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Medical Group Calls Addiction Brain Disorder, Not Behavior Problem

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The American Society of Addiction Medicine (ASAM), the largest professional society of doctors dedicated to treating and preventing addiction, has released a new definition of addiction, calling it a chronic brain disorder, not just a behavior problem, USA Today reports. The medical group announced the new definition after a four-year process that involved 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,” Dr. Michael Miller, Past President of ASAM, who oversaw the development of the new definition, said in a news release. “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.”

This marks the first time ASAM has taken an official position that addiction is not simply related to substance abuse. The group said outward behaviors of substance abuse are manifestations of underlying disease that involve different parts of the brain. According to the new definition, addiction is a primary disease, not the result of other causes such as psychiatric problems. ASAM notes addiction is chronic and must be managed throughout a person’s lifetime.

Dr. Raju Hajela, Past President of the Canadian Society of Addiction Medicine, who chaired the ASAM committee that came up with the new definition, said addiction is not a choice. “The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them.”

Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), told USA Today the new definition will help her agency convince more primary care doctors to screen patients for signs of addiction. According to NIDA, 23 million Americans need substance abuse treatment, but only two million receive it.

22 Responses to this article

  1. Avatar of Christine
    Christine / February 6, 2014 at 8:34 pm

    I think we’re missing a huge point here. Firstly, drug addiction isn’t learned. Secondly, people CHOOSE to do that drug in the first place (excluding those who are on drugs prescribed to them). They are very well aware that the drug is addictive, but they think it will never happen to them. The root of the problem is their poor choice!

  2. Ben House / November 15, 2012 at 7:49 am

    Dan Amen’s scans show effects of drugs on brains and how when the use is stopped the brain often returns to more normal scans. Other studies show the development of neural pathways and habit and how the brain can be retrained. The brain is indeed involved, but the how is not yet fully understood; clearly not a cause effect thing but a systems thing.
    I hope this “new” ASAM report will not justify simple one solution treatment with new drugs from big pharm.

  3. Avatar of Joe Anticoli
    Joe Anticoli / September 27, 2011 at 5:30 pm

    What opiate addict has never experienced feelings of abandonment and hopelessness generated by the rigors and general failure of orthodox treatment. Many drug treatment settings are devolving into little more than D.U.I court clearinghouses, accepting anyone with a legal referral. Our prison system has morphed into a “narco-penal” industrial complex that reverse engineered drug addiction via a cartoon social policy that self-justifying promotes its unholy alliance between multi-billion dollar criminal cartels on one side and U.S. law enforcement and criminal justice systems on the other. Our nation’s ‘alphabet soup’ of agencies connected with “war on drugs” have a combined annual outlay exceeding the annual budgets of 240 countries, combined ! No wonder there’s a wide disparity with science-based addiction medicine and what is actually being delivered at the local level. With the introduction of medications that ameliorate post-acute withdrawal limiting the distraction of dysphoria and cravings, patients can focus on treatment aimed at reducing stress and anxiety, exploring underlying behaviors that need changing, rebuilding healthy relationships, self-esteem, restoring careers and finances, and understanding the etiology of their addiction. Instead what many receive is a physical and psychic pounding until submission and surrender to the “program” occurs. Applying the universal truths contained in the twelve-steps can be spiritually transformative, but participation in the fellowship or any “recovery program” should be offered only as a voluntary adjunct to clinical treatment; and not as a substitute for it. No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual’s particular case, is critical to his/her ultimate success in returning to functionality in the family, workplace, and society. It has been a long time in coming that addiction medicine is practiced with the same precision and held to the same standard of efficacy as other medical disciplines. Now more than ever, former active addicts can have the best chance of regaining lives characterized by health, dignity, and citizenship.

  4. notwhatyouthink / August 22, 2011 at 12:31 pm

    I believe addiction can be combination of behavioral, social, learned, cultural, spiritual, physical, brain disorders or what ever. The Thing we often forget is all this stuff is theory. You cannot cut someone’s brain open or give them a blood test says “yep there it is a chemical imbalance.” They conclusively have addiction brain, depressed brain, anxiety brain, or whatever. Than there is the whole question of the chicken and egg argument, what came first, or what other behaviors or situations influenced the condition. The thing I fear is that we are relying way too much on treating people with drugs to correct chemical imbalances or brain disorders while ignoring other factors that may be equally or more important. The twelve step program talks of the “easier softer way” of which one does not exist, but it is comforting to reduce complexity to simplicity.

  5. Avatar of Roget Lockard
    Roget Lockard / August 19, 2011 at 10:39 pm

    Dave & Chris; Very apt, thoughtful, non-dogmatic comments. I view addiction, in its essence, as a state of consciousness; a profoundly flawed frame of mind — a frame of mind shared to a large extent by most humans alive today. As you suggest, Dave, at the heart of addiction is the mistaken belief that control is the optimal path to fulfillment. From my perspective, the biomechanics of addiction — the details of neurochemistry, genetics, etc. — are about how addiction happens, not why it happens. Human longing is center-stage in the drama of addiction, and human longing resists scientific delineation, calibration and manipulation. These, and corollary ideas, inform my website: http://rogetlockard.com/index.php

  6. Carlos / August 19, 2011 at 5:14 pm

    My problem with this Disease Concept and I have had a number of conversations with Dr. Jeffery Kamler president of the Florida Society of Addiction Medicine. All of these claims are based on face value agreement and scientific research data is not the main source of information to reach the conclusion. Too much data is missing to reach such conclusion. Too much is missing. There is no objective test (like a blood test, MRI, genetic test etc). As far as I can tell all behavior can be taken to a extreme and can become deadly. So those two conditions are lost in the shuffle. The word disease is attractive to the medical profession. I have no doubt that something neurological is going on, but that is true for all behaviors.

  7. Bill Poel / August 19, 2011 at 4:40 pm

    Obviously, DD Boots has never seen a Pet Scan(Brain Scan) of an addict compared the Pet Scan of a normal person. Addicts brains have been seriously changed which is quite a clue as to why an addict thinks and does things a non-addict wouldn’t. There is no doubt that addiction is a brain issue.

  8. Avatar of Mike Morrison
    Mike Morrison / August 19, 2011 at 3:38 pm

    Really ASAM? You are coming out with this profound statement now? You have just discovered that addiction is not a moral issue or a behavioral problem? Really?

  9. Dave / August 17, 2011 at 3:27 pm

    More black and white, either/or thinking. But then the obsession with control that underlies dogmatism is part of the problem both for the substance dependent person and for the society that deals with them. On the other hand, recovery tends to be more of a surrender to life on life’s terms which is often complex, nuanced and subtle (varying shades of grey). In my opinion, problems with substances are a disease, a choice, influenced by neurobiology and heredity, influenced by personality, influenced by social and cultural factors — in short tremendously complex. And recovery involves openess and flexibility. Let’s stop the debate and just keep our focus on finding practical ways to help people change whether it’s medicine, counseling, 12 step groups, drug courts or whatever.

  10. DD BOOTS / August 16, 2011 at 8:19 pm

    Addiction is NOT a brain disorder it is a learned lifestyle and the
    medical profession and professional that deal with addicts only want to classify it as a brain disorder so that they can get paid and reimbursed by insurance and other sources because most of the addicts themselves would never pay them!

  11. perryrants / August 16, 2011 at 7:58 pm

    duh. i have been “teaching” that concept for a lot longer than 4 yrs. it’s was never about the substance that one took, it about how the substance tricks your brain into pleasure overdrive! hence, really rich addicts and really poor addicts.

  12. John French / August 16, 2011 at 4:43 pm

    The new ASM long-form definition can be found at:
    http://www.asam.org/DefinitionofAddiction-LongVersion.html

  13. Avatar of Larisa Marie
    Larisa Marie / August 17, 2011 at 11:33 pm

    Wow, wake-up Fox News! There are so many things wrong with your statement, it’s difficult to know where to begin. Might want to do a little research on addiction before you make comments – just a suggestion.

  14. Avatar of Linda Molnar
    Linda Molnar / August 18, 2011 at 8:11 pm

    Addiction is not a learned behaviour. Some are prediposed to have it. I definately agreee with the authors. I lost my 20 year old son to his addiction. My husband lost his father at 28 years old. My husband has been clean and sober and I am able to have a glass of wine occasionaly. I do not get drunk. We did not model this behaviour for our son. Why don’t people educate themselves before spouting off something they know nothing about. I volunteer with City of Angles.NJ I know alot about addiction.

  15. Avatar of Sue
    Sue / August 19, 2011 at 10:17 am

    Addiction is not a learned lifestyle!!
    I totally believe that it stems from a brain disorder or chemical imbalance..people that start drugs usually have a problem with depression, anxiety and just not feeling “normal.” Then the brain is affected by the drugs and makes the addict feel how they wish they always feel. Then it just snow balls out of control!!
    That’s my belief because I have seen it in my own family!

  16. Roger Macauley / September 29, 2011 at 1:55 pm

    Entering into a lifestyle doesn’t negate the fact that it is a brain disorder. Read Dr.Gerald Mays book ” Addiction and Grace.” Study his powerfull comments about the brain and its function in the addiction process- Feedback, Adaptation and Habituation.

  17. Avatar of Chris
    Chris / August 18, 2011 at 5:44 pm

    I could’t agree more. For too long people have oversimplified addiction. Just like the old “Nature vs. Nurture” debate, it’s not a “vs.” issue, but a “via” issue. Personality and biology are intertwined.

  18. Avatar of Cheryl
    Cheryl / August 20, 2011 at 1:16 pm

    I can testify that it is not a learned behavior. We raised our children in a home without drugs and alcohol (for the sole purpose of giving them a Leave it to Beaver environment) and yet 2 of them became addicts through experimentation outside the home.

    I am thankful that ASAM provides yet one more clarification on the issue, so that science can utitlized and investigate the information further.

    I am also thankful that my kids had NA and AA available to them in order to work through the behavior problems once they got their disease of addiction under control.

    I am grateful that I had an opportunity to get my own support for the PTS that followed the horrific period of time in my life:

    Nar-Anon Family Groups
    http://www.nar-anon.org

  19. Avatar of George Sproul
    George Sproul / August 20, 2011 at 11:57 pm

    I couldn’t agreement with you more. This article will help educate people and help remove (slowly) the stigma surrounding addiction. I’m sorry for your loss.

  20. Avatar of Randee
    Randee / February 5, 2013 at 8:33 am

    I am sorry for your loss of your son, but he probably learned to use drugs with his friends. Not because of your father-in-laws addiction.My parents are drug addicts and alcoholics, I learned that behavior…

  21. Avatar of cynthia
    cynthia / August 21, 2011 at 1:35 pm

    okay michael morrison. you KNOW that many, many people DO make it a moral thing. so, it doesn’t hurt to reiterate. right?

  22. Carlos / August 23, 2011 at 6:01 pm

    I think you are reaching too far. I am not an expert in Brain Scans, and I promise to learn a lot more about neuroscience. I am not too sure that we have gotten to the point of knowledge and technologies were we can speak with certainty that brain scans can identify brain pathology. We all seem to be caught up on this neuro-chemical web and I am not too sure .We surely cannot trace brain and synapse pathways. Most of what I research I know the data is very soft. We are told frequently that neuro-chemical imbalances in the brain are causing symptoms. The fact is that there is no shred of valid evidence to support the claim and it does not seem to bother us. We are more convinced by repetition than by truly knowing what those “brain scans” really means. Way too much speculation for my taste, the brain chemistry, scans and pathways, I acknowledge we as a profession know more about the brain than when I went to college, but I am not too sure we are at the level where we can make compelling claims like they are stated to us. I mean really, how much do you know about brain behavior? Do you really feel confident that what we are told you can agree with because you are certain that what we are told is accurate?

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