Following a four-year process involving more than 80 experts, the American Society of Addiction Medicine (ASAM) has adopted a new definition of addiction, having concluded that addiction is a chronic brain disorder and not simply a behavioural problem involving too much alcohol, drugs, gambling or sex.
When people see compulsive and damaging behaviours in friends or family members—or public figures such as celebrities or politicians—they often focus only on the substance use or behaviours as the problem. However, these outward behaviours are actually manifestations of an underlying disease that involves various areas of the brain, according to the new definition by ASAM, America’s largest professional society of physicians dedicated to treating and preventing addiction.
“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviours manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviours 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.”
The new definition is the result of an intensive four‐year process involving more than 80 experts, including top addiction authorities, addiction medicine clinicians and leading neuroscience researchers from across the US, as well as extensive dialogue with the National Institute on Drug Abuse (NIDA).
The new definition also describes addiction as a primary disease, meaning that it is not the result of other causes such as emotional or psychiatric problems. Addiction is also recognised as a chronic disease, like cardiovascular disease or diabetes, meaning that it must be treated, managed and monitored over a life‐time.
Two decades of advancements in neurosciences convinced ASAM that addiction needed to be redefined by what’s going on in the brain. Research shows that the disease of addiction affects neurotransmission and interactions within reward circuitry of the brain, leading to addictive behaviours that supplant healthy behaviours, while memories of previous experiences trigger craving and renewal of addictive behaviours. Meanwhile, brain circuitry that governs impulse control and judgment is also altered in this disease, resulting in the dysfunctional pursuit of rewards. This area of the brain is still developing during teenage years, which may be why early exposure to alcohol, drugs and gambling is related to greater likelihood of addiction later in life.
There is longstanding controversy over whether people with addiction have choice over antisocial and dangerous behaviours, said Dr. Raju Hajela, past president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on the new definition. He stated that “the disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviours are a manifestation of the disease, not a cause.”
“Choice still plays an important role in getting help. While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviours is necessary,” Hajela said.
“Many chronic diseases require behavioural choices, such as people with heart disease choosing to eat healthier or begin exercising, in addition to medical or surgical interventions,” added Dr. Miller. “So, we have to stop moralising, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment.”
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