People in recovery from addiction often look back and say, “I knew I wasn’t a bad person, but somehow I couldn’t stop doing bad things.” Now there’s a formal explanation – addiction is neither a choice nor a sign of weakness, but rather a chronic brain disease.
Although addiction specialists have long supported this “disease concept,” the American Society of Addiction Medicine (ASAM), the nation’s largest professional society of physicians dedicated to treating and preventing addiction, has formalized the theory into a new definition of addiction.
What does this revised definition mean to people struggling with addiction?
You Have a Disease.
Rather than looking at addiction as a moral weakness or character flaw, ASAM defines addiction as a chronic brain disease similar to heart disease and diabetes. By bringing addiction within the scope of more widely understood diseases, addiction experts believe there will be greater support and compassion for those struggling with addiction.
“The new ASAM definition is an important advance in the treatment of addictions,” says David Sack, M.D., the CEO at Promises drug rehab centers in Malibu and Los Angeles. “Our society is officially endorsing the view that addiction is no longer about drugs, but rather changes that take place in the reward circuitry of the brain.”
As a result of this shift in thinking, addiction specialists predict a reduction in the stigma associated with addiction, which may encourage more people to get help. But stigma takes a long time to change, explains Dr. Sack, estimating that it could take 25 years to meaningfully shift the general population’s beliefs about addiction.
“Seventy years ago, cancer carried stigma. People didn’t talk about it; they thought they could ‘catch’ it,” says Dr. Sack. “But with increased awareness stigma dissipates over time, and the new ASAM definition is an important step in the right direction.”
Addiction Is Addiction Whether to Drugs, Gambling, Sex or Food.
The new ASAM definition of addiction encompasses “process” addictions such as food, sex and gambling, in addition to drug and alcohol addiction. This view is backed by extensive research which suggests that behavioral disorders affect the same reward centers of the brain as drugs of abuse.
Dr. Sack points to research on Parkinson’s disease as an example of the way dopamine affects the brain. When Parkinson’s is treated with medications that raise dopamine levels or mimic endogenous dopamine in the brain, a certain proportion of patients develop impulsive behavioral syndromes, such as compulsive spending, hypersexuality or gambling addiction.
“When you raise dopamine levels in a group of people who have never abused drugs or alcohol, we sometimes see other compulsive behaviors begin to surface,” Dr. Sack notes. “This is very strong evidence that like drug addiction, impulsive disorders are related to dopamine regulation in the brain.”
Tanning is another example. Research has shown that compulsive tanners’ brain circuitry is affected in an analogous way as opiate addicts. Users have even developed withdrawal syndrome when they abruptly stop tanning, similar to opiate withdrawal.
Although ASAM recognizes that all addictions stem from the same neurobiological processes, the DSM (the manual used by clinicians to diagnose and treat mental health disorders) categorizes drugs and alcohol separately from behavioral disorders. This means that while awareness is growing, there is still a certain level of uncertainty surrounding the diagnosis and treatment of process addictions.
You Need Treatment.
According to ASAM, people do not choose to be addicted, and likewise they cannot simply choose not to be addicted. Addiction is a disease that requires intensive treatment that combines “self-management, mutual support, and professional care provided by trained and certified professionals,” ASAM reports.
While comprehensive addiction treatment is a hallmark of Promises Treatment Centers, experts hope that this same level of cutting-edge care will eventually be available on a wider scale.
“Dramatic changes in the way we treat addiction will take time, but what the ASAM definition will likely do is change the way the field researches addiction and interprets results,” explains Dr. Sack. “This, in turn, may improve access to high-quality, long-term treatment.”
Insurance May Help Cover Treatment Costs.
In many instances, drug rehabilitation is covered, at least in part, by insurance. The more addiction is recognized as a disease, the greater the likelihood that insurance will cover more aspects of treatment and at higher levels of care (e.g., residential as opposed to outpatient).
However, because the ASAM definition is at odds with the proposed criteria in the DSM-V in key instances, experts believe that in the short term insurers may choose the diagnosis of convenience, the one that translates into the lowest required payment.
“We will likely see insurance companies confining the most intensive and expensive forms of addiction treatment to the smallest population possible,” says Dr. Sack. “But if the ASAM definition and other measures stimulate the type of research we are hoping, we may eventually see more treatment coverage for all types of addictions.”
Relapse Is Part of the Disease of Addiction.
ASAM describes relapse as a “common feature of addiction.” Instead of viewing relapse as an embarrassment or failure, it is acknowledged as part of the disease of addiction.
“People rarely relapse because they didn’t get anything out of treatment or they simply didn’t want sobriety badly enough,” says Dr. Sack. “Instead, the threat of relapse is evidence that many brain changes caused by drugs last long after the drugs are stopped, and that genetic predispositions can be difficult to overcome.”
Instead of blame or shame, the hope is that more addicts suffering from relapse will be guided back into treatment with a clearer understanding that long-term treatment and monitoring are required for a successful recovery.
There’s Never Been a Better Time to Get Help.
The National Institute on Drug Abuse estimates that 23 million Americans are in need of substance abuse treatment but that only two million Americans actually seek help. If costs, stigma or fear of failure have prevented you from getting the treatment you need, what the ASAM definition of addiction means to you is that there has never been a better time to get help. Addiction is not your fault, but it is your responsibility. Only you can put yourself on the path to recovery.