Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.
The American Society of Addiction Medicine (ASAM) just released this new definition of addiction 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 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 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.
“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,” Hajela said in a statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”
Even so, Hajela pointed out, 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,” Hajela said.
This “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, the researchers said.
“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,” Miller said.
© 2012 LiveScience.com. All rights reserved
By David L. Rosenbloom, Ph. D.
Stigma is one of the meanest and most difficult aspects of addiction because it makes it harder for people and families to deal with their problems and get the help they need. Society imposes stigma – and its damage – on addicts and their families because many of us still believe that addiction is a character flaw or weakness that probably can’t be cured. The stigma against people with addictions is so deeply rooted that it continues even in the face of the scientific evidence that addiction is a treatable disease and even when we know people in our families and communities living wonderful lives in long-term recovery.
Stigma is the reason there is so much social and legal discrimination against people with addictions. It explains why addicts and their families hide the disease. Discrimination always hurts stigmatized groups because they are excluded from the rules that apply to “normal” people. So insurance companies get away with refusing to pay for alcohol or drug treatment, or with charging higher deductibles and co-pays than for treating any other disease. People who need the help are often afraid to speak up. State and federal agencies feel safe in denying food stamps and baby formula to mothers who have past drug convictions because mothers who used drugs have few supporters in the political system and face lots of people who think they must be “bad mothers.” Though studies have found that helping employees to recover is more cost-effective than termination, some employers believe that firing an employee with a drinking problem is a lot easier than providing rehabilitation. A firestorm of protest would erupt if employers treated workers with cancer or heart disease the same way.
People who are victims of stigma internalize the hate it carries, transforming it to shame and hiding from its effects. Too often, people with alcohol and drug problems and their families begin to accept the ideas that addiction is their own fault and that maybe they are too weak to do anything about it. In many ways, hiding an addiction problem is the rational thing to do because seeking help can mean losing a job and medical insurance, or even losing your child when a social service agency declares you an unfit parent because you have an alcohol or drug problem.
The stress of hiding often causes other medical and social problems for the individuals and their families. This is especially true when an adolescent has an alcohol or drug problem. Fear often prompts kids to hide the problem from parents. Then, when parents find out, stigma makes them feel guilty and somehow negligent. Illness and family dysfunction explode. When that happens, parents find it even harder to fight for the care and resources their child urgently needs from a social and medical system that blames the family and the child.
FIVE THINGS YOU CAN DO TO FIGHT STIGMA
We may not change overnight the way society feels about people with alcohol and drug problems, but we can end the legal discrimination caused by stigma
1. Demand equal medical insurance coverage for alcohol and drug treatment.
2. Tell your elected representatives to stop punishing babies for the past problems of their mothers.
3. Tell your state lawmakers to remove the legal barriers that prevent people recovering from addictions from getting jobs.
4. Give more than lip service to the reality that addiction is a disease, not a character weakness.
5. Be an advocate for an individual or family with an addiction problem.
By William Pullen
Recently The BBC news website ran a piece based on an article in Neurology magazine about how “running may keep thinking skills”. I’ve included it below as I think it illustrates another benefit of exercise. Although the research concerns younger people I believe the benefits of movement whether it be walking, tai chi, or running, are available to everyone. I need to include my usual addendum that DRT is not about getting fit nor about colluding in fantasies of perfection. Instead DRT aims to promote what Dr Jacobs refers to below as “total fitness” which incorporates social, physical and mental aspects of health. And for those that just want to talk/walk/sit and not run it’s very much there for you too. DRT is talk therapy first. By doing that in outside spaces with “mother nature” we already begin to break up rigid thinking.
As mentioned before, we don’t aim for perfection so “total fitness” is a concept we hold lightly for those who subscribe to a more holistic understanding of health. Sometimes, for some people, it’s better to just sit down on a park bench. For others, the info is below:
• Aerobic exercise in your 20s may protect the brain in middle age, according to a US study.
• Activities that support cardio fitness – such as running, swimming and cycling – led to better thinking skills and memory 20 years on.
• Scientists say the research, reported in Neurology, adds to evidence the brain benefits from good heart health.
• Cardio fitness is a measure of how well the body absorbs oxygen during exercise and transports it to the muscles.
• Researchers at the University of Minnesota, Minneapolis, tested almost 3,000 healthy people with an average age of 25.
“This is one more important study that should remind young adults of the brain health benefits of cardio fitness activities such as running, swimming, biking or cardio fitness classes” They underwent treadmill tests of cardiovascular fitness during the first year of the study and again 20 years later. They were asked to run for as long as possible before they became exhausted or short of breath.
Cognitive tests taken 25 years after the start of the study measured memory and thinking skills. People who ran for longer on the treadmill performed better at tests of memory and thinking skills 25 years on, even after adjusting for factors such as smoking, diabetes and high cholesterol.
People who had smaller time differences in their treadmill test 20 years later were more likely to do better on the executive function test than those who had bigger differences. “Many studies show the benefits to the brain of good heart health,” said study author Dr David Jacobs.
“This is one more important study that should remind young adults of the brain health benefits of cardio fitness activities such as running, swimming, biking or cardio fitness classes.” Dr. Jacobs said a concept was emerging of total fitness, incorporating social, physical and mental aspects of health. “It’s really a total package of how your body is and the linkage of that entire package of performance – that’s related to cognitive function many years later and in mid-life,” he told BBC News.
Dr Simon Ridley, Head of Research at Alzheimer’s Research UK, said: “A growing body of evidence suggests exercise may cut the risk of cognitive decline and dementia, and much research has shown a link between healthy habits in mid-life and better health in old age.
Looking for peace in your life and relief from the daily stress we all encounter? Try this short list of changes in your routine. It’s not comfortable at first but the more you do it the more comfortable it will become.
Add to your daily routine the following: If you miss a day or one of the steps don’t worry its OK, get back in stride the next day.
- Set aside 5-10 minutes each night before sleep to meditate, no digital devices and not TV. Let your mind unwind and be at peace before you fall asleep.
- Avoid red and processed meats and sugar. Chew your food deliberately and completely before you swallow, take your time. Meals are to be enjoyed not hurried like a race. Eat as much fruit and vegetables as possible.
- Do 15-30 minutes of exercise each day, even if it’s just a walk.
You can expand the timeframe, as you get more comfortable with your routine. Make time for your mind and body to grow in a healthy way.