What is Addiction?

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What is addiction? – This question has finally been answered comprehensively by The American Society of Addiction Medicine (ASAM). In 2011 they released the latest definition of addiction after a four year process involving more than 80 experts, defining addiction as a disorder involving many brain functions, mainly an imbalance in the reward circuitry. This imbalance creates a problem experiencing pleasure and compels people to seek ways to boost their pleasure related brain chemistry by using substances.

The human reward system is designed to support survival however over time it is hijacked by the chemical payoffs provided by substances and addictive behaviours. The reward circuit bookmarks things that are important: E.g. food, nurturing children, earning money, sexual intimacy, achieving goals etc. However the substance use or particular behaviour starts taking priority over what really promotes survival. Addiction is a condition that permanently changes the way our brain works and requires intensive work to reverse its hold over a sufferer. Consequences of this condition range from loss of Jobs or relationships to life threatening situations, and are described as Biological, Psychological, Physical and more recently accepted as spiritual also.

What is Addiction?

ASAM: Public Policy Statement: Definition of Addiction

“Short Definition of Addiction: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviours. Addiction is characterized by inability to consistently abstain, impairment in behavioural control, and craving, diminished recognition of significant problems with one’s behaviours and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death”

The “destructive and unhealthy” behaviours themselves are all symptoms of what is addiction to the sufferer. The Doctors believe the state of addiction is not the same as the state of intoxication or even physical dependency; Substance misuse is often considered a form self-prescribing, enabling people to temporarily escape from the problems and other conditions that trouble them such as stress and/or anxiety through to mental health disorders, however the relief is short-lived and more problems result from the using itself.

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Group room 1 - What is addiction?

Common symptoms

Compulsive behaviour
Reward seeking (pleasure)
Relief seeking (escape)
Impaired decision making
Anxiety (fear)
Low Stress threshold (sensitivity)
Impaired emotions (moods swings)
Alcoholic agoraphobia and isolation
Depression (decreased motivation)
Low Boredom threshold
Low self esteem and low self worth

Specialists see the latest ASAM definition as conformation of what has since the publication of Alcoholics Anonymous in 1939, come to be commonly known as “the disease concept” Many people see addiction as a moral, social or self inflicted, however understandable this is it’s a dangerous mistake. The World Health Organisation and many other respected professional bodies have also recognised Alcoholism as an illness since the 1950’s.

Medical help: Don’t be confused about addiction, it cannot be cured in a traditional medical sense, it is best viewed as chronic condition like Diabetes. Treatment means addressing psychological, environmental and social aspects (triggers) of the problem, not just its biological condition.

Medical treatment in this field is known as “medication-assisted therapy” not “therapy-assisted medication.”  Medication alone fails in the long-term. An analogy is with depression, if you ask people what depression is, they’ll say it’s a serotonin deficiency and that the solution is to prescribe antidepressant medication. This is a simplistic and short-term way of managing depression. Medication can be helpful however it needs to be combined with talk therapy and lifestyle change. Also humans become tolerant to all drugs and medication so a sustainable long-term solution is needed. There is no pill, which can cure addiction, so choosing a recovery lifestyle over unhealthy behaviours is the same as people with heart disease who choose to eat healthier or begin an exercise program.

The term dependence and the term addiction have been interchangeable in recent times, however the latest medical thinking is that Substance dependence can be a symptom of addiction, not the addiction itself, the cause is the brain chemistry deficit that pre-exists it, low dopamine levels. And the same goes for substance-abusers who binge occasionally for example. The reason for making this distinction is not to exclude people who do not form a physical-dependency and to include those users of non-physically-addicting substances like stimulants, as they are equally compulsive and problematic.

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What is Addiction Brain Chemistry?

Understanding the role of the neurotransmitter-dopamine in addiction is helpful: Low dopamine levels can not only cause addiction but depression, loss of satisfaction, poor focus and many other symptoms.

What causes low Dopamine levels?  Dopamine levels are depleted by stress, certain antidepressants, drug use, poor nutrition, poor sleep and genetic predisposition. People with addictions are low on dopamine.  A low dopamine level causes us to unconsciously seek out dopamine raising drugs and behaviours and get addicted to them. All drugs of addiction and addictive behaviours stimulate dopamine release or increase its activity and produce the hedonic response, “I like that” motivation, incentive stimulus and goal directed behaviours.

What causes low Dopamine and what is addiction? No one is completely sure however a reasonable assumption is our early environment and development plays a role and Genetic makeup is also believed to be a contributing factor in many cases however the important issue is it cannot be removed.