Therefore, referring to addiction as a disease, without specifying when or why a condition is called a disease, results in the automatic association with the BDM. Therefore, it seems best to use disorder and disease both interchangeably to indicate the disruptive nature of addiction without inferring what the cause is of addiction, by explicitly stating that disease does not automatically imply a brain disease. By doing so, the terminology is broad enough to satisfy all of those studying addiction. Perhaps it will lose specificity as such, but since addiction is a highly heterogeneous disorder that requires an individual approach to the cause and course of the disease, it may very well be left more general.
Persistent impacts of smoking on resting-state EEG in male chronic smokers and past-smokers with 20 years of abstinence
Although this phenomenon is not necessarily present in every patient, it reflects important symptoms of clinical addiction, and is captured by several DSM-5 criteria for SUD [101]. Examples are needle-sharing despite knowledge of a risk to contract HIV or Hepatitis C, drinking despite a knowledge of having liver cirrhosis, but also the neglect of social and professional activities that previously were more important than substance use. While these behaviors do show similarities with the compulsions of OCD, there are also important differences. For example, “compulsive” substance use is not necessarily accompanied by a conscious desire to withhold the behavior, nor is addictive behavior consistently impervious to change. Because of this, neurobiology is a critical level of analysis for understanding addiction, although certainly not the only one. It is recognized throughout modern medicine that a host of biological and non-biological factors give rise to disease; understanding the biological pathophysiology is critical for understanding etiology and informing treatment.
The Neurobiology of Addiction: Exploring the Brain’s Reward System
Critics question the existence of compulsivity in addiction altogether [5,6,7, 89], typically using a literal interpretation, i.e., that a person who uses alcohol or drugs simply can not do otherwise. Were that the intended meaning in theories of addiction—which it is not—it would clearly be invalidated by observations of preserved sensitivity of behavior to contingencies in addiction. Indeed, substance use is influenced both by the availability of alternative reinforcers, and the state of the organism. The roots of this insight date back to 1940, when Spragg found that chimpanzees would normally choose a banana over morphine. However, when physically dependent and in a state of withdrawal, their choice preference would reverse [102]. The critical role of alternative reinforcers was elegantly brought into modern neuroscience by Ahmed et al., who showed that rats extensively trained to self-administer cocaine would readily forego the drug if offered a sweet solution as an alternative [103].
Addiction is a disease: We must change our attitudes toward addicts
- No less important will be future research situating our definition of SUD using more objective indicators (e.g., [55, 120]), brain-based and otherwise, and more precisely in relation to clinical needs [121].
- Experience with addiction treatment must surely make us even more dubious about the theory that addiction is a disease.
- The BDM model can help explain why addictive behaviour is more difficult to control in theory.
- It’s important to look at both sides of this argument to understand the different attitudes towards addiction that people hold in society today.
Importantly, he reminds us that drug abuse is a behavioral, or psychiatric, disorder. He also notes that drug abuse is the only psychiatric disorder that has two Federal research institutes dedicated to it, namely the National Institute on Drug Abuse (NIDA) and the National Institute on Alcoholism and Alcohol Abuse (NIAAA). The reason for this comes from three key points regarding how addiction affects an addict. The third point of note is that a person’s risk of addiction rises based on hereditary factors. It is not trivial to delineate the exact category of harmful substance use for which a label such as addiction is warranted (See Box 1).
- Through my work, I have connected with thousands of people in recovery from addiction.
- Many wrongly believe that marijuana, psychedelics, and other psychoactive drugs can improve mental health.
- It shows that it is not the large amount of addiction research in itself what sets the models apart, but rather their extrapolated conclusions.
- However, abuse also extended to those of lower socioeconomic status, largely in the form of opium smoking in “opium dens.” Heyman makes the case that public concern raised by drug abuse among the lower classes set the wheels in motion for governmental responses.
Misconceptions, stigma and ignorance about those who suffer from addiction are widespread. My 9-year-old knows how to recognize the signs of alcohol intoxication and knows that drugs like methamphetamine can alter one’s perception of reality. I am purposely raising my kids to know that it’s not the substance (alcohol or drugs) that is the problem, https://thewashingtondigest.com/top-5-advantages-of-staying-in-a-sober-living-house/ but that other factors make some people more vulnerable to substance use becoming dysfunctional. My kids will all know at a young age that since genetic predisposition accounts for 50 percent of the chance of developing addiction, they are 10 times more likely to develop addiction than their friends without a family history of addiction.
Old Clinical Follow-Up Studies: Empirical Support for the Disease Account
- The self-help industry is booming, which reflects the tendency of so many of us to procrastinate, overeat, skip exercising, and opt for whatever is most convenient.
- Because addiction is such a complex phenomenon, there are many theories about what addiction is.
- The first of the seven chapters provides an overview of the history of drug use and abuse, as well as information about its current prevalence.
- From a psychological standpoint, when this happens the brain has created special pathways for the activity to make it an easier trigger for that positive stimuli within the individual.
As this essay is based on how those we call addicts behave, it would be most efficient to begin with a brief summary of key aspects of the natural history of addiction. In this article, I have focussed on the concept of addiction in order to highlight and overcome some confusion and controversy regarding the addiction-debate. At the start, I attempted to provide a neutral definition of addiction that steers clear of normative conclusions and assumptions, which could be accepted by a majority of addiction researchers. Such a definition is recommended in order to research addiction from unbiased premises. Afterwards, it was shown that when highlighting the commonalities of the BDM and the CM, these models are not always as antithetical as they seem.
The neurobiology of drug addiction: cross-species insights into the dysfunction and recovery of the prefrontal cortex
To strive for a universal model and application of it, therefore, does not do justice to the heterogeneity of the individuals involved. Increasing access to treatment and support is crucial for individuals with addiction to recover. This can include improving insurance coverage for addiction treatment, expanding the availability of medication-assisted treatment, and increasing funding for community-based support programs. Blaming and punishing individuals with addiction is not effective and can be harmful.
The Ethics of Blaming and Punishing Individuals with Addiction
Heyman notes appropriately, however, that 3% yields a very large absolute number of individuals. He also points out an interesting exception; American military men who served in Vietnam showed an astonishing 40% rate of addiction to opiates following their use. One, the high rate of opiate addiction among Vietnam veterans highlights the fact that understanding a drug’s action at the neuronal level is not sufficient to account for the facts of drug abuse. Two, and this comes later in the book, opiate addiction in Vietnam veterans may have implications for the study of addiction in broader populations.
These are the two sides of the addiction debate, and which side wins plays a critical role in how medical professionals should approach addiction treatment. The present paper is a response to the increasing number of criticisms of the view that addiction is a chronic relapsing brain disease. In many cases, we show that those criticisms target Sober House tenets that are neither needed nor held by a contemporary version of this view. Common themes are that viewing addiction as a brain disease is criticized for being both too narrow (addiction is only a brain disease; no other perspectives or factors are important) or too far reaching (it purports to discover the final causes of addiction).