“But What If It Isn’t?” – Exploring Alternatives to the Chronic, Relapsing Brain Disease Model

The great Irish playwright and wit Oscar Wilde (1854-1900) has been quoted as saying “the answers are all out there, we just need to ask the right questions.” Looking at the history of our field, Wilde’s words were exemplified as we questioned the perspective of substance use disorders as moral and pathological failings – a view considered to be an objective reality in the nineteenth century (Harding, 1988; Feehly, 2022). Fast forward to the past few years, the field generally views the disease model of addiction to be the standard-bearing theory (Volkow & Koob, 2015). Simply put, most agree that SUDs are chronic, relapsing diseases of the brain. With Mr. Wilde’s encouragement, one could ask “But what if they aren’t?”