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Dr. Herbart Kleber: Addiction As A Disease

Published November 19, 2019 By Addiction Helpline America

On October 1st, 2019, Google Doodle celebrated the 23rd anniversary of Dr. Herbart Kleber's election to the National Academy of Medicine. The Doodle can be seen here. Kleber was recognized for being the first physician to recognize addiction as a disease. As most scientists and psychiatrists as well as the community at large viewed addiction on an angle of moral failing, Kleber treated his patients with various medications and offered necessary care to prevent relapse.

Following various breakthrough scientific researches, the American Society of Addiction Medicine (ASAM) released a new definition of addiction.

ASAM now defines addiction as:

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.”

Addiction is considered as a disease because it is characterized by an individual’s inability to abstain, control behavior and cravings and lack of cognizance of dysfunctions caused by addiction. It is a chronic brain disease since it involves cycles of relapse and remission. Like other chronic diseases, if left untreated, addiction causes progressive damage to a person’s social, physical, emotional, and psychological life – which, eventually results to disability or premature death.

A key characteristic among substance abuse disorders and behavioral addiction is that, the affected individuals continue to use drugs or engage in addictive behaviors despite being aware of the adverse consequences. Usually, the addicted individuals want to stop but are unable.

Addiction is defined as a primary disease an implication that it is a unique medical condition occurring independently. Though in some cases, addiction is amplified by psychiatric conditions such as PTSD, ADHD, depression, schizophrenia and bipolar disorder.

Like chronic conditions such as diabetes, heart disease, Crohn disease, cancer or Parkinson’s disease, addiction is caused by a combination of several factors. Environmental, biological and behavioral factors are the common risk factors to addiction.

Social and psychological factors drive a person to use addicting substances which, with combination of genetic factors triggers addiction. Understanding the mechanisms under which substance abuse disorders and behavioral addiction occurs assists in designing appropriate recovery programs.

Addiction is a disease because will power is not enough for someone to quit. Even people with strong resolve find themselves shackled in the chains of addiction since it is a process that changes the neural patterns of the brain. Most addicts are helpless and hopeless about overcoming cravings.

Why You Shouldn’t Blame People for Addiction

It does not matter how someone begins using drugs or engaging in behaviors such as gambling, we should not see addiction as a product of moral failing. People make choices about whether to use a substance or engage in an activity. But they have no choice regarding how their brains responds to particular stimulus.

Some people find it easy to stop using substances but others find it rough and sometimes even impossible. The mechanisms underpinning cravings are partly neurophysiologic. Factors including genetics, family relationships and one’s environment predispose people to addiction. These are external factors we have little control about. 

Since the etiology of addiction reciprocates that of other chronic diseases, we should not blame people who become addicts. Rather, we should help them by giving support and guiding them to seek for treatment.

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Is Addiction a Disease or a Choice?

Some people argue that addiction is not a disease because it is all about individual choices. Indeed, the first use of a substance or engagement in a behavior is all about choice. But subsequent compulsive use is caused by altered neuropathic pathways of the brain responsible for reward and motivation.

Episodic use of a substance slowly spirals into addiction. By the time you realize that you have developed dependence on a drug, trying to quit becomes difficult because your brain neurology has changed. However how much you try, compulsion resulting from brain stimuli overcomes your will power.

Chronic diseases such as diabetes and heart disease mostly result from our lifestyle choices – improper diet, lack of exercises etc. But do we consider them a moral failing? Guess not. Like these diseases, addiction may actually be a product of our choices, but it requires treatment to overcome.

Others think addiction is not a disease because some people usually recover on their own. Mild substance abuse disorders can go away when you stop indulging in addicting substances. But people struggling with severe addiction needs intensive treatment accompanied by recovery programs that prevents relapse. 

Let’s discuss the interactions between various neurons, brain stimulus, genetics and a person’s neuropathology to understand why addiction is a disease.

Neuroscience of Addiction

Characteristics of substance abuse disorders and behavioral addiction include impaired control over the addicting substance, preoccupation and use of the substance despite the negative consequences. Addiction affects the prefrontal cortex (PFC)of the brain. PFC regulates the limbic reward areas of the brain and an individual’s executive functions such as self-control, salience attribution and awareness.

Disruption of the proper functioning of the prefrontal cortex is marked by increased amounts of the substance one has to take to achieve the desired effects. Withdrawal syndromes begin to showcase whenever an individual attempt to stop using the addicting substance.

Some people have biogenetic predisposition to addictions; however, early-life traumatic experiences, can also predispose one to addiction. Social factors such as familial norms and peers can also create a ripe environment for developing addiction.

Sensitivity to intoxication and sedative effects as well as the development of tolerance and withdrawal has genetic origins. Research shows that families with history of alcoholism tend to have reward circuitry systems that respond exaggeratively to alcohol. It has also been found that people with the problem of addiction have low-beta endorphin levels. Endorphins are neurotransmitters produced by the body to cope with stress and pain.

Continued use of drugs reduces dopaminergic levels. This causes a person to use more of a drug to achieve the same levels of pleasure. Dopamine is a neurotransmitter that relays the brain’s emotional responses.

As shown in the figure below, addiction affects the prefrontal cortex, nucleus accumbens and ventral tegmental areas (VTA). These are the regions of the brain that control reward and motivation systems.

Figure 1

Naturally, behaviors such as sleeping, eating, and sex are rewarding to the brain. During addiction, the addicting substance or behavior hijacks reward pathways such that the body depends on an external substance/behavior for pleasure.

Therapies aimed for recovery and preventing relapse attempt to rewire the brain’s reward system to its natural system. Treatment programs are designed to help your body reward circuitry to depend on natural physiological responses for reward and motivation.

Ideally, addiction occurs in cycles starting from the initial phases of dependence and compulsive use to advanced phases of desperation use. The more you use an addicting substance, the more you need it thus creating a progressive vicious circle – the hallmark of all addictions.

Figure 2

Understanding that addicts are trapped in a system of drug acquisition to quench persistent reward pattern caused by addiction is essential in providing appropriate treatments. In most cases, people struggling with addiction tend to assume the destructive and alienating effects of addiction. Most addicts enter treatment because of consequences such as spouse threat to divorce, possible job loss, and legal difficulties.

Risk Factors for Addiction

Since addiction is a disease, there are some factors that can explain why some people fall to addiction while others don’t. Some of the risk factors to addiction include:

  • Genetic predisposition – family history
  • Influence from peers and friends
  • The age at which someone starts using drugs
  • Stress and depression
  • Curiosity
  • Drug availability and environment
  • Lack of parental supervision

As discussed earlier, genetics play a role in addiction. This means that some people are more likely to get addicted than others. Also, if you spend much of your time with addicts, you are likely to fall into addiction.

People who start taking substances or engaging in addicting behaviors at an early age are likely to develop substance abuse disorders. Stress can drive people to using substances that gives false sense of pleasure. Repeated use of these substances to avert stress leads to stress.

Some people might just be curious of the feeling ‘high’ effect. One or two tests of drugs can quickly spiral into dependency and into addiction. People living in disoriented families are also likely to engage in drug abuse than those living in functional families.

Effects of Addiction

Substance abuse disorders and behavioral addictions are associated with various short and long-term effects.

The short-term effects of addiction include:

  • Withdrawal syndrome
  • Anxiety
  • Aggression and irritability
  • Weight loss
  • Strained family relationships
  • Abandoning long-term friendships
  • Cravings and impaired judgment
  • Euphoria

Long-term effects of addiction can be classified as social, physical, mental or financial. Long-term use of certain substances can lead to neurological impairment opening a channel for mental illness.

Some of the physical effects of addiction include:

  • Organ damage
  • Diseases e.g. HIV/AIDS, cancer, gastrointestinal disease etc.
  • Prenatal and fertility issues
  • Hormonal problems
  • Malnourishment

Mental issues associated with addiction include:

  • Depression and anxiety
  • Memory loss
  • Mood swings
  • Psychosis
  • Aggression and paranoia

Legal and social long-term effects of addiction include:

  • Divorce
  • Financial difficulties
  • Job loss
  • Suicide or homicides
  • Heavy fines and jail-term sentences

The affected individuals can experience some or many of these effects depending on the type of addicting substance and the nature of addiction. As addiction takes a toll on one’s life, the consequences are dire and unconcealable.

Overcoming Addiction

You can get help from the disease of addiction by seeking professional assistance from certified therapists and psychiatrists. Addiction is reversible but the recovery journey can be long marked by issues of relapse and remission.

The first step in overcoming addiction is recognizing that you have a problem and seeking assistance. After detoxification process, you can choose inpatient, outpatient or residential treatment option. Choice of treatment method depends on severity your specific addiction, your job, your preferences, family support and finances.

Addiction is a neuropathological problem and not a choice. It is about how substances and behaviors change the reward and motivation neurological functions of the brain. If you are struggling with addiction, finding professional help from family therapy sessions, support peer groups, or rehab centers can help you start the recovery process. The earlier you start, the better.

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