The Reward System Remembers Then Asks For More
Dopamine makes us feel good and want to keep doing what we’re doing. It also teaches the brain to repeat the behavior. Cues trigger the reward system, fuel cravings and create a habit loop. The smell of pie baking can have you salivating and anticipating the taste delight that’s coming. Addiction fuels habits toocraving a cigarette every morning with coffee or wanting a hit when you drive past the house where you used to do drugs.
When you take a drug, your brain releases a flood of dopamine, way more than it would when you’re eating your favorite pie, for instance. Your brain overreacts and cuts back on dopamine production to bring it down to a normal level.
As you continue to use drugs, your body produces less dopamine. Things that brought you pleasurethat pie, friends, and even drugsdon’t anymore. Once you’re addicted, it takes more and more drugs just to feel normal.
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 rewardsbe it food, sex, or drugscan 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.
Relapses Are A Reality But They’re Not Failure
Getting sober is hard. Staying on track is too. That’s the nature of living with a chronic disease. Success takes managing the changes in the brain and learning how to change deeply rooted behaviors. And then the toughest part for many: committing to managing new behaviors for the rest of your life. Sometimes it’s too much. Relapses happen, often many times. They’re not a treatment failure, but a cue to get back on track. That can mean making adjustments with or changing treatment.
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The International Classification Of Diseases 10th Revision
The International Classification of Diseases, 10th revision includes diagnoses of harmful use for alcohol or substance dependence, for any substance, including alcohol. Harmful alcohol use is defined as heavy alcohol use , and that overuse of alcohol has caused physical harm , psychological harm or has led to harmful social consequences .
Substance dependence is defined by either current use or a current persistent and strong desire to use the substance, plus two or more of the following: continued substance use despite harm, difficulty controlling use, tolerance, and withdrawal.
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.
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Addiction As A Mental Health Disorder
In order to be classified with a substance abuse disorder, you or your loved one must display at least two of the following within a 12-month period, as published by NIDA:
- Taking more of the substance than intended during a sitting or for a longer duration than intended
- Withdrawal symptoms when the substance is removed
- Unsuccessful attempts to stop using the substance
- Excessive amounts of time spent obtaining, using and recovering from the effects of the drugs or alcohol
- Substance abuse interferes with the fulfillment of familial, school, or occupational obligations
- Continued substance abuse despite negative physical or social consequences
- Withdrawal from activities previously enjoyed due to substance abuse
- Repetitive use of substance in physically dangerous situations6
If you or a loved one has any of these symptoms, its time to get help.
The Disease Model And Addiction Treatment
Now that weve covered the disease model, lets go over some of the ways that the disease model of addiction has informed how we view and treat addiction today.
For the most part, all treatment methods and techniques used in substance abuse treatment programs today are informed by the disease model. Because rather than working toward a cure for substance abuse, drug and alcohol addiction treatment centers approach the treatment of addiction much like a psychiatrist would approach the treatment of a mental or emotional disorder, which is to say that the goal is more about identifying and managing symptoms of the disorder.
Cognitive-behavioral therapy is often the backbone of a substance abuse treatment center, for instance. Also commonly called talk therapy, CBT is used to explore some of the underlying causes of addiction. Its also used to identify a persons triggers and teach strategies for avoiding or nullifying those triggers to safeguard sobriety. Again, CBT is largely for identifying and managing symptoms of addiction.
This is why you often see many holistic treatments and training in substance abuse treatment programs. For instance, its quite common for drug and alcohol treatment centers to offer life skills training or financial coaching, both of which address some of the common effects of long-term addiction.
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Chronic And Relapsing Developmentally
Much of the critique targeted at the conceptualization of addiction as a brain disease focuses on its original assertion that addiction is a chronic and relapsing condition. Epidemiological data are cited in support of the notion that large proportions of individuals achieve remission , frequently without any formal treatment and in some cases resuming low risk substance use . For instance, based on data from the National Epidemiologic Survey on Alcohol and Related Conditions study , it has been pointed out that a significant proportion of people with an addictive disorder quit each year, and that most afflicted individuals ultimately remit. These spontaneous remission rates are argued to invalidate the concept of a chronic, relapsing disease .
The NESARC data nevertheless show that close to 10% of people in the general population who are diagnosed with alcohol addiction never remitted throughout their participation in the survey. The base life-time prevalence of alcohol dependence in NESARC was 12.5% . Thus, the data cited against the concept of addiction as a chronic relapsing disease in fact indicate that over 1% of the US population develops an alcohol-related condition that is associated with high morbidity and mortality, and whose chronic and/or relapsing nature cannot be disputed, since it does not remit.
Is Addiction A Disease
Addiction, clinically referred to as a substance use disorder, is a complex disease of the brain and body that involves compulsive use of one or more substances despite serious health and social consequences. Addiction disrupts regions of the brain that are responsible for reward, motivation, learning, judgment and memory.
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Addiction Isn’t A Choice But Treatment Is
Everyone makes a choice about using drugs or taking a drink for the first time. You don’t have a choice about how your brain reacts, however. When substance use rewires your brain, your ability to make good decisions gets hijacked. Willpower and shaming won’t undo the changes in the brain and cure addiction. There is no cure, but treatment helps you manage and successfully live with the disease. Just as someone with diabetes or heart disease has to choose to exercise and change to a healthy diet to control their disease, someone with addiction has to choose treatment. A court order or family’s ultimatum may be behind that choice. But often, someone chooses on their own, wanting a life without addiction and the problems that come with it more than the drugs.Scientists don’t know why some people can successfully quit using drugs on their own, and others can’t. For most people, recovery takes treatment that includes behavioral therapy and often, medications to help control cravings and help the brain adapt to functioning without drugs.
Finding Help For Drug Or Alcohol Addiction
Addiction is a highly treatable disease. Michaels House offers a supportive care environment focused on healing the whole personbody, mind, and spirit. Our comprehensive treatment plans, including recreation and other holistic options, can help you move forward and begin recovery. Call our toll-free helpline, , 24 hours a day to speak to an admissions coordinator about available treatment options.
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How Common Is Addiction
Addiction is unfortunately very common. Around 20 million people in the United States suffer from a substance use disorder. A substance use disorder often refers to substances that unnaturally increase dopamine levels in the reward pathway. These substances include prescription painkillers, illicit substances, nicotine or alcohol . Substance addictions are the most well-known form of addictions but people can also suffer from behavioral addictions which include the following:
- Exercising or dieting.
- Video gaming and the internet.
Causes & Risk Factors
People become addicted because of a combination of factors.
- Genetic factors: Some people may inherit a vulnerability to the addictive properties of drugs.
- How drugs interact with the brain: People use alcohol and other drugs because they stimulate the brain in ways that “feel good.” This immediate rewarding experience makes people want to repeat it. All substances with addictive potential stimulate the release of dopamine, a chemical in the brain that is associated with reward and pleasure.
- Environment: Peoples’ home and community and the attitude of their peers, family and culture toward substance use can influence whether or not they develop substance use problems. People who experience prejudice or marginalization may use substances to cope with feelings of trauma or social isolation.
- Mental health issues: More than 50 per cent of people with substance use disorders have also had mental health problems at some point during their lifetimes. When people have mental health problems, even limited substance use can worsen the problem.
- Coping with thoughts and feelings: People may turn to substances as a way of coping with difficult emotions or situations. They start to rely on substances to regulate their emotions
Risk factors for substance use problems in youth include:
- alcohol or other drug problems among family members
- poor school performance
The protective factors for substance use problems include:
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How Are Addictions Diagnosed
To diagnose addiction, your provider may refer you to a psychiatrist, psychologist or a drug and alcohol counselor. Your healthcare provider will ask you questions about your activities and patterns of substance use. Tell your provider if youve tried to stop drinking or doing drugs, and why. Share whether youve had physical or psychological withdrawal symptoms whenever you have tried to stop.
Your provider will do a physical exam and may obtain a blood and urine test from you. These tests give your provider information about your overall health. They can also help rule out underlying health conditions.
The Disease Model Of Addiction: History And Explanation
The traditional medical model of disease only requires the presence of an abnormal condition that induces distress, discomfort, or dysfunction to the affected person. However, the contemporary medical model states that addiction occurs due to changes in the mesolimbic pathway in the brain. It also addresses the fact that such disease may be influenced by other sociological, psychological or biological factors, even though the mechanisms of these factors are not completely understood. Using the contemporary medical model, addiction was categorised as a disease.
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People Addicted To Substances Are Vulnerable To Other Addictions
For those with drug and alcohol addiction, the risk of developing other addictions increases significantly. As stated earlier, chronic drug use rewires the brain. It is common for people who are addicted to one drug to become addicted to another drug or activity. This is often referred to as cross-addiction in the disease model of addiction. This can be seen particularly in those families with a strong history of addiction.
Is Drug Addiction A Disease
The Centers for Disease Control and Prevention define chronic illness as, Conditions that last one year or more and require ongoing medical attention, limit activities of daily living, or both. Notice that this definition deals with the effects of the illness, rather than its cause. In that context, addiction is definitely an illness.
Kolmac Outpatient Recovery Center Counselor Rennie Grant and Kolmac Psychiatrist Dr. Tony Massey state, the disease model of addiction doesnt dispute . But once a substance is introduced, a new dynamic occurs that has to do with the complex reality of brain chemistry. The way the brain forms dependencies to substance and subsequently dictates behavior is also a critical informant of whether addiction is a disease or a choice.
Below, we discuss in-depth the definition of addiction, reasons why addiction is considered a disease, how addiction is related to brain function, and where the disease model of addiction can fall short.
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How Substance Use Physically Changes The Brain
Alcohol or drug abuse causes physical changes in the brain by creating long-lasting impairments to key functions and regions. These changes are responsible for establishing the brain disorder that makes substance abuse difficult to discontinue.
Drugs and alcohol bind to the receptor cells in the brain, leading to a release of certain neurotransmitters such as serotonin and dopamine, which in turn gives rise to an all-round feeling of relaxation, euphoria, and pleasure. Once these substances enter the brain, the brain is less likely to produce its own. Because of this, the brain reduces its production of dopamine, serotonin and other neurochemicals, as they are being released unnaturally due to substance use.
This affects the receptors and the brains risk/reward system, and the excess neurochemicals produced leads to tolerance and dependence and subsequent physical or psychological addiction to the substance. These processes change the physiology of the brain and it takes a significant amount of work to get it back to its normal state.
The Disease Model Of Addiction
The definition of addiction varies among individuals, organizations, and medical professionals, and societys viewpoints about addiction are ever-evolving. The National Institute on Drug Abuse , the Substance Abuse and Mental Health Services Administration , and the National Institutes of Health all similarly describe addiction as a long-term and relapsing condition characterized by the individual compulsively seeking and using drugs despite adverse consequences.1
These organizations call addiction a disorder or a disease because:1
- Addiction changes how the brain responds in situations involving rewards, stress, and self-control.
- These changes are long-term and can persist well after the person has stopped using drugs.
Comparing substance addiction to heart disease may help illustrate why it is defined as a disease by so many:1
- Both addiction and heart disease disturb the regular functioning of an organ in the body the heart for heart disease and the brain for addiction.
- They both can lead to a decreased quality of life and increased risk of premature death.
- Addiction and many types of heart disease are largely preventable by engaging in a healthy lifestyle and avoiding poor choices.
- They are both treatable to prevent further damage.
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What Is The Definition Of Addiction
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individuals life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.
Who Is Likely To Develop An Addiction
Anyone can develop a substance use disorder, but people with a family history of addictions are at higher risk. People who have mental health disorders including depression or post-traumatic stress disorder are more likely to have co-morbid substance use disorders as well. Noteworthy, gay, lesbian, bisexual or transgender populations are also vulnerable to substance use disorders because they experience significantly more psychiatric issues than the heterosexual population. Factors in these experiences include things like discrimination and issues of family dynamics.
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How To Treat Addiction As A Disease
Individuals can receive personalized therapy. Attending a 12-Step program can help many people, but it doesnt work for everyone.
You can try dialectical behavioral therapy. It is a form of talk therapy in which a therapist teaches a patient positive behaviors.
They learn distress tolerance, distracting themselves from difficult situations. They develop mindfulness, finding peace within themselves. These skills can diminish the environmental factors that can cause addiction.
Physical therapy can help mitigate pain and anxiety, which addiction can cause. An individual can go through detoxification, cleansing their body from drugs in their system.
Some people have comorbidity. They have addiction alongside another disease like bipolar disorder. Many therapies treat both conditions at the same time, allowing a person to live a full life.
When Should I See My Healthcare Provider About Addiction
Addiction is a serious disease. If you or someone you care about has a problem with addiction, talk to your provider right away. Treatments and support groups can help.
A note from Cleveland Clinic If you or someone you know is living with addiction, you may feel overwhelmed and out of control. But there is hope. Addictions are treatable. Through hard work and commitment, millions of people have overcome substance use disorders to live happy, healthy lives. Talk to your provider about a treatment plan that works for you. Dont get discouraged if you have setbacks along the way. It is possible to overcome this, and you are not alone.
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Why Is Addiction Considered A Disease
Addiction is considered a disease largely as a way to remove stigma, guilt, moral blame, and shame from those who use substances or certain behaviors repeatedly to feel intense euphoria and as a way to encourage humane treatment. It is also viewed as a disease in order to facilitate insurance coverage of any treatment.
Unfortunately, at the very same time, it prods people to see themselves as hapless victims of a process beyond their control. Addiction is definitely difficult to understand, because it starts out as a voluntary activity but, for many people, the brain adapts so quickly to that activity it becomes difficult to control. Changes in neural circuitry make the reward extra compelling it becomes difficult to pay attention to anything else and difficult to stop, even when use creates problems and there is a desire to quit.
The fact that addiction changes the way the brain works lends credibility to the idea of a lifelong disease, even though, according to the National Institute of Drug Abuse, the changes are persistentwhich is not the same as permanent. But turning addicts into patients keeps them from doing what is essential for recoverydiscovering a personal goal deeply, individually meaningful and rewarding enough to satisfy the neural circuitry of desire.