Addiction – a brain disorder say experts

By Dr. Ananya Mandal, MDAug 17 2011

According to the American Society of Addiction Medicine, addiction is a chronic brain disorder like any other chronic brain disease such as obsessive-compulsive disorder and body dysmorphic disorder. Neurological abnormalities like disruptions in neurotransmission and the reward system drive addiction, the group said in a statement.

ASAM past President Michael Miller said, “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.” The statement added that addiction is not enabled by another primary disease and is in fact the primary disease.  The illness “hijacks” the brain's reward system and murders impulse control, the statement also said. Genetic factors are responsible for half of the likelihood that a patient will become an addict.

Miller explained, “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…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.” Treatment should include psychosocial rehabilitation, the statement said.

Authors add that the focus and insight into neurological underpinning of behavioral disorders such as addiction has been accelerating in the past years due to huge advances in brain imaging and neuroscience. The ASAM policy statement was based on a four-year process involving more than 80 experts and “extensive dialogue” with the National Institute on Drug Abuse.

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.

“The behavioral problem is a result of brain dysfunction,” agrees Dr. Nora Volkow, director of the National Institute on Drug Abuse. She welcomed the statement as a way to help her own agency's work to spur more primary care physicians to screen their patients for signs of addiction. NIDA estimates that 23 million Americans need treatment for substance abuse but only about 2 million get that help.

Then there's the frustration of relapses, which doctors and families alike need to know are common for a chronic disease, Volkow said. “You have family members that say, 'OK, you've been to a detox program, how come you're taking drugs?'…The pathology in the brain persists for years after you've stopped taking the drug.”