Is Addiction a brain disease?
Addiction and alcoholism treatment specialists see the latest ASAM definition as a validation of what has, since the publication of Alcoholics Anonymous in 1939, come to be commonly known as “the disease concept” of addiction. “Many people in the population at large see addiction as a moral, social or chosen problem; however understandable this is, it is a dangerous mistake. The world health organisation and many other respected professional bodies have also recognised “Alcoholism” as an illness since the 1950’s.
Is Addiction a brain disease?
The Disease concept and the medical modal: Don’t be confused, addiction cannot be cured in the traditional medical sense or in a Hospital. Treatment of addiction and alcoholism means addressing psychological, environmental and social aspects (triggers) of the problem, not just its biological condition. It’s called “medication-assisted therapy” not “therapy-assisted medication”
Humans become tolerant to all drugs/medication so a sustainable long-term solution must be found. Addiction is like cardiovascular disease or diabetes, recognized as a chronic disease, it must be treated, managed and monitored over a person’s lifetime because there is no pill which alone can cure addiction, so choosing “a recovery lifestyle” over unhealthy behaviours is akin to people with heart disease who choose to eat healthier or begin exercising.
NOTE: The human reward system is designed to support survival and has been hijacked by the chemical payoff provided by substance use or addictive behaviours. The reward circuitry bookmarks things that are important: eating food, nurturing children, having sex, sustaining intimate friendships. Use of the substance then starts to happen at the expense of what otherwise would promote survival. Addiction is a condition that changes the way our brain works.
So a quick “Detox” (the acute phase) will certainly never be a lasting answer, it’s a quick fix like the using itself, or “flight to health” as we say and cannot replace addiction and alcoholism treatment. The alcoholic/addict in the longer-term is like a rat that has become habituated by a scientist, to choosing cocaine over food. The rat in the short-term cannot control the neurological impulse to choose the cocaine! The rat will continue to seek it, ignoring food and water! The rat’s nerve-impulse to use the cocaine has nothing to do with free will. The addict cannot control these spontaneous overwhelming neurological impulses to use, any more than the rat can in the short-term.
The neurological impulse is called a craving
So Addiction is a brain disease, not about will power or substances or physical dependency. The problems facing addicts, alcoholics, and their families, who come to Hope Rehab, are miserable, painful, and infuriating, often feeling hopeless. But to imagine an addict can just change when he or she wants to is a common misunderstanding, even when physically clean. Addiction is based in physically altered neurotransmitter balances (brain chemistry) and driven by active neural pathways which have been permanently established, and they will not just disappear or stop. The physical dependence on the substances is secondary but also powerful! Although physical withdrawal does not change the underlying Primary neurological addictive disorder it is uncomfortable. After detoxification, long-term overpowering cravings are predictable. These cravings are, in reality, spontaneous nerve impulses. So the early weeks in addiction and alcoholism treatment are when people are most likely to relapse and require a safe place.
Brain chemistry: Understanding the role of the neurotransmitter-dopamine in addiction is helpful so at Hope Rehab Center we teach you about this important subject: 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 is Addiction and Alcoholism?
The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts, defining addiction as…
“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 behaviors.”
The “destructive and unhealthy” behaviour themselves are all symptoms of the addiction, not the disease itself. The state of addiction is not the same as the state of intoxication or even physical dependency; Substance abuse is considered a form self-prescribing or self-medicating, allowing their users to escape temporarily from the condition that troubles them, from simple stress and/or anxiety to mental disorders. However, the relief or highs provided by drugs and alcohol are short-lived.
Common symptoms of active and non-active Addiction
- Compulsive behaviour (low impulse control)
- Reward seeking (pleasure)
- Relief seeking (escape)
- Impaired decision making (distorted thinking)
- Anxiety (fear)
- Obsession (distorted thinking)
- Low Stress threshold (sensitivity)
- Low frustration tolerance (impatience)
- Denial of responsibility or ability to change
- Impaired emotions (moods swings)
- Resentful attitude (blame)
- Co-dependency (expecting too much from others)
- Alcoholic agoraphobia and isolation (protecting and hiding)
- Depression (lack of gratitude and self pity)
- Lack of motivation (fatigue)
- Low Boredom threshold (loss of interest)
- Low self esteem and low self worth
- Self centeredness and narcissistic traits
- Projecting into the future or fantasy