Theories of Opiate Addiction: Time for Pruning

Abstract

Both the United States and Canada have great difficulty achieving consensus on opiate drug policy. This, in some measure, is the fault of the scientific community, which has failed to provide the clear theoretical understanding of opiate addiction from which policy could be readily derived. We believe that the confusing mass of competing theories can be greatly simplified, and a measure of clarity achieved, through consideration of two opposing orientations which pervade the theoretical literature. We label these the “exposure” orientation and the “adaptive” orientation. Recent data shows clearly that the exposure orientation is obsolete. The adaptive orientation, though it fits the new evidence, is scientifically underdeveloped. A major reorientation of research is desirable and would, we believe, eventually provide a firmer basis for policy decisions.