We’ve been saying it for years – addiction is a disorder of the brain and not a matter of personal choice. Modern medicine is fully embracing this reality and we hope it will lead to more humane treatment of the sufferers of alcoholism and drug addiction.
Addiction experts have released a new definition of addiction, describing it as a chronic brain disorder and not just a behavioral problem. This new definition from the American Society of Addiction Medicine (ASAM) applies to multiple addictions, including gambling, compulsive eating and sex in addition to alcohol and drugs. It was formulated following a four-year process that involved more than 80 experts.
The new “long definition” of addiction describes it as a primary
disease, meaning it is not a symptom or effect of other psychiatric or
emotional issues. Like diabetes and cardiovascular disease, the new
definition says that addiction is a chronic disorder that must be
treated and monitored over an entire lifetime. The definition also
recognizes the role of genetics in determining who will be vulnerable
Addictionologist Kevin McCauley told us: “Addiction is a chronic brain disorder and not just a behavioral problem.”
The new “long definition” of addiction describes it as a primary disease, meaning it is not a symptom or effect of other psychiatric or emotional issues. Like diabetes and cardiovascular disease, the new definition says that addiction is a chronic disorder that must be treated and monitored over an entire lifetime. The definition also recognizes the role of genetics in determining who will be vulnerable for addiction.
Dr. Raju Hajela, leader of the ASAM committee that formed the new definition, released a statement saying that although addiction is a disease and not a choice, people who are suffering from addiction do have the power to choose recovery. When people who are suffering from addiction seek recovery treatment, it is the equivalent of someone with genetic heart disease choosing to exercise and eat a healthy diet in addition to seeking medical and surgical interventions.
Addiction is not a choice but people who are suffering from addiction do have the power to choose recovery.
The new definition is meant to supplant the American Psychiatric Association’s definition of “substance dependence” (instead of “addiction”) in the standard Diagnostic and Statistical Manual of Mental Disorders (DSM). It was prompted by research into addiction that has taken place over the past two decades. Researchers have found that addiction is tied to the brain’s reward circuitry so that thinking about previous experiences with an addictive substance or behavior can trigger strong cravings and lead to further addictive behavior. The areas of the brain that govern impulse control and judgment are modified by addiction, causing affected individuals to purse addictive behavior regardless of the consequences. Thinking, feeling and perceptions are distorted by addiction.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, welcomes the new definition and hopes it will motivate primary physicians to screen patients for signs of drug addiction. NIDA statistics show that about 23 million Americans need treatment for substance addiction but only 2 million per year receive help. Defining addiction as a chronic disease will also help set expectations for relapse, which Dr. Volkow says is often difficult to understand for the families of people who undergo addiction treatment.
Dr. Michael Miller, past ASAM president who worked with the committee that developed the new definition, would like to see the focus on addiction shift from social, moral and criminal issues to the underlying neurological problem. The definition says that addiction is not about substances or the quantity or frequency of use – it’s about brains. According to Dr. Miller, it’s time to stop moralizing and blaming people who have the disease of addiction and start creating opportunities for proper treatment.