With early stages of addiction, a doctor may recommend medication and therapy. Later stages may benefit from inpatient addiction treatment in a controlled setting. They say, “Oh, you’re taking the attention away from the population public health.” I say, “No, actually it makes me more interested in population public health now that I understand the neuroscience.
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We provide arguments to support this view, discuss why apparently spontaneous remission does not negate it, and how seemingly compulsive behaviors can co-exist with the sensitivity to alternative reinforcement in addiction. Most importantly, we argue that the brain is the biological substrate from which both addiction and the capacity for behavior change arise, arguing for an intensified neuroscientific study Why Alcoholism is Considered a Chronic Disease of recovery. More broadly, we propose that these disagreements reveal the need for multidisciplinary research that integrates neuroscientific, behavioral, clinical, and sociocultural perspectives. The most widely used definitions of drug addiction are of the condition having a chronic course that is typically characterized by relapse.
What are the signs?
Although this phenomenon is not necessarily present in every patient, it reflects important symptoms of clinical addiction, and is captured by several DSM-5 criteria for SUD 101. Examples are needle-sharing despite knowledge of a risk to contract HIV or Hepatitis C, drinking despite a knowledge of having liver cirrhosis, but also the neglect of social and professional activities that previously were more important than substance use. While these behaviors do show similarities with the compulsions of OCD, there are also important differences. For example, “compulsive” substance use is not necessarily accompanied by a conscious desire to withhold the behavior, nor is addictive behavior consistently impervious to change. In dismissing the relevance of genetic risk for addiction, Hall writes that “a large number of alleles are involved in the genetic susceptibility to addiction and individually these alleles might very weakly predict a risk of addiction”. He goes on to conclude that “generally, genetic prediction of the risk of disease (even with whole-genome sequencing data) is unlikely to be informative for most people who have a so-called average risk of developing an addiction disorder” 7.
- Surely, if overcoming addiction were as easy as simply choosing to stop, the problem of addiction would be much easier to address and relapse would not be as common.
- For example, it is true that most substance abuse begins with a decision (although in many cases substance use began with a prescription from a doctor for a real medical problem and evolved into abuse).
- Drug use can have significant and damaging short-term and long-term effects.
- If we can eliminate the empty “disease” label, then people who suffer with an addiction can finally stop thinking of themselves as “diseased.”
- Evidence of generally intact decision making does not fundamentally contradict addiction as a brain disease.
- Some person was addicted and let’s say they robbed somebody or they drove their car and they killed somebody.
Comment on Heilig et al.: The centrality of the brain and the fuzzy line of addiction
Epidemiologically, it is well established that social determinants of health, including major racial and ethnic disparities, play a significant role in the risk for addiction 75, 76. Contemporary neuroscience is illuminating how those factors penetrate the brain 77 and, in some cases, reveals pathways of resilience 78 and how evidence-based prevention can interrupt those adverse consequences 79, 80. In other words, from our perspective, viewing addiction as a brain disease in no way negates the importance of social determinants of health or societal inequalities as critical influences.
Someone with an addition won’t stop their behavior, even if they recognize the problems the addiction is causing. In some cases, they’ll also display a lack of control, like using more than intended. Doesn’t work, kills some people, costs a lot of money, compromises liberty. If you accept that it’s an illness, it opens up much more therapeutic options that work a lot better, cost a lot less, and do not compromise liberty in a way that’s offensive to most people who live in free societies.
A systematic review and meta-analysis on the transcriptomic signatures in alcohol use disorder
We can be disappointed in ourselves and others when they engage in bad behavior but still say but we’re still going to show some compassion to you. The other part that recognizing it as an illness is, it gets us out of doing something that is stupid and mean and doesn’t work and costs a lot of money, which is trying to punish addiction out of people. It was not that long ago when, for addiction to heroin people were put in a prison for years, and still in some parts of the world people are sent off to brutal work camps to just sort of knock the stuffing out of them. Tobacco alone is like 8 million people a year, alcohol’s not far behind it, and then you have the illicit drugs killing about 600,000 people a year, which is an extraordinary amount of mortality.
Due to the toxic nature of these substances, users may develop brain damage or sudden death. “It is not a complete loss of autonomy—addicted individuals are still accountable for their actions, but they are much less able to override the powerful drive to seek relief from withdrawal provided by alcohol or drugs.” When this reward system is disrupted by substance misuse or addiction, it can result in the person getting less and less enjoyment from other areas of life when they are not drinking or using drugs, according to the Surgeon General’s report. However, alcoholism has been recognized for many years by professional medical organizations as a primary, chronic, progressive, and sometimes fatal disease. The National Council on Alcoholism and Drug Dependence offers a detailed and complete definition of alcoholism, but the most simple way to describe it is a mental obsession causing a physical compulsion to drink. Knowing how addiction works psychologically meets these requirements.
If not from the brain, from where do the healthy and unhealthy choices people make originate? To resolve this question, it is critical to understand that the ability to choose advantageously is not an all-or-nothing phenomenon, but rather is about probabilities and their shifts, multiple faculties within human cognition, and their interaction. Yes, it is clear that most people whom we would consider to suffer from addiction remain able to choose advantageously much, if not most, of the time. However, it is also clear that the probability of them choosing to their own disadvantage, even when more salutary options are available and sometimes at the expense of losing their life, is systematically and quantifiably increased. There is a freedom of choice, yet there is a shift of prevailing choices that nevertheless can kill.
Recognizing addiction to be just a common psychological symptom means it is very much in the mainstream of the human condition. In fact, as I’ve described elsewhere, addiction is essentially the same as other compulsive behaviors like shopping, exercising, or even cleaning your house. But inside, it is basically the same as these other common behaviors. As you likely know, addictive acts occur when precipitated by emotionally significant events.
