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Addiction Is a Chronic Brain Disease, Not Just Bad Behaviors or Bad Choices
Chevy Chase, MD, August 15, 2011
The American Society of Addiction Medicine (ASAM) has released a new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling or sex. This the first time ASAM has taken an official position that addiction is not solely related to problematic substance use.
When people see compulsive and damaging behaviors in friends or family members—or public figures such as celebrities or politicians—they often focus only on the substance use or behaviors as the problem. However, these outward behaviors are actually manifestations of an underlying disease that involves various areas of the brain, according to the new definition by ASAM, the nation’s largest professional society of physicians dedicated to treating and preventing addiction.
“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”
The new definition resulted from an intensive, four‐year process with more than 80 experts actively working on it, including top addiction authorities, addiction medicine clinicians and leading neuroscience researchers from across the country. The full governing board of ASAM and chapter presidents from many states took part, and there was extensive dialogue with research and policy colleagues in both the private and public sectors.
The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes such as emotional or psychiatric problems. Addiction is also recognized as a chronic disease, like cardiovascular disease or diabetes, so it must be treated, managed and monitored over a life‐time.
Two decades of advancements in neurosciences convinced ASAM that addiction needed to be redefined by what’s going on in the brain. Research shows that the disease of addiction affects neurotransmission and interactions within reward circuitry of the brain, leading to addictive behaviors that supplant healthy behaviors, while memories of previous experiences with food, sex, alcohol and other drugs trigger craving and renewal of addictive behaviors. Meanwhile, brain circuitry that governs impulse control and judgment is also altered in this disease, resulting in the dysfunctional pursuit of rewards such as alcohol and other drugs. This area of the brain is still developing during teen‐age years, which may be why early exposure to alcohol and drugs is related to greater likelihood of addiction later in life.
There is longstanding controversy over whether people with addiction have choice over antisocial and dangerous behaviors, said Dr. Raju Hajela, past president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on the new definition. He stated that “the disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”
“Choice still plays an important role in getting help. While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.
“Many chronic diseases require behavioral choices, such as people with heart disease choosing to eat healthier or begin exercising, in addition to medical or surgical interventions,” said Dr. Miller. “So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment.”
To read the full Definition of Addiction, visit.
Dr. Miller is past president of ASAM. Dr. Hajela is past president of the Canadian Society of Addiction Medicine and is a board member of ASAM. The American Society for Addiction Medicine is a professional society representing close to 3,000 physicians dedicated to increasing access and improving quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addictions.
Understanding Addiction as a Brain Disease
Addiction is a complex condition that affects the brain's reward system, leading to compulsive behaviors and cravings for the substance or behavior. It is often characterized by physical and psychological dependence, tolerance, and withdrawal symptoms when the substance or behavior is taken away.
Research has shown that addiction can cause changes in the brain's structure and function, particularly in the areas related to motivation, decision-making, and self-control. These changes can make it difficult for a person to quit using the substance or engaging in the behavior, even if they want to.
The Impact of Addiction on Physical Health and Wellbeing
Addiction not only affects the brain but also has a significant impact on physical health and wellbeing. Substance abuse can lead to a range of health issues, including liver disease, heart disease, lung disease, and cancer. Injection drug use can increase the risk of contracting infectious diseases such as HIV/AIDS and hepatitis C.
In addition to these physical health problems, addiction can also lead to poor nutrition, lack of sleep, and neglect of personal hygiene. Over time, these factors can contribute to a weakened immune system and an increased risk of infections.
Furthermore, addiction often leads to risky behaviors such as driving under the influence or engaging in unprotected sex, which can result in accidents or sexually transmitted infections.
Overall, it is essential to recognize that addiction is not just a mental health issue but also a physical one that requires comprehensive treatment and support for the individual's overall wellbeing.
Strategies for Preventing Addiction Before It Starts
Preventing addiction before it starts is crucial in reducing the number of individuals who suffer from this chronic brain disease. There are several evidence-based strategies that have been proven to be effective in preventing addiction.
Education and Awareness
One of the most effective ways to prevent addiction is through education and awareness campaigns. Schools, communities, and healthcare providers can play a crucial role in educating individuals about the risks of substance abuse and addictive behaviors. By raising awareness about the dangers of addiction, individuals can make more informed decisions about their health and wellbeing.
Building Resilience
Building resilience is another strategy that has been shown to be effective in preventing addiction. Resilience refers to an individual's ability to cope with stress, adversity, and trauma. Developing coping skills, building social support networks, and practicing mindfulness are all effective ways to build resilience.
Limiting Access to Substances
Limiting access to substances such as alcohol and drugs is also an important strategy for preventing addiction. This can include policies such as increasing taxes on alcohol or restricting the sale of tobacco products to minors.
Addressing Underlying Mental Health Issues
Finally, addressing underlying mental health issues can also help prevent addiction. Many individuals turn to substance abuse or addictive behaviors as a way of coping with mental health issues such as anxiety or depression. By providing early intervention and treatment for these underlying issues, individuals may be less likely to turn to substances or addictive behaviors as a way of coping.
The Stigma Around Addiction
Despite the growing understanding of addiction as a brain disease, there is still a lot of stigma and misunderstanding surrounding it. Many people still view addiction as a moral failing or a choice and believe that people with addiction should simply "just quit" or "try harder."
This stigma can make it difficult for people with addiction to seek help and can also lead to discrimination and mistreatment. It is important to recognize addiction as a medical condition and to offer support and compassion to those who are struggling with it.
The Importance of Early Intervention in Treating Addiction
Early intervention is crucial in treating addiction and preventing it from becoming a chronic, lifelong condition. The longer a person struggles with addiction, the more difficult it can be to overcome.
Studies have shown that the earlier an individual seeks treatment for addiction, the more likely they are to achieve long-term recovery. Early intervention can prevent the physical and psychological damage caused by addiction from becoming irreversible.
In addition, early intervention can help individuals address underlying mental health issues or trauma that may be contributing to their addictive behaviors. By addressing these underlying issues, individuals can develop healthier coping mechanisms and reduce the risk of relapse.
It is important for healthcare providers, family members, and friends to recognize the signs of addiction and encourage individuals to seek help as soon as possible. Treatment options may include medication-assisted therapy, behavioral therapy, support groups, or a combination of these approaches.
Overall, early intervention is key in treating addiction and improving outcomes for individuals struggling with this chronic brain disease.
Treatment for Addiction
Because addiction is a chronic brain disease, it requires medical treatment and ongoing support. Treatment options may include medication, therapy, and support groups, among others. It is important for people with addiction to work with medical professionals to develop a personalized treatment plan that addresses their unique needs and challenges.
Recovery from addiction is a lifelong process that requires ongoing support and management. This may include continued therapy or support group participation, as well as lifestyle changes and stress management strategies.
Addressing the Root Causes of Addiction through Therapy and Counseling
While treating addiction requires medical intervention, it's also important to address the root causes of addictive behaviors. Therapy and counseling can help individuals identify and work through underlying issues that may be contributing to their addiction.
Therapy can provide a safe space for individuals to explore past traumas, mental health issues, or relationship problems that may be driving their addictive behaviors. By addressing these underlying issues, individuals can develop healthier coping mechanisms and reduce the risk of relapse.
Counseling can also help individuals build skills such as stress management, communication, and problem-solving. These skills can be particularly helpful in preventing relapse by providing individuals with more effective tools for managing stressors in their lives.
Overall, therapy and counseling are important components of comprehensive treatment for addiction. By addressing the root causes of addictive behaviors, individuals can achieve long-term recovery and improve their overall quality of life.
American Society of Addiction Medicine
4601 North Parke Avenue, Upper Arcade, Suite 101
Chevy Chase, MD 20815‐4520
Phone (301) 656‐3920
Fax 301‐656‐3815
Web www.asam.org
Contact
Dan Forman
1-800-392-9186
info@addictiondoctor.org
Conclusion
Addiction is a chronic brain disease that requires medical treatment and ongoing support. It is not a moral failing or a lack of willpower, but rather a complex condition that affects the brain's reward system and can cause changes in structure and function. By understanding addiction as a medical condition, we can support those who are struggling with it and help them to achieve lasting recovery.
