August 17, 2011

Addiction Now Thought To Be ‘Chronic Brain Disorder’

Addiction is not merely a matter of willpower, but rather a chronic brain disorder, said the American Society of Addiction Medicine (ASAM) in its newly released definition of the condition.

The updated classification is aimed at helping families and their doctors better understand the challenges of treating disorder, said ASAM, the nation's largest professional society of physicians dedicated to treating and preventing addiction.

"Addiction is about a lot more than people behaving badly," said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition.

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 ASAM's new definition.

"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. Miller.

"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."

ASAM's new definition is the result of a comprehensive, four-year process that included input from more than 80 experts, including top addiction authorities, addiction medicine clinicians and leading neuroscience researchers from across the United States.

The full governing board of ASAM and chapter presidents from many states took part, and there was extensive dialogue with the National Institute on Drug Abuse (NIDA).

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, and therefore must be treated, managed and monitored over an entire lifetime, the organization said.

Two decades of advancements in neurosciences convinced ASAM that addiction needed to be redefined according to what takes place in the brain. 

Research shows that addiction affects neurotransmission and interactions within the 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 might explain 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 anti-social 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.

"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," he said.

"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."

Dr. Miller noted the similarities between addiction and other chronic diseases, and emphasized the need to avoid blaming those suffering from the condition.

"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."


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