Addiction is a chronic brain disease, not just bad behavior or bad choices.

The American Society of Addiction Medicine (ASAM) has released a new definition of addiction, highlighting that addiction is a chronic brain disorder and not just a behavioral problem involving excess alcohol, drugs, gambling, or sex.  This marks the first occasion of ASAM stating addiction is not solely related to problematic substance use.

When people witness damaging and compulsive behaviors in friends, family, or public figures, the majority only focus on the actual substance use or behavior as the problem. According to ASAM, these outward behaviors are manifestations of an underlying disease that involves various areas of the brain.  

“At its core, addiction isn’t just a social, moral, or criminal problem. It’s a brain problem whose behaviors manifest in all these other ares,” said Dr. Micheal Miller, former president of ASAM. “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.”

The new definition resulted from an intensive four year process with more than 80 experts actively working on it, including: top addiction authorities, addiction medicine clinicians, and neuroscience researchers from across the country.

Addiction is described as a primary disease, meaning that it is not the result of other emotional causes or psychiatric problems. Addiction is also recognized as a chronic disease, like cardiovascular disease or diabetes, so therefore it must be treated, managed, and monitored over a life-time.

Two decades of advancements in neuroscience convinced ASAM that addiction needed to be redefined by what is going on in the brain. The disease of addiction affects neurotransmissions and interactions within the reward circuitry of the brain. This leads to addictive behaviors that supplant healthy behaviors, while memories of prior experiences (food, sex, alcohol, drugs) trigger cravings and renewal of addictive behaviors.

The brain circuitry that governs impulse control and judgment is also altered, resulting in the dysfunctional pursuit of rewards like drugs or alcohol. This area of the brain is still developing during teenage years, which may be why early exposure to alcohol or drugs is linked to a greater likelihood of addiction as an adult.

There has been a longtime controversy if people with addiction have choice over anti-social and dangerous behaviors. Dr. Raju Hajela, chair member of the ASAM committee, stated that “the disease creates distortions in thinking, feelings and perceptions, which drives people to behave in ways that aren’t 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 added, “Many chronic diseas require behavioral choices, such as people with heart disease choosing to eat healthier or begin exercising, in addiction 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.”

SAMHSA recently worked with the behavioral health field to develop a working definiton of recovery that captures the common experiences of those in recovery.

Some of the guiding principles are:

• Recovery is person-driven
• Recovery occurs via many pathways
• Recovery is holistic
• Recovery is supported by peers and allies
• Recovery is supported through relationships and social networks
• Recovery is culturally based and influenced
• Recovery is supported by addressing trauma
• Recovery involves individual, family, and community strengths and responsibility
• Recovery is based on respect
• Recovery emerges from hope

Addiction treatment, including therapy or Suboxone, is offered at Apex Behavioral Heatlh. Dr. Chung, Dr. Ramesh, and Dr. Kwon are our Suboxone providers.