When most of us witness compulsive and harmful behaviors in family members, friends, and even public figures, we generally focus on the use of the substance or the obsession target and their behaviors as the problem.
These noticeable behaviors, however, are really manifestations of a disease involving several areas of the brain, say ASAM authors of the new definition. ASAM is the USA's largest professional society of doctors dedicated to preventing and treating addiction.
Dr. Michael Miller, former president of ASAM, who oversaw the development of the new definition, said:
"At its core, addiction isn't just a social problem or a moral problem or a criminal problem. It's a brain problem whose behaviors manifest in all these other areas. Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It's about underlying neurology, not outward actions."
ASAM says the new definition is the result of a thorough, four-year process with input from over 80 experts, including top addiction authorities, addiction medicine doctors, and eminent neuroscience scientists from across the USA, as well as every member of ASAM's governing board, chapter presidents from several states, and experts from NIDA (National Institute on Drug Abuse).
Addiction is now described as a primary disease - not caused by something else, such as a psychiatric or emotional problem.
Addiction is also a long-term (chronic) disease, and like other chronic diseases, such as diabetes or cardiovascular disease, treatment and monitoring has to be maintained throughout the patient's lifetime.
Neuroscience research has advanced tremendously over the last 20 years. New findings over the last two decades have convinced experts and ASAM members that the definition of addiction needed to be changed so that the focus is on what is happening in the brain.
In its web site, ASAM stated:
"Research shows that the disease of addiction affects neurotransmission and interactions within reward circuitry of the brain, leading to addictive behaviors that supplant healthy behaviors, while memories of previous experiences with food, sex, alcohol and other drugs trigger craving and renewal of addictive behaviors."
In this disease, brain circuitry that directs impulse control and judgment become altered - the patient has a dysfunctional pursuit of rewards when seeking out, for example, alcohol and other drugs. Early exposure to drugs and alcohol are linked to a higher risk of becoming addicted later in life because this area of the brain is still developing during a human's teenage years.
Whether or not people have a choice over antisocial and dangerous pursuits has been a controversial subject for many years.
Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on the new definition, said:
"The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.
Choice still plays an important role in getting help. While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary."
Dr. Miller said:
"Many chronic diseases require behavioral choices, such as people with heart disease choosing to eat healthier or begin exercising, in addition to medical or surgical interventions. So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment."
Written by Christian Nordqvist