Is Addiction a Disease?
Despite the research into addiction and facts on addiction as a disease, many people mistakenly believe that addiction is a choice, once addiction begins the choice is gone.
Definition of Addiction
Addiction, also referred to as substance use or alcohol use disorder, is defined by the National Institute on Drug Abuse (NIDA) as a chronic, relapsing disorder in which there is compulsive drug use despite negative consequences that can bring about long-lasting changes in the brain. Addiction is a complex brain disorder that affects an individual's mental health.
Addiction: Disease or Choice?
However, despite the research into addiction and facts on addiction as a disease, many people mistakenly believe that addiction—whether to alcohol, drugs, tobacco, or a behavior such as gambling—is a choice. And while the first drink or use of drugs usually was a choice, once addiction begins the choice is gone.
Often family, friends, and loved ones of those with an alcohol use disorder (AUD) or substance use disorder (SUD) think that if their loved one had enough willpower or if they cared enough about themselves and loved ones that they’d stop drinking or drug use. People who love someone battling addiction often say, “If they really wanted to stop they would” or “If they cared enough about me or our family they’d stop”. When it comes to addiction, this simply isn’t true.
The Disease Model Of Addiction
Addiction is deadly and millions of Americans are living in active addiction to numerous substances. These include alcohol, drugs, and tobacco products. Every year thousands succumb to the detrimental impact of addiction. In fact, according to the NIDA, drug and alcohol addiction cost the United States more than $740 billion annually. In addition, addiction is killing more and more Americans each year. Data shows that in 2016, drug overdoses took the lives of 63,000 people and more than 88,000 died from excessive alcohol use.
As these numbers grow, it’s vital now more than ever to truly understand what addiction is, how to recognize addiction, and ways to get help. As mentioned, addiction is a complex brain disease and while the initial choice to drink or use a drug is voluntary in most cases, with continued use dependence develops, the brain begins to change, and the choice is no longer a choice. The person with the addiction is compelled to seek the drug or drink—regardless of consequences it may have.
Substance Use Effects on the Brain
When a drug, including alcohol, is taken into the body it acts on the brain’s reward circuits and areas of the brain such as the prefrontal cortex. Depending on the drug, the reward circuits are impacted somewhat differently. In general, alcohol and drugs interfere with the brain sending, receiving, and processing signals through neurotransmitters.
Certain drugs mimic natural neurotransmitters in the body while others prompt the brain to release very large amounts of these ‘feel good’ chemicals. Both disrupt the normal communication in the brain. When the brain releases these chemicals that create feelings of pleasure, the behavior that produced the good feelings is repeated. Continued use of drugs often replaces the body’s natural release of dopamine and other feel-good chemicals. This results in the person being unable to experience pleasure or other good feelings without the drug in their body. These large surges in dopamine ‘train’ the brain to seek the substance, leading to compulsive, drug-seeking behaviors often seen in those struggling with AUD or SUD.
It’s important to understand that the good feelings or euphoria often associated with drug use are more intense and seemingly rewarding to the user. The NIDA uses the illustration of whispering versus speaking into a microphone to describe this. The example states that a person’s normal reward system stimulation is like whispering into someone’s ear, and the drug-induced reward being like someone speaking loudly into a microphone.
As the body is under the influence and experiencing euphoria, the brain adjusts by producing fewer neurotransmitters or by reducing the number of receptors that are able to receive signals. This results in the individual being unable or less able to naturally experience the feelings of pleasure or happiness. At this point, the individual needs to take the drug to experience even the normal feelings of reward and pleasure. In turn, this leads to increased tolerance and more compulsive drug-seeking behavior. Once this cycle begins, the circle of addition continues and gets worse.
Why does willpower not suffice?
Initially, and often early, a person's decision to use substances is influenced by his or her culture and environment, as well as their free choice. Some people are more susceptible to substance use disorders due to factors such as a family history of addiction, trauma, or other mental health disorders. An addicted brain becomes incapable of making good choices or exhibiting willpower. Loss of control over substance use is perhaps the most defining symptom of addiction.
Other Causes of Addiction
It is estimated that 40% to 60% of someone's risk for addiction is due to biological factors. These factors include:
- The relationship between genes and epigenetics (how environmental factors affect gene expression)
- Stage of development
The developmental stage of an individual is particularly important because teens who use drugs are very likely to become addicted and continue to use drugs as adults.
People's experiences are influenced by all kinds of environmental factors. Here are a few of the most influential factors:
- Home environment
- Family dynamics
Furthermore, the route of administration of these substances can heavily influence the likelihood of addiction. The effects of some routes will be more intense. A drug injection will produce an intense euphoria that cannot be matched by snorting or swallowing. The rapid onset of intense highs tends to dissipate quickly, so the quicker comedown may also encourage drug abuse.
Is Addiction A Chronic Disease?
The definition of chronic disease is one that is long-term and can be controlled but not cured.
Addiction does not usually result from substance use. Many people who use alcohol and drugs excessively, such as teenagers in high school and college, tend to reduce their usage when they begin taking on more adult responsibilities. Nevertheless, 25 to 50 percent of people with substance abuse problems develop chronic, severe disorders. Addiction to them is a progressive, relapsing disease requiring intense substance abuse treatment and continued aftercare, monitoring, and family or peer support to manage.
It is good to know that, even in severe, chronic cases, recovery is possible, provided that long-term treatments are followed up with continued monitoring and support for recovery.
How Is Substance Use Disorder Treated?
There are effective treatments for substance use disorders.
To begin with, you must recognize the problem. If an individual fails to recognize problematic substance use, recovery may be delayed. Although caring friends and family often initiate treatment, self-referrals are also welcome and encouraged.
The symptoms of substance use disorder should be formally assessed by a medical professional. It is possible to benefit from treatment, regardless of the severity of the disorder. Substance use disorders are a serious problem and often go undetected.
Multiple types of treatment are often required due to the extensive impact SUDs have on a person's life. The most effective treatment most often involves a combination of medication and individual or group therapy. To lead to sustained recovery, treatment needs to take into account the individual's unique circumstances and any coexisting medical, psychiatric, or social problems.
The goal of treating drug dependence is to control cravings, relieve withdrawal symptoms, and prevent relapses. Psychological treatment can help individuals with SUD better understand their behavior and motivations, develop a larger sense of self-worth, cope with stress, manage (potential) triggers, and address other psychiatric problems or conditions.
Treatment for Addiction
The good news is that addiction, like other chronic diseases, is highly treatable. The research into addiction treatment has led to numerous evidence-based treatments that help people live in recovery from alcohol addiction and drug addiction. An effective treatment program enables individuals to counteract the effect of the drug on their brain, behaviors, and ultimately their lives.
If you or a loved one are living with addiction, Caron is here for you. Each year we help thousands of individuals begin their lives in recovery through comprehensive, evidence-based treatment that works. No matter how far down you or a loved one has gone into addiction, there is hope. At Caron, we believe recovery isn’t just possible, it's probable. Learn more online or call us today at 1-800-854-6023.
By Melinda Castro, MA