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This brief is a critique of the brain disease model and many supposed implications of that model. It begins with a brief history of the model and moves to a discussion of the motivations behind the characterization of addiction as a “chronic and relapsing brain disease.” We follow with an enumeration of fallacious inferences based upon the brain disease model, including the very notion that addiction becomes a “brain disease” simply because it has neurobiological correlates. Regardless of whether addiction is labeled a brain disease, the real question, we contend, is whether the behavioral manifestations of addiction are unresponsive to contingencies. We then present an overview of data demonstrating that addiction is a set of behaviors whose course can be altered by foreseeable consequences. The same cannot be said of conventional brain diseases such as Alzheimer’s or multiple sclerosis. The best scientific and clinical data we have do not support the view that addicts are unable to refrain from using substances by choice. By “choice” we mean the product of the capacity to respond to incentive and reasons, which obviously varies among addicts but which are virtually never entirely lost. Data amply show that addicts retain that capacity. Finally, we demonstrate how a decision in favor of the probationer could have significant implications for the future of treatment-based approaches to criminal justice, as well as for criminal responsibility more generally. We conclude that the probationer’s claim should be denied because it rests on refuted scientific premises and will have negative consequences if it is accepted.


Criminal law, probation violation, addiction, substance use disorder (SUD), brain disease model, brain changes, alteration of behaviors, choice, capacity to change behavior, treatment-based approaches to criminal justice

Publication Title

Submitted in Commonwealth v. Eldred, Commonwealth of Massachusetts Supreme Judicial Court

Publication Citation

Submitted in Commonwealth v. Eldred, Commonwealth of Massachusetts Supreme Judicial Court, SJC-12279