Why Addiction Is Considered a Chronic Brain Disease

It's More Than Bad Behaviors or Bad Choices

Overhead shot of hard drugs and alcohol on wooden table. Addiction concept
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Addiction is a chronic brain disease that's more about the neurology of the brain than the outward manifestations of behavioral problems and poor choices, according to a group of addiction medicine professionals.

In April 2011, the American Society of Addiction Medicine (ASAM) released its new Definition of Addiction, which, for the first time, extends addiction to include behaviors other than problematic substance abuse. A group of 80 addiction experts worked for four years to arrive at the new definition of addiction and concluded that addiction is about the underlying neurology of the brain—not about outward behavior.

Addiction Alters Your Brain's Reward System

Addiction affects your brain's reward, motivation, memory, and related circuitry to the extent that your motivations are altered so that your addictive behaviors replace healthy, self-care behaviors.

The brain's reward system is also altered in such a way that the memory of previous rewards—be it food, sex, or drugs—can trigger a biological and behavioral response to engage in the addictive behavior again, in spite of negative consequences, and sometimes even though you no longer even find pleasure in the activity.

Impulse Control Is Also Altered

Addiction also affects the frontal cortex of your brain in such a way as to alter your impulse control and judgment. This results in the "pathological pursuit of rewards," ASAM says when addicts return to their addictive behavior in order to "feel normal."

The frontal cortex is involved in inhibiting impulsivity and delaying gratification. Because this area of the brain continues to develop into young adulthood, the ASAM experts believe this is why early-onset exposure to substances is linked to the later development of addiction.

Characteristics of Addiction

According to the ASAM definition, addiction is characterized by:

  • Inability to consistently abstain
  • Impairment in behavioral control
  • Craving or increased “hunger” for drugs or rewarding experiences
  • Diminished recognition of problems with your behaviors and relationships
  • A dysfunctional emotional response

Other Features of Addictive Behavior

These conditions are also commonly present in addiction:

  • Cravings and addictive behaviors are triggered by external cues
  • A risk of relapse even after long periods of abstinence
  • Resistance to change despite increasing problems

Impaired Control and Judgment Problems

ASAM says that behavioral manifestations and complications of addiction, due to impaired control, can include:

  • Engaging in more addictive behavior than you intended
  • Increased time lost from work or school
  • Continued substance use despite physical or psychological consequences
  • Narrowing of your addictive behavior repertoire; for instance, you only drink one brand of a certain type of alcohol
  • Lack of readiness to get help, despite admitting a problem

Addiction Can Cause Cognitive Changes

Cognitive changes in addiction can include:

  • Preoccupation with the substance or addictive behavior
  • An altered sense of the pros and cons of addictive behaviors
  • A false belief that your problems are not predictable consequences of addiction

Addiction Can Cause Emotional Changes

ASAM believes emotional changes in addiction can include:

  • Increased anxiety, dysphoria, and emotional pain
  • Situations seeming more stressful than they really are
  • Difficulty identifying and expressing feelings

The Reason for a New Definition of Addiction

In the past, diagnosis of addiction has focused on outward manifestations of a person's behaviors, which can be observed and confirmed by standardized questionnaires. The new definition of addiction instead focuses on what's going on inside you, in your brain.

The experts at ASAM hope their new definition leads to a better understanding of the disease process, which they say is biological, psychological, social, and spiritual in its manifestation. Addiction can manifest itself in many behaviors beyond substance abuse.

The Implications for Treatment

Traditionally, people with addictions have sought and received treatment for a particular substance or behavior. This has sometimes resulted in the person substituting one addiction for another—what ASAM calls the "pathological pursuit of rewards"—because the underlying cause was not treated.

ASAM suggests that comprehensive addiction treatment should focus on all active and potential substances and behaviors that could be addictive. ASAM was careful to point out that the fact that addiction is a primary, chronic brain disease does not absolve addicts from taking responsibility for their behaviors.

Just as people with heart disease or diabetes have to take personal responsibility for managing their illness, if you have an addiction, you also must take the steps necessary to minimize your chance of relapse, ASAM said.

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