Addiction a Brain Disease, ASAM Says

Deborah Brauser

August 31, 2011

August 31, 2011 — For the first time, the American Society of Addiction Medicine (ASAM) has officially recognized that addiction is not solely related to substance misuse and is, in fact, a chronic brain disease.

"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," ASAM Past President Michael Miller, MD, said in a news release.

"The disease is about brains, not drugs. It's about underlying neurology, not outward actions," added Dr. Miller, who oversaw the development of the new addiction definition.

Findings from brain circuitry studies prompted more than 80 experts to come together 4 years ago to begin the process of developing a new definition of addiction.

Previous research has shown that addiction affects neurotransmission in the reward area of the brain, triggers craving of addictive behaviors based on memories of previous experiences, and alters areas that govern impulse control and judgment.

Chronic Condition

Although ASAM adopted aspects of its new definition internally in April, it was recently released to the public with final tweaks based on subsequent discussion by board members.

Highlights include its description of addiction as a primary disease, which means "it's not the result of other causes such as emotional or psychiatric problems." ASAM also notes that addiction is a chronic condition, and so should be "treated, managed, and monitored over a life-time."

Raju Hajela, MD, chair of the ASAM new definition committee and past president of the Canadian Society of Addiction Medicine, said in the release that this disease drives behaviors that others might not understand.

"Simply put, addiction is not a choice[, but] choice still plays an important role in getting help. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary," added Dr. Hajela.

David Kupfer, MD, chair of the American Psychiatric Association's Task Force for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), told Medscape Medical News that "a number of mental disorders" that are currently in the DSM-4 and that will be in the DSM-5 are considered chronic and persistent.

"Addictive disorders, anxiety disorders, certainly depressive or bipolar disorders, schizophrenia, some of the neurocognitive disorders such as Alzheimer's — they are disorders that are no different than cardiovascular disease, or diabetes, or even asthma in many ways," said Dr. Kupfer.

"Thinking about it that way has helped a lot of people trying to revise the current DSM to realize that what we are seeking to do is try and find out the underlying physiology and the underlying psychopathology and etiology of these disorders. There's no question that you have this interaction of what's going on in the brain and what's going on in terms of expression of behavior," he added.

Definition Reduces Stigma

He noted that the new definition is consistent with "parallel developments" currently going on in other areas of psychiatry.

"We're running into the same exciting areas. It doesn't mean we have the answers. It means we have our work cut out for us in terms of how to integrate what we're learning about how the brain functions with what we learn about behavior," said Dr. Kupfer.

"It's very nice to see this society endorsing the fact that in many ways addiction may very well be a chronic brain disorder, and not simply a behavioral disorder. And that I totally agree with."

Overall, he said, it is important to get this information out to the public, to let those affected know that it is okay to come in for treatment.

"The only way that we will really get rid of stigma is to continue to point out and show again and again, hopefully with more science, that these disorders are no different than any of the other disorders that we are treating throughout the rest of medicine. So anything like this new definition helps."

The new, full definition of addiction is available on the ASAM Web site.

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