On October 1, 2019, Google Doodle celebrated the 23rd anniversary of Dr. Herbart Kleber’s election to theNational Academy of Medicine. 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 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 in disability or premature death.
A key characteristic of 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 PSTD, 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 common risk factors for addiction.
Social and psychological factors drive a person to use addicting substances, which, with a 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.
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 participate in an activity. But they have no choice regarding how their brains respond to a 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 of.
Since the etiology of addiction reciprocates that of other chronic diseases, we should not blame people who become addicts. Instead, we should help them by giving support and guiding them to seek treatment.
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 a dependence on a drug, trying to quit 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 exercise, 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 need intensive treatment accompanied by recovery programs that prevent relapse.
Let’s discuss the interactions between various neurons, brain stimulus, genetics, and a person’s neuropathology to understand why addiction is a disease.
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.
Increased amounts of the substance one mark disruption of the proper functioning of the prefrontal cortex has to take to achieve the desired effects. Withdrawal syndromes begin to showcase whenever an individual attempts to stop using the addicting substance.
Some people have an abiogenetic 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 a 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.
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 stages 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.
Understanding that addicts are trapped in a system of drug acquisition to quench persistent reward patterns 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.
Since addiction is a disease, some factors can explain why some people fall to addiction while others don’t. Some of the risk factors to addiction include:
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 use substances that give a false sense of pleasure. Repeated use of these substances to avert stress leads to stress.
Some people might be curious about 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.
Substance abuse disorders and behavioral addictions are associated with various short and long-term results.
The short-term effects of addiction include:
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:
Mental issues associated with addiction include:
Legal and social long-term effects of addiction include:
You can get help from the disease of addiction by seeking professional assistance from certified therapists and psychiatrists. Addiction is reversible, but issues of relapse and remission can long mark the recovery journey.
The first step in overcoming addiction is recognizing that you have a problem and seeking assistance. After the detoxification process, you can choose inpatient, outpatient, or residential treatment options. The choice of treatment method depends on the 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