The Clinical Team at Health Care Resource Centers is our team of physicians and medical directors within the organization. HCRC is a CARF accredited organization and has been providing addiction treatment services for over 32 years in the New England area. Adi Jaffe, Ph.D., is a lecturer at UCLA and the CEO of IGNTD, an online company that produces podcasts and educational programs on mental health and addiction. I don’t wonder why my clients behave the way they do any more than I wonder why they cross the street while looking to the left. In the end it comes down to training, and if we want to end up with a different set of behaviors, we have to understand the mechanisms and processes that got us there and make a change. Politics and pontification aside, am I really so sure that addiction is NOT a disease?
Comment on Heilig et al.: The centrality of the brain and the fuzzy line of addiction
That history deepened my understanding of addiction and helped me make sense of my own experiences. Each person will have a number of biological and environmental risk and protective factors.1 A risk factor is something that puts the individual in more danger of becoming addicted, while a protective factor is something that minimizes that danger. Addiction and physical dependence are often talked about as though they are interchangeable; however, they are separate phenomena that can exist without the other. 3 Someone using their opioid pain medications as prescribed can develop some physiological dependence but may not exhibit the compulsive behaviors of addiction. Conversely, some drugs may be used in a compulsive manner that indicates an addiction without physically relying on it to feel well. With repetition, these bursts of dopamine tell the brain to value drugs more than natural rewards, and the brain adjusts so that the reward circuit becomes less sensitive to natural rewards.
Persistent impacts of smoking on resting-state EEG in male chronic smokers and past-smokers with 20 years of abstinence
Not all individuals with a SUD are addicted to the drug in question, but a subgroup are. At the severe end of the spectrum, these domains converge (heavy consumption, numerous symptoms, the unambiguous presence of addiction), but at low severity, the overlap is more modest. The exact mapping of addiction onto SUD is an open empirical question, warranting systematic study among scientists, clinicians, and patients with lived experience. No less important will be future research situating our definition of SUD using more Sober House objective indicators (e.g., [55, 120]), brain-based and otherwise, and more precisely in relation to clinical needs [121]. Finally, such work should ultimately be codified in both the DSM and ICD systems to demarcate clearly where the attribution of addiction belongs within the clinical nosology, and to foster greater clarity and specificity in scientific discourse. It is important to challenge misconceptions and stereotypes surrounding addiction in order to reduce stigma and improve access to treatment and support.
The Correlates of Quitting and the Role of Treatment
- Regarding clinical diagnosis, as it is typically used in scientific and clinical parlance, addiction is not synonymous with the simple presence of SUD.
- Much of the critique targeted at the conceptualization of addiction as a brain disease focuses on its original assertion that addiction is a chronic and relapsing condition.
- 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).
- Due to the addictive nature of these medicines, they unwillingly became dependent on these powerful drugs by following their doctor’s orders.
- But maybe it robs us of the sense that we can overcome it through our courage and our creativity—something you can hardly do with a real disease.
- I’m used to arguing cleverly that the “disease concept” of addiction is really just a metaphor, and a sloppy one at that.
- Furthermore, efficacy of treatment approaches such as contingency management, which provides systematic incentives for abstinence [107], supports the notion that behavioral choices in patients with addictions remain sensitive to reward contingencies.
Recognizing that addiction is a habit in the scientific sense of the word makes clear that recovery is possible with deliberate action to change, which reverses the changes to the brain. The fact that addiction changes the way the brain works lends credibility to the idea of a lifelong disease, even though, according to the National Institute of Drug Abuse, the changes are “persistent”—which is not the same as permanent. But turning addicts into patients keeps them from doing what is essential for recovery—discovering a personal goal deeply, individually meaningful and rewarding enough to satisfy the neural circuitry of desire.
Experience with addiction treatment must surely make us even more dubious about the theory that addiction is a disease. The most popular way of helping people manage their addictive behavior is Alcoholics Anonymous (AA) and its various 12-step offshoots. This requirement is met by members of AA and other secular programs that help people with addictive behaviors and encourage their members to turn their will and lives over to the care of a supreme being. What kind of disease is this for which the best available treatment is religion (Antze, 1987)? An activity based on a religious belief masquerading as a clinical form of treatment tells us something about what the activity really is–an ethical, not medical, problem in living. Annual U.S. overdose deaths recently topped 100,000, a record for a single year, and that milestone demonstrates the tragic insufficiency of our current “addiction as disease” paradigm.
The participants were interviewed according to a questionnaire designed to produce an APA diagnosis when warranted. For those who currently or in the past met the criteria for “substance dependence” (the APA’s term for addiction), there were additional questions aimed at documenting the time course of clinically significant levels of drug use. Figure Figure11 summarizes the findings regarding remission and the duration of dependence. Commonly, relapse rates may exceed 50% within 6 months of completion of initially successful treatment (McClellan, McKay, Forman, Cacciola, & Kemp, 2005).
- That does not in any way reflect a superordinate assumption that neuroscience will achieve global causality.
- A common criticism of the notion that addiction is a brain disease is that it is reductionist and in the end therefore deterministic [81, 82].
- Both actions are selfish, and the second undermines the goals of the first, which anyone could have foretold.
- Heyman acknowledges genetic contributions, but points out that genetic influence is not a sound basis for concluding that drug abuse is a disease process.
- The roots of this insight date back to 1940, when Spragg found that chimpanzees would normally choose a banana over morphine.
- This is relevant because a common feature of addictive drugs is that they provide immediate benefits but delayed costs.
- The brain changes that occur during addiction can make it extremely difficult for individuals to stop using drugs or alcohol without proper treatment and support.
Symptoms of Addiction
But the proportion of people in the U.S. who use cannabis frequently has increased 15-fold in the three decades since 1992, when daily cannabis use hit a low point. For example, if addiction is a disease, then you must contract it at some point, and then you have it, and then you get treatment, and if the treatment works, then you’re cured. I can talk like that, and I can conclude that those are NOT the characteristic features of addiction. But now I’m not so sure, and I wonder if I’m the one being too superficial https://theohiodigest.com/top-5-advantages-of-staying-in-a-sober-living-house/ to give this matter the attention it deserves. Behind me the camera picked up vague shapes in a dark, messy living room—watching it afterward, I thought I looked like a resident in some unlit chamber of hell, compared to the bright faces in the studio in Toronto. But the real problem was that one of the three other guests was an MD, a psychiatrist, named Peter Selby—a guy who does both research and clinical work at a psychiatric/addiction institute in Toronto, called the Centre for Addiction and Mental Health.
The disease model of addiction suggests that addiction is a chronic, relapsing brain disease. It is characterized by changes in the brain’s reward system, leading to compulsive drug-seeking behavior. According to this model, addiction is not simply a matter of willpower or choice, but rather a complex interaction between genetic, environmental, and neurobiological factors. Addiction involves an initial “honey moon” period, followed by alternating periods of remission and relapse, and then an eventual return to a more sober life. Most addicts quit using drugs at clinically significant levels, they typically quit without professional help, and in the case of illicit drugs, they typically quit before the age of 30. The correlates of quitting include many of the factors that influence voluntary acts, but not, according to Figure Figure1,1, drug exposure once drug use meets the criteria for dependence.