"4E" Cognition - A New Approach to Addiction and Recovery

From the 2024 Research to Recovery Conference on April 17-19 at Virginia Commonwealth University.

This lecture summarizes the current state of addiction neuroscience and how its findings validate the lived experiences of people with addiction. The lecture will then address criticism of the Brain Disease Model of Addiction (BDMA) - namely, that it does not address the social and ecological factors crucial to a complete understanding of addiction and recovery. An enactivist approach based on "4E Cognition" goes beyond the brain to explore the role of the body and environment in choice-making and addiction. Focusing on recent developments in psychoneuroimmunology, computational psychiatry, and embodied consciousness, this "4E" approach answers criticisms of the traditional BDMA without losing its explanatory and predictive power.

At the end of this course participants should be able to:

1. Describe the main neuroscientific theories used to explain Substance Use Disorder and addiction symptomology as defined by the DSM-5.
2. Describe and analyze the arguments for and against the brain disease model of addiction (BDMA)
3. Understand how a "4E" approach to addiction answers criticisms of the BDMA

Dr. Kevin McCauley is a Meadows Senior Fellow, joining the Meadows Behavioral Healthcare team in 2016. A 1992 graduate of Drexel University School of Medicine, he first became interested in the treatment of substance use disorders while serving as a Naval Flight Surgeon where he observed the U.S. Navy’s policy of treating addiction as a safety (not a moral) issue and returning treated pilots to flight status under careful monitoring.
After developing his own addiction to prescription opioids, however, Dr. McCauley was court-martialed and imprisoned at Fort Leavenworth, Kansas. There he read voraciously of what was known about the disease of addiction at that time. Today, he has over 15 years of continuous sobriety and has worked in a non-clinical capacity at several treatment centers, giving over 2,000 lectures on the neuroscience of addiction and recovery management. From 2004 to 2008, Dr. McCauley was Director of a level III Recovery Residence in Sandy, Utah, and the first president of the Utah Association for Recovery Residences.
Dr. McCauley wrote and directed two films: Memo to Self, about the concepts of recovery management, and Pleasure Unwoven, about the neuroscience of addiction, which won the 2010 Michael Q. Ford Award for Journalism from the National Association of Addiction Treatment Providers.
Kevin currently lives with his wife, Kristine, in Sedona, Arizona, where he is a graduate student at the University of Arizona School of Public Health.