Addiction now defined as brain disorder, not behavior issue.
Decades of research convinced American Society
of Addiction Medicine to change definition
Addiction is a chronic brain disorder
and not simply a behavior problem involving alcohol, drugs, gambling or sex,
experts contend in a new definition of addiction, one that is not solely
related to problematic substance abuse.
The American Society of Addiction
Medicine (ASAM) just released this new definition of addiction after a
four-year process involving more than 80 experts.
“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 also describes
addiction as a primary disease, meaning that it’s not the result of other
causes, such as emotional or psychiatric disorders. And like
cardiovascular disease and diabetes, addiction is recognized as a chronic
disease; so it must be treated, managed and monitored over a person’s lifetime,
the researchers say.
Two decades of advancements in
neuroscience convinced ASAM officials that addiction should be redefined by
what’s going on in the brain. For instance, research has shown that addiction
affects the brain’s reward circuitry, such that memories of previous
experiences with food, sex, alcohol and other drugs trigger cravings and more addictive
behaviors. Brain circuitry that governs impulse control and judgment is also
altered in the brains of addicts, resulting in the nonsensical pursuit of
“rewards,” such as alcohol and other drugs.
A long-standing debate has roiled
over whether addicts have a choice over their behaviors, said Dr. Raju Hajela,
former president of the Canadian Society of Addiction Medicine and chair of the
ASAM committee on addiction’s new definition.
“The disease creates distortions
in thinking, feelings and perceptions, which drive people to behave in ways
that are not understandable to others around them,” Hajela said in a
statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the
disease, not a cause.”
Even so, Hajela pointed out, choice
does play a role in getting help.
“Because there is no pill which
alone can cure addiction, choosing recovery over unhealthy behaviors is
necessary,” Hajela said.
This “choosing recovery” is
akin to people with heart disease who may not choose the underlying genetic
causes of their heart problems but do need to choose to eat healthier or begin
exercising, in addition to medical or surgical interventions, the researchers
said.
“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,” Miller said.
