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A New Definition for Addiction

 [Thank you to LiveScience.com for inspiration and materials]

According to a new definition recently released by The American Society of Addiction Medicine (ASAM), addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex.

The (ASAM) definition of addiction comes after a four-year process involving more than 80 experts.

“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,” said Dr. Michael Miller, past president of ASAM and current medical director of the Herrington Recovery Center at Rogers Memorial Hospital in Oconomowoc, Wis. who oversaw the development of the new definition. “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 also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person’s lifetime, the ASAM staff researchers say.

Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what’s going on in the brain. For instance, research has shown that addiction affects the brain’s reward circuitry, such that memories of previous experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.

A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition. With the new findings, the brain appears to play a much larger role than previously believed. “The behavioral problem is a result of brain dysfunction,” suggests Dr. Nora Volkow, director of the National Institute on Drug Abuse.

Just what does happen in the brain? It’s a complex interplay of emotional, cognitive and behavioral networks.

Genetics plays a role, meaning some people are more vulnerable to an addiction if they, say, experiment with drugs as a teenager or wind up on potent prescription painkillers after an injury.

Age does, too. The frontal cortex helps put the brakes on unhealthy behaviors, Dr. Volkow explains. It’s where the brain’s reasoning side connects to emotion-related areas. It’s among the last neural regions to mature, one reason that it’s harder for a teenager to withstand peer pressure to experiment with drugs.

Even if you’re not biologically vulnerable to begin with, perhaps you try alcohol or drugs to cope with a stressful or painful environment, Dr. Volkow says. Whatever the reason, the brain’s reward system can change as a chemical named dopamine conditions it to rituals and routines that are linked to getting something you’ve found pleasurable, whether it’s a pack of cigarettes or a few drinks or even overeating. When someone’s truly addicted, that warped system keeps them going back even after the brain gets so used to the high that it’s no longer pleasurable.

Make no mistake: Patients still must choose to fight back and treat an addiction, stresses Dr. Miller. But understanding some of the brain reactions at the root of the problem will “hopefully reduce some of the shame about some of these issues, hopefully reduce stigma,” he says.

And while most of the neuroscience centers on drug and alcohol addiction, the society notes that it’s possible to become addicted to gambling, sex or food although there’s no good data on how often that happens. It’s time for better study to find out, Dr. Miller says.

In a related statement, Dr. Hajela opined, “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.”

“Even so”, Dr. Hajela continued, “choice does play a role in getting help. . .Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary.”

According to ASAM researcher staff, “choosing recovery” is akin to people with heart disease who may not choose the underlying genetic causes of their heart problems but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions.

Dr. Miller concludes, “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.”

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