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Over the past decade, addiction has come out of the shadows and into popular culture as never before. This is a time when the very definition of addiction is hotly contested, and we appear to be a tipping point where the “spiritual” framing of addiction is fast yielding to the “scientific” one. Some of us wonder what has taken so long.
Science rarely progresses in a straight line, and the science of addiction is no exception. Since the mid-1960s, when the approach to substance use disorder began to shake off the dark cloak of moral stigma, the fields of medicine, psychology, neuroscience, sociology and advocacy have, at times, competed and, at other times, collaborated to advance our understanding of the nature, causes, course and, most important, treatment of addiction. As moralism gave way to medicine, so abstinence expanded to include controlled drinking and spontaneous remission. No sooner does one model gain ascendance than cracks appear in its certitudes and it is forced to make room or make way for new thinking.