Addiction is not only about willpower. It is a chronic brain disease, says a new definition aimed at helping families and their doctors understand better the challenges of treating it.
“Addiction is about a lot more than people behaving badly,” Michael Miller of the American Society for Addiction Medicine said.
That is true whether it involves drugs, alcohol, gambling or compulsive eating, the doctors group said on Monday.
Addiction generally is described by its behavioral symptoms — the highs, the cravings, and the things people will do to achieve one and avoid the other. The new definition does not disagree with the standard guide for diagnosis based on those symptoms.
Two decades of neuroscience have uncovered how addiction hijacks different parts of the brain, to explain what prompts those behaviors and why they can be so hard to overcome. The society’s policy statement, published on its Web site, is not a new direction as much as part of an effort to translate those findings to primary care doctors and the general public.
“The behavioral problem is a result of brain dysfunction,” said Nora Volkow, director of the National Institute on Drug Abuse (NIDA).
She welcomed the statement as a way to help her own agency’s work to spur more primary care physicians to screen their patients for signs of addiction. NIDA estimates that 23 million Americans need treatment for substance abuse, but only about 2 million get that help.
Then there is the frustration of relapses, which doctors and families alike need to know are common for a chronic disease, Volkow said.
“You have family members that say: ‘OK, you’ve been to a detox program, how come you’re taking drugs?’” she said. “The pathology in the brain persists for years after you’ve stopped taking the drug.”
Just what does happen in the brain?
It is a complex interplay of emotional, cognitive and behavioral networks. Genetics play a role, meaning some people are more vulnerable to an addiction if they, say, experiment with drugs as a teenager or wind up on potent prescription painkillers after an injury. Age does too.
The frontal cortex helps put the brakes on unhealthy behaviors, Volkow explained. It is where the brain’s reasoning side connects to emotion-related areas. It is among the last neural regions to mature, one reason that it is harder for a teenager to withstand peer pressure to experiment with drugs.
Volkow said intriguing research is under way to use those brain findings to develop better treatments, not just to block an addict’s high temporarily, but also to strengthen the underlying brain circuitry to fend off relapse.
Topping Miller’s wish list: Learning why some people find recovery easier and faster than others, and “what does brain healing look like.”