31 Aug Addiction as a Brain Disorder
A new definition for addiction has initiated a lively discussion among experts as to where emphasis ought to be placed when describing the condition. The American Medical Association categorized alcoholism as a disease over 50 years ago, but until recently, addictions have been defined largely in behavioral terms.
Following four years of consideration by 80 experts, our American Society of Addictive Medicine (ASAM) now defines addiction as “…a primary, chronic disease of motivation, brain reward, memory and related circuitry … with characteristic bio-psycho-socio-spiritual manifestations.”
The definition shifts emphasis away from behaviors and focuses more on brain dysfunction. There is certainly a weight of evidence demonstrating the brain changes which occur in addicts. Twenty years of neuroscience has proven that chemical changes in the brain can help explain the difficulty a person experiences when trying to break free of addictions even after detox and treatment. And the propensity for teens, who have immature frontal cortexes, to make poor choices makes them a particularly vulnerable population for developing addictions.
Part of the motivation for developing a new definition of addiction was a desire to remove the stigma associated with the label. Just how successful the attempt will prove is up in the air.
In 2010, the American Journal of Psychiatrists released a study involving 630 participants polled concerning opinions on alcoholism. The participants were interviewed in 1996 and again in 2006. The number of those surveyed who believed that alcoholism was a brain disorder rose over the 10 years from 38 percent to 47 percent. However, the increased belief that alcoholism was brain-related did not produce a decrease in the stigma attached to the condition. On the contrary, the percentage of people who felt that alcoholism was connected to poor character increased from 49 percent to 65 percent.
In a similar vein, psychiatrists at the University of Nevada uncovered negative associations with the words “disease” and “chronic.”
Critics have also taken issue with the ASAM’s inclusion of spirituality in its description. That addiction can be connected to genetic (bio), social (socio) and emotional (psycho) conditions has also been established through research. Some, however, take objection to the inclusion of references to beliefs about God as part of the definition. Such beliefs hold no position in definitions of other chronic diseases like cancer, diabetes or depression. Those opposed to the spiritual component of ASAM’s definition say that addiction is a medical disease affecting the brain separate from any belief system related to God.
Defining addiction only in terms of brain disease, similar to heart disease or diabetes, could be problematic for another reason – plenty of people overcome addictions without any outside treatment or intervention. A study conducted in 2005 surveyed 4,442 alcoholics not currently undergoing treatment for their addiction. When the group was interviewed a year later researchers found that 75 percent of them had improved sufficiently so that they no longer qualified as active alcoholics. Only 25 percent of the group had received outside treatment. Furthermore, there are a far greater number of people who meet the criteria for addiction in their youth and then demonstrate recovery in later years than ever attend 12 step programs or seek treatment from a medical professional.
The National Institute on Drug Abuse says that an estimated 23 million Americans are in need of substance abuse treatment but that only two million Americans actually seek out help. Perhaps greater energy should be directed toward recovery than has so far been spent on disputable definitions.
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