Addiction is now defined as a brain disorder, not a behavior problem

In Mind & Body, Science & Technology
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Addiction is a chronic brain disease (or is it?)

When experts bring out a new definition, an explanation supported by scientific research, reality is redefined. We all feel relieved that the problem is now better understood and will finally be handled appropriately.

Except, when I learned that addiction is being treated as a disease, I instinctively felt ill at ease.

That was when the American Society of Addiction Medicine (ASAM) released new definition of addiction in 2011 after a four-year process involving more than 80 experts, stating that addiction is a chronic brain disorder.

“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 said at the time. “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.”

This new slant on addition and addictive behaviors also meant that people with addictions would no longer be treated as third-rate citizens. This was a positive outcome of the new definition, as we shouldn’t blame or judge a person for a behavior we can observe but don’t have direct experience of.

Back to my uneasiness at addiction being described as a disease. What are the characteristics of disease, and does addiction comply – does addiction show the same characteristics?

“Addiction has very little in common with diseases.  It is a group of behaviors, not an illness on its own.  It cannot be explained by any disease process.”

This is the viewpoint of Dr Lance Dodes a Training and Supervising Analyst Emeritus with the Boston Psychoanalytic Society and Institute and recently retired as an assistant clinical professor of psychiatry at Harvard Medical School.

At Psychology Today Dr Dodes analyzes: “In addiction there is no infectious agent (as in tuberculosis), no pathological biological process (as in diabetes), and no biologically degenerative condition (as in Alzheimer’s disease).  The only ‘disease-like’ aspect of addiction is that if people do not deal with it, their lives tend to get worse.”

ASAM based their definition of addiction on research that had shown that addiction affects the brain’s reward circuitry where memories of previous encounters with things like alcohol or drugs trigger craving for more of the same, leading to addictive behavior. The research also showed that the part of the brain that governs impulse control and judgment altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.

That’s the point. There wasn’t a disease of the brain to begin with. The use substances like alcohol and drugs and engaging in behaviors like gambling or watching porn result in changes in the brain. When those changes are established, the person is addicted. After the changes in the brain, after the behavior.

So, if addiction is a disease, it’s a disease caused by human behavior.