Human World

Addiction now defined as chronic disease of the brain

What is addiction? Whatever you may have thought, the official definition of it has now officially changed. According to the American Society of Addiction Medicine (ASAM), addiction is not a behavioral problem but instead is a “primary, chronic disease of brain reward, motivation, memory, and related circuitry.”

In other words, it’s all in the head, in that physical, electrochemically signaling bundle of nerves we call the brain.

What happens in that bundle of nerves to produce addiction? Many parts of the brain interact to form the outward signs of the disease. Your smart parts in the front of your brain engage with the parts involved in memory and motivating and rewarding you to form the circuitry of addiction. What emerges from all of this anomalous neuron talk are the problems with impulse control (grab a drink!), altered judgment (one more can’t hurt!), and the pursuit of the object of addiction in spite of negative outcomes (drinking until 4 a.m. even if you have to be at work four hours later).

A key factor in identifying addiction is the “pathological pursuit of reward” or some other form of release through substance use or behaviors. The smart parts at the front of your brain are supposed to be the chaperone wagging a finger and saying “No.” When they don’t do that, a person with an addiction may pursue the object of the addiction to the exclusion of everything we typically consider important: life, family, love, work, food. Whatever that object is – alcohol or other drugs, gambling, pornography, Internet use – the reward and release it brings trump everything else.

Unfortunately, those chaperoning circuits don’t fully mature until you’re an adult. Interfering with their maturation through exposure to addictive substances or activities in the teens can warp their communication with the other parts of the brain involved in addiction. The result? Hardwiring of the circuitry that results in the “primary, chronic disease of brain reward, motivation, memory, and related circuitry.” The circuits are set to override or bypass that chaperone saying “No.”

Your genes are no help, either, if you inherit genes that predispose you and your brain to establishing that anomalous circuitry. According to ASAM, genes are about 50 percent responsible for the development of addiction. Environmental factors, including culture, form the other 50 percent. What the ASAM definition changes, they hope, is the cultural stigma associated with addiction. By designating it as a brain or neurobiological disorder – which it is – ASAM aims to de-stigmatize addiction and remove issues of morality or blame from something that is obviously a disease.

What remains unclear, however, is whether or not this change in terminology will have the desired effect. As Maia Szalavitz writes for, such changes in terminology can even exacerbate negative perceptions of those with the disease of addiction.

Internet addiction relies on the same interacting pathways of memory, motivation, and reward as other addictions. Photo credit: Michael Mandiberg

What does the change in definition mean when it comes to treatment for addiction? Szalavitz notes that “emphasizing recovery and resilience is probably more useful than focusing on definitions of brain disease.” Current practice already tends to focus on these factors, and the new definition emphasizes what many therapists and other medical professionals already have long known. Possibly more important, however, the research that brought the world this new ASAM definition reflects decades of findings all pointing to the same conclusion: Addiction is a problem with brain circuitry, not a moral, ethical, or behavioral issue. That same research may bring therapeutic breakthroughs, including drugs targeting those circuits or the chemical imbalances that perpetuate them. Definitely an improvement over the historical view of anyone with an addiction as flawed, immoral, and out of control.

August 21, 2011
Human World

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