Addiction=Disease

Addiction now defined as brain disorder, not behavior issue
Decades of research convinced American Society of Addiction Medicine to change definition
  - updated 8/15/2011 1:15:01 PM ET

  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 problems. 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.