Harms and benefits of discussing the brain disease model of addiction in therapeutic settings

INTRODUCTION: Discussion of the brain disease model of addiction in clinical settings could harm or benefit the expectations held by treatment-engaged persons who use drugs (PWUD) regarding their therapeutic outcomes, but no study has experimentally tested this. METHODS: Thirty-four PWUD who were engaged with Waythrough drug and alcohol recovery services were interviewed. Utilising methods from consumer psychology, PWUD were asked to imagine brain disease and social stress models of addiction being discussed in two hypothetical therapist led support groups (in counterbalanced order within-subjects) and rate the therapeutic outcomes they expected would arise from each group. RESULTS: Participants agreed less with the brain disease model (d=0.37) and expected its discussion would reduce their likelihood of recovery (d=0.57), their therapeutic alliance with the facilitator and group peers (d=0.43), and self-blame for their addiction (d=0.40), compared to if the social stress model was discussed. Differences between conditions in expected quitting effort (d=0.29), adaptive coping (d=0.28), and negative self-perception (d=0.05) were not statistically significant. CONCLUSIONS: Treatment-engaged PWUD expected that discussion of the brain disease model of addiction in a hypothetical support group, compared to the social stress model, would harm their recovery chances and therapeutic alliance but benefit them by reducing self-blame for their addiction. Numeric effects on quitting effort and adaptive coping need replication with a larger sample. The null effect on negative self-perception informs theories of self-stigma. The study provokes reflection on how scientific addiction models are incorporated into clinical discourse to maximise clients' recovery capital and avoid inadvertent epistemic harms.