to compulsive and automatic substance-seeking and taking.
When the functions of the prefrontal cortex are reduced, addicts fail to control their emotional states and impulsive actions. At the biological level, substance abuse leads to the hyper activation of the reward pathways in the brain and hypo activity of the PFC, resulting in faulty decision-making. Therefore, addiction is a complex process rather than a lack of willpower or “laziness.”
The Role of Stigma in Outcomes of Addiction
It is evident from the literature review on the stigma of addiction on the behavior of individuals with substance use disorders in seeking healthcare services. It is well documented that many patients delay in seeking healthcare services due to fear of stigmatization by the society or the criminal justice system (Tsai et al., 2019). In addition, healthcare professionals are also likely to be biased against individuals with SUD. The bias results in poor treatment outcomes for these patients (McLellan et al., 2000). Understanding addiction as a disease led to decrease in the stigma associated with addiction, higher utilization of healthcare services, increased patient treatment and improvement in MMT (methadone maintenance treatment) outcomes due to adherence to the treatment.
Public Health Policy Considerations
The literature reveals major differences between the punitive policies and the public health approaches in the management of addiction. It is clear that the rhetoric of the 'war on drugs' has seen many individuals with SUDs being incarcerated without leading to reduction in the addiction and drug trade (National Institute on Drug Abuse, 2020). Public health approach treats substance use disorders as a brain disease. Policies that are evidence-based and lead to reduction in morbidity and mortality due to substance use are well recommended (McLellan et al., 2000). Treatment and not incarceration leads to better recovery rates among patients with SUDs and helps in promoting pro-social behaviors.
Research Methodology
Qualitative research design was chosen for the study because of the interest to study the addiction phenomena from the neurobiological paradigm. Qualitative research design was chosen to explore the views of scientific literature and public health research about the association between the brain disease hypothesis of addiction and the understanding of addiction as a moral failing.
Interpretive research philosophy was applied in the study to interpret various views on the brain disease hypothesis of addiction and the understanding of addiction as a moral failing. Researchers aimed at finding out how the various authors, healthcare experts and policymakers were interpreting the concepts of addiction and brain disease hypothesis of addiction. Secondary data was used for the research since the aim was not to conduct primary data collection but reviewing literature on understanding addiction as a moral failing and its implications. Secondary data was collected from various research articles, books and other published materials related to the topic.
Thematic analysis approach was used for analysis of secondary data. Researcher went through the selected documents to come up with the themes and patterns. The researcher sorted out the various concepts, ideas and terms used in the documents to come up with themes and patterns. The researcher also came up with the key themes in the selected documents and linked them to the research problems and objectives. Some of the key themes found during the study included the neurobiology of addiction and brain disease, stigma and treatment of addiction as a public health issue.
Findings
From the findings of the study, it can be concluded that addiction is indeed a brain disease and not moral failing as supported by the evidence in the study. The reward and dopamine circuits are key components in causing the addiction associated with substance use and substance use disorders. From the study, it can also be noted that while voluntary decision may cause one to start using the drugs, continued use is caused by neurobiological processes that are out of one's control making it extremely hard for one to stop substance use.
In the process, the study has revealed that stigma is one of the major factors causing substance use disorders and addictions. It has been discovered that moral failing has no effect on treatment seeking among substance use disorder patients. This is because stigma causes healthcare workers to have negative attitudes towards the patients which affects their treatment in many ways. In addition, the study has found that public health treatment approach to substance use disorders yields better results than criminal justice approach in most cases.
Conclusion
There are several reasons why it is essential for the concept of addiction to be changed from moral failing to that of chronic brain disease with different dimensions including the neurobiological, psychological and social ones. From the research conducted, it is possible to establish scientifically that continued use of addictive substances leads to damage of reward circuit and prefrontal cortex of the brain leading to compulsive drug-seeking behaviors. These addictive substances lead to interference with dopamine circuit in the brain which affects an individual's mental condition leading to lack of self-control in drug seeking. Thus, understanding of addiction as moral failing is a wrong concept that hinders people from getting treatment and other kinds of help in overcoming substance use and dependence. A combination of the efforts of the health sector and psychological as well as implementation of sound public policies to control the use of drugs could yield better results in treating the condition.
Recommendations
· It is recommended that there should be continuous efforts to enlighten the public on the concept of addiction being a chronic brain disease and not a moral failing.
· There is a need to regularly train the healthcare workers on how to handle substance use and dependence cases effectively.
· There is need for more investment on treatment and rehabilitation to provide better health services in the community as well as better health for the entire community.
· There is also need to come up with an early intervention program in the schools and hospitals to combat the issue of substance abuse and dependency in the community.
Other studies that may be done include survey and interview of healthcare professionals, policy makers, and recovered addicts in order to get more insight into the public health problems of substance abuse and addiction.
Throughout most of the twentieth century, addiction was considered to be a result of moral failure. People with substance use disorder (SUD) were considered to be “bad,” and they were harshly criticized due to the belief that drug addiction was a conscious decision to misbehave (Leshner, 1997). Despite the fact that healthcare providers have recognized addiction as a medical condition several decades ago, it is still questionable whether or not the problem in question should be regarded as a disease. Neurobiological paradigm assumes that substance addiction is a chronic, non-accidental brain disease caused by the intake of psychoactive substances. This paper seeks to analyze the effects of changing the approach from the “moral model” to “chronic brain disease” on the field of health care and law enforcement.
Key Terms: Substance Use Disorder, Neuroplasticity, Stigma, Public Health Policy.
Case Description
In this paper, Subject X is a 34-year-old male patient diagnosed with severe opioid use disorder (see DSM-5, American Psychiatric Association, 2013).
Initial (Voluntary) Phase
When Subject X was 26 years old, he had an injury while playing sports. His doctor prescribed him opioids to relieve pain. Subject X took them voluntarily and was able to control his intake of the medicine. It means that he used opioids for recreation and not because of treatment needs.
In the first period of the study, Subject X was not addicted to the substance. The patient did not have any cravings and experienced no harmful effects when he stopped using the medication. There were no signs of dependence on opioids and seeking the substance.
Intermediate (Neuroadaptation) Phase
Due to the constant use of the opioid medication, Subject X developed tolerance to the substance, meaning that the initial dose was ineffective, and he had to increase the dosage in order to achieve the same effect. As a consequence of the increasing doses, the patients experienced severe withdrawal symptoms every time they stopped taking the medication. This issue had a negative impact on Subject X's life negatively. Therefore, the patient used opioids in order to avoid these symptoms. Consequently, at the certain stage, Subject X became addicted to the substance as he could not stop taking it despite all the adverse effects of opioids.
Compulsive (Brain Disease) Phase
At the age of 30, Subject X was diagnosed with Severe Opioid Use Disorder because he exhibited maladaptive patterns of use in accordance with the DSM-5 criteria (American Psychiatric Association, 2013). It is important to note that the patient could not control his use of the substance despite the negative consequences of it for his career, finances, and relationships. At this stage, Subject X was addicted to opioids and had impaired brain circuitries.
The neurobiological changes caused by chronic opioid use affected the patient in a way that he lost control over substance use. Diagnostic tests showed that Subject X's dopamine receptors in the striatum and the volume of the prefrontal cortex changed due to the substance use. In spite of the fact that he chose to use the substance voluntarily, subject x developed addiction to the substance. Thus, Subject X's case is a good example of how people can become addicted to a substance that they used initially voluntarily. Chronic substance use leads to changes in the brain of people that use opioids.
Research Question
How the neurobiological changes do caused by substance addiction challenge the traditional notion of 'moral failure,' and what are the implications of this understanding for contemporary public health policy?
Objectives
For determination of the neurobiological mechanisms put forward in the article which underlie substance abuse;
To examine how intentional use of substances differs from addiction;
To examine the impact of the ‘moral failure’ concept on patients’ well-being;
To appraise the efficiency of public health policies based on medical and criminal approaches.
Literature Review
Neurobiology of Reward System
The brain disease theory is predicated on neurobiological changes in the reward mechanism of the individual affected. Studies have revealed that dopamine release as a consequence of taking drugs in the nucleus accumbency occurs several times more often than in the case of natural reward triggers (Koob & Volkow, 2016). As a result, this increases the salience of drug-related cues in the dopamine pathway which disrupts the reward process making substance use the most attractive option.
Due to the hyper activation of the reward pathway, the prefrontal cortex reduces the production of dopamine in order to protect neurons from excitotoxicity. The reduction in dopamine transporters makes it difficult for individuals to enjoy activities and, therefore, leads to anhedonia, the core characteristic of substance addiction (Volkow et al., 2016).
Prefrontal Cortex Dysfunction and Executive Control
Those who advocate for the “moral model” of addiction may claim that the inability to fight against the urge to take drugs or alcohol is associated with weak executive control skills that need to be strengthened through greater efforts to abstain from substance use. However, the detrimental effects of chronic substance abuse on cognitive functioning, particularly the prefrontal cortex (PFC), have been firmly established by now (Goldstein & Volkow, 2011). PFC hypo activity is the core mechanism underlying addiction that prevents self-regulation and leads to compulsive and automatic substance-seeking and taking.
When the functions of the prefrontal cortex are reduced, addicts fail to control their emotional states and impulsive actions. At the biological level, substance abuse leads to the hyper activation of the reward pathways in the brain and hypo activity of the PFC, resulting in faulty decision-making. Therefore, addiction is a complex process rather than a lack of willpower or “laziness.”
The Role of Stigma in Outcomes of Addiction
It is evident from the literature review on the stigma of addiction on the behavior of individuals with substance use disorders in seeking healthcare services. It is well documented that many patients delay in seeking healthcare services due to fear of stigmatization by the society or the criminal justice system (Tsai et al., 2019). In addition, healthcare professionals are also likely to be biased against individuals with SUD. The bias results in poor treatment outcomes for these patients (McLellan et al., 2000). Understanding addiction as a disease led to decrease in the stigma associated with addiction, higher utilization of healthcare services, increased patient treatment and improvement in MMT (methadone maintenance treatment) outcomes due to adherence to the treatment.
Public Health Policy Considerations
The literature reveals major differences between the punitive policies and the public health approaches in the management of addiction. It is clear that the rhetoric of the 'war on drugs' has seen many individuals with SUDs being incarcerated without leading to reduction in the addiction and drug trade (National Institute on Drug Abuse, 2020). Public health approach treats substance use disorders as a brain disease. Policies that are evidence-based and lead to reduction in morbidity and mortality due to substance use are well recommended (McLellan et al., 2000). Treatment and not incarceration leads to better recovery rates among patients with SUDs and helps in promoting pro-social behaviors.
Research Methodology
Qualitative research design was chosen for the study because of the interest to study the addiction phenomena from the neurobiological paradigm. Qualitative research design was chosen to explore the views of scientific literature and public health research about the association between the brain disease hypothesis of addiction and the understanding of addiction as a moral failing.
Interpretive research philosophy was applied in the study to interpret various views on the brain disease hypothesis of addiction and the understanding of addiction as a moral failing. Researchers aimed at finding out how the various authors, healthcare experts and policymakers were interpreting the concepts of addiction and brain disease hypothesis of addiction. Secondary data was used for the research since the aim was not to conduct primary data collection but reviewing literature on understanding addiction as a moral failing and its implications. Secondary data was collected from various research articles, books and other published materials related to the topic.
Thematic analysis approach was used for analysis of secondary data. Researcher went through the selected documents to come up with the themes and patterns. The researcher sorted out the various concepts, ideas and terms used in the documents to come up with themes and patterns. The researcher also came up with the key themes in the selected documents and linked them to the research problems and objectives. Some of the key themes found during the study included the neurobiology of addiction and brain disease, stigma and treatment of addiction as a public health issue.
Findings
From the findings of the study, it can be concluded that addiction is indeed a brain disease and not moral failing as supported by the evidence in the study. The reward and dopamine circuits are key components in causing the addiction associated with substance use and substance use disorders. From the study, it can also be noted that while voluntary decision may cause one to start using the drugs, continued use is caused by neurobiological processes that are out of one's control making it extremely hard for one to stop substance use.
In the process, the study has revealed that stigma is one of the major factors causing substance use disorders and addictions. It has been discovered that moral failing has no effect on treatment seeking among substance use disorder patients. This is because stigma causes healthcare workers to have negative attitudes towards the patients which affects their treatment in many ways. In addition, the study has found that public health treatment approach to substance use disorders yields better results than criminal justice approach in most cases.
Conclusion
There are several reasons why it is essential for the concept of addiction to be changed from moral failing to that of chronic brain disease with different dimensions including the neurobiological, psychological and social ones. From the research conducted, it is possible to establish scientifically that continued use of addictive substances leads to damage of reward circuit and prefrontal cortex of the brain leading to compulsive drug-seeking behaviors. These addictive substances lead to interference with dopamine circuit in the brain which affects an individual's mental condition leading to lack of self-control in drug seeking. Thus, understanding of addiction as moral failing is a wrong concept that hinders people from getting treatment and other kinds of help in overcoming substance use and dependence. A combination of the efforts of the health sector and psychological as well as implementation of sound public policies to control the use of drugs could yield better results in treating the condition.
Recommendations
· It is recommended that there should be continuous efforts to enlighten the public on the concept of addiction being a chronic brain disease and not a moral failing.
· There is a need to regularly train the healthcare workers on how to handle substance use and dependence cases effectively.
· There is need for more investment on treatment and rehabilitation to provide better health services in the community as well as better health for the entire community.
· There is also need to come up with an early intervention program in the schools and hospitals to combat the issue of substance abuse and dependency in the community.
Other studies that may be done include survey and interview of healthcare professionals, policy makers, and recovered addicts in order to get more insight into the public health problems of substance abuse and addiction.
