There remains considerable debate about the nature of addiction, even among addiction psychiatrists. On one side stand those who see addiction as a chronic and relapsing brain disease characterized by intense cravings and compulsion to which the individual with addiction has no choice but to relinquish control. On the other side stand those who see addictive behavior as a choice – a constrained one perhaps, but fundamentally an intentional and conscious act subject to self-control. Both views carry intuitive appeal but also seem to conflict with one another and raise challenging questions. If addiction is a brain disease, how can we hold people responsible for addictive behavior? If addictive behavior reflects choice, how can we explain recurrent akrasia (acting against one’s best judgment) in the face of self-destruction? The practice of addiction psychiatry often benefits from educating patients and the public about addiction, and treatment decisions are often informed implicitly or explicitly by beliefs about the nature of addiction. Reflecting on how to conceptualize addiction is therefore of practical use to clinicians. In this interactive workshop, we use a series of clinical vignettes drawn from psychopharmacology, psychotherapy, trauma-informed treatment, and the Anglo-American law to examine and challenge our understandings of the nature of addiction. Participants will draw from their clinical experience, neuroscience and behavioral psychology knowledge, and philosophical/ethical reasoning to work through these cases. Throughout, participants will engage in a series of discussions with peers to attain a deeper and more sophisticated understanding of the nature of addiction.

• Consider two different ways of conceptualizing addiction, the advantages and disadvantages of each, and how to reconcile them
• Clarify one's own beliefs about the nature of addiction and reflect on how these beliefs influence one's clinical practice
• Practice applying different ways of conceptualizing addiction to optimize clinical care through case discussions that bring together psychopharmacology, psychotherapy, trauma-informed treatment, and the law

• Choice
• Compulsion
• Responsibility