Among addiction experts and researchers, there’s been a long-running debate as to whether drug or alcohol addiction, and even “behavioral addictions” such as compulsive gambling, are actual diseases or not. It’s not just a matter of semantics — if researchers can trace addiction’s root causes to an actual medical malfunction in the brain, perhaps that disease could be directly treated.
Who am I to disagree with a “four-year process with more than 80 experts actively working on it?”
Their result? Addiction is a “chronic brain disorder and not simply a behavioral problem.”
I suppose if we wanted, one could argue that all mental disorders can be viewed as “brain disorders” and not “simply behavioral problems.” After all, where does thinking and emotions come from, if not the brain?
But does this change anything? Does it help us in really getting to the heart of addiction? I’m not so sure.
The actual new definition of addiction proposed by the American Society of Addiction Medicine was first published on April 12 2011, but apparently didn’t get much notice. So the Society released a press release yesterday to help draw attention to it. Here’s the intro to the new definition:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviors, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviors. Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.
With just a few minor changes, the following paragraph is also just as true, but replaces the word “addiction” with “human behaviors and social interactions:”
Human behaviors and social interactions are a primary, chronic condition of brain reward, motivation, memory and related circuitry. Human behaviors and social interactions affect neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and rewarding behaviors supplant less-rewarding behaviors. Human behaviors and interactions with others also affect neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in those behaviors in the future.
The point? Everything we do affects these areas of the brain, especially anything we personally find enjoyable — like most of us do when socializing with other people (whether in-person or online). When we are having an enjoyable conversation with another person, it leads to a biological and behavioral response. We can even “crave” talking to that person again, since we often make a date to see that person again. None of these things are necessarily unique to addiction.
What does it mean when 54 percent of respondents in a recent survey felt some level of addiction to their social network of choice? If the majority of people feel something, doesn’t that become the new normal, so it is by definition not something unusual or disordered? Words like “addiction” quickly become meaningless if they describe a sense or behavior most of us are feeling.
These supposedly new descriptions of addiction are simply restatements of what we know about the brain and its reward circuitry. We don’t know — yet, anyway — exactly how these brain interactions are going wrong in people who become addicted (since not everyone who drinks becomes an alcoholic). Is it a virus? A malformed gene?
The medical biases here are throughout the document, emphasizing the biology over the other messy stuff — like environment and psychology. For instance, one paragraph emphasizing the biology starts with the sentence:
Genetic factors account for about half of the likelihood that an individual will develop addiction.
Which naturally means that the other half of the likelihood that an individual will develop an addiction is related to non-genetic factors — your environment and your psychological makeup. Things you can influence and change (or that other people can influence and change on your behalf, if need be). But the definition doesn’t actually say that… instead it bogs down in its own heavy, obtuse language making it sound like genetics is a key to understanding this “chronic brain disorder.”
While I commend the American Society of Addiction Medicine for sharing their latest understanding of addictions with us, I don’t believe this helps clarify anything. Instead, all it does is open up dozens of new questions for me. It re-emphasizes how little we actually understand about what the brain is doing, and why it’s doing certain things in some people, but not others.
By emphasizing the “brain disease” model over the more accepted bio-psycho-social model of addiction, the Society is putting the focus and spotlight on the brain — an organ scientists still just barely understand. Yes, our understanding has increased 100 fold in the past two decades, but it’s still a drop in the bucket of what remains.
Addiction is a complicated process. Simplifying it down to a “brain disease” seems to really remove much of the complexity of the problem, and gives people who don’t bother reading the new long definition (linked below) a short-hand way of saying, “It’s not my fault.”
It’s not a person’s fault if they develop an addiction. But they do have to take ownership of the problem, and work toward its resolution — no matter what we call it. If “brain disease” helps someone get help for their addiction, well then, maybe it’s not all bad.
Read the press release: ASAM Releases New Definition of Addiction
Read the new definition: Public Policy Statement: Definition of Addiction