Why Is Addiction Considered a Disease?

Addiction is a chronic and relapsing disease of the brain, with both the American Medical Association and the American Society of Addiction Medicine (ASAM), and the American Psychiatric Association concurring on this. Recently, ASAM clarified its definition of addiction as follows:

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.

People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.

Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.

Adopted by the ASAM Board of Directors September 15, 2019

While the idea of addiction as a disease may be a difficult concept to grasp, science has borne this out as fact.

As brain mapping and neural technologies continue to advance, evidence continues to support the belief that addiction is a chronic but treatable brain disease.

Just as lifestyle choices can contribute to diseases such as diabetes, heart disease, or lung cancer, the same logic can be applied to the discussion of addiction.

Each day, adults have the opportunity to choose wisely when considering various lifestyle options. In our humanness, we may choose the hamburger more often that a spinach salad. We may be reluctant to give us smoking, or indulge our sweet tooth too often when we know we should limit sugar intake.

Where some individuals that consistently make less than stellar lifestyle choices may end up with a serious medical condition as a result, others, making the same poor choices, are able to avoid any health ramifications at all.

The genetic predisposition to acquiring a disease based on unwise lifestyle choices is no different with a substance use disorder. Many people flagrantly abuse drugs and alcohol and do not end up with a chemical dependency, where others with the genetic predisposition for addiction do.

Genetics prewire us, influencing in a significant way how our brain will respond to the introduction of a substance. For example, it may come as a total surprise to someone who drinks the same amount of alcohol as their peers that they are the one who acquires an alcohol use disorder.

Why? Because they were, unknowingly, genetically predisposed to alcoholism. Often, by the time it becomes clear that there is a problem it the brain has already become altered by the substance.

Consider opiate addiction. A flood of dopamine is experienced when opiates are ingested, hence the euphoric high that results. In response to the consistent presence of the opiate, the brain’s reward center comes to expect the substance, and begins to produce less and less natural dopamine.

This alters brain pathways and chemistry, making the individual a prisoner to the drug. Increased tolerance to the opiate causes the individual to use higher and more frequent dosing, only further impacting brain chemistry.

As addiction takes hold, any attempt to withhold the substance results in highly unpleasant withdrawal symptoms.

At some point in the addiction continuum toward chemical dependency, the individual loses all control over the substance. Regardless of the mounting negative consequences, which severely impact all aspects of life, the addict finds him or herself a slave to the constant drug cravings.

The brain expects the next dose, and if it is not forthcoming the individual becomes violently ill. The disease of addiction has thereby resulted from either the initial unwise choice to misuse opiates, or as the natural progression of chemical dependency through using prescription opioids legitimately.

There is still mystery surrounding the disease of addiction. Why is it that some individuals can engage in substance misuse, even for a prolonged period, without ever becoming addicted or dependent on the substance?

Science has yet to definitively identify the exact factor that makes the difference. There are several factors that may play into someone developing an addiction to drugs or alcohol. These include:

• Brain chemistry
• Began using alcohol, drugs or nicotine at an early age
• Genetics. Some individuals have a family history of addiction, indicating a genetic predisposition towards developing the problem.

• History of physical or sexual abuse, trauma exposure, or growing up in a home where family members engaged in substance abuse
• Personality traits, such as gravitating toward high-risk behaviors, impulsivity, or having a mental health disorder

Of all the identified factors that might determine who will become addicted to a substance, genetics is believed to be the most influential. Interestingly, behavioral addictions that also result in compulsive actions, such as gambling, shopping, or work, or pornography, may share similar genetic and personality components to substance addiction.

The disease of addiction evolves over time. There are typically triggers that lead to the compulsive urge to use a substance, including legitimate triggers such as pain following an injury or surgery.

As tolerance increases, more of the substance will be required to obtain the initial effects, such as pain relief, relaxation, euphoria.

Increased consumption can then result in altered brain pathways and chemistry, and ultimately addiction. The signs of addiction include behavioral, psychological, and physical symptoms:

• Engaging in high-risk behaviors, such as driving under the influence
• Avoiding social events
• Loss of interest in usual hobbies and past-times
• Secretive behaviors
• Lying about how substance consumption, hiding substances at home, in the car, or at work
• Doctor shopping (prescription narcotics)

• Drug or alcohol cravings
• Obsessed about having enough of the substance on hand
• Unable to limit consumption, or to stop, even when desiring to stop
• Neglecting responsibilities or obligations in favor of substance use
• Unable to quit the substance, regardless of mounting negative consequences

• Health problems due to the substance abuse
• Lack of personal hygiene
• Sleep disturbances
• Weight loss or gain in a short period of time
• Change in appearance, bloated, pinpoint pupils, dilated pupils
• Withdrawal symptoms when substance is withheld

According to the Center on Addiction, approximately 25%-50% of people with a substance use disorder have a severe, chronic disorder. This is indicative of the disease model of addiction, which often involves a progression of the disease and relapses when attempting to abstain.

Someone with the disease of addiction will need to engage in ongoing, continuing treatment in order to manage it. Detoxification, rehabilitation, medication support, and ongoing continuing care efforts can be effective in managing the disease.

A significant number of individuals struggling with addiction also have mental health comorbidity. This refers to a mental health disorder that co-occurs with the substance use disorder.

For example, someone with an anxiety disorder may have a co-occurring benzodiazepine addiction.

Likewise, someone battling alcoholism may have coexisting depression. When there are both a substance use disorder and a mental health disorder present simultaneously it is referred to as a dual diagnosis.

It is essential that the individual receive treatment for the co-occurring mental health disorder at the same time as the addiction treatment.

The mental health disorder must be managed in order to achieve a sustained recovery from substance use disorder. Someone with co-occurring disorders should seek out an addiction recovery center that provides the psychiatric component for dual diagnosis treatment.

Treatment of a drug or alcohol addiction requires a multi-pronged approach, which will be designed for the individual during the intake process.

During intake, the clinical staff will conduct a thorough assessment to determine the exact diagnosis, as well as any specific or unique features that should be addressed during treatment.

Using this information, a customized treatment plan is devised.

Therapeutic interventions include:

• Detox. Detox allows the body to expel all residual toxins associated with drugs or alcohol.
• Psychotherapy. Evidence-based therapies include cognitive behavioral therapy, dialectical behavior therapy, contingency management, and motivational enhancement therapy.

• Medication support. Medications that help the individual stabilize in early recovery include naltrexone, buprenorphine, and methadone.
• Peer or family group sessions. Small group therapy sessions focus on improving communication and relating skills.
• Psychosocial education. Life skills classes, recovery tools, and relapse prevention are taught.

• Nutrition and Exercise. An emphasis on eating nutritiously to help restore health, and on getting physical activity are complementary to treatment
• Holistic methods. Activities that promote relaxation and stress reduction can be helpful during treatment and in recovery long-term. Including yoga, meditation, mindfulness, deep breathing, and massage therapy.

• Recovery meetings. Recovery communities, such as A.A., N.A., and SMART Recovery provide an important source of social support.
• Aftercare. Post-rehab activities that support sustained sobriety include sober living housing and outpatient therapy.

While true that addiction is a chronic, progressive, relapsing disease of the brain, it is also true that, like many diseases, it can be managed and even reversed to a degree. Recovery success depends on a lifelong commitment to sobriety and emotional wellness.