Science of Addiction

Addiction is a brain disease, not a choice, says the American Society of Addiction Medicine

By Missy Wilkerson

The AA Blog – September 9, 2011

Described in the Alcoholics Anonymous Big Book as “cunning, baffling, powerful,” addiction often seems as inscrutable as the human mind itself. Its reach is widespread: Else Pedersen, executive director of Bridge House, estimates 10 to 15 percent of the population has an addiction. “We all either have this or have some strong primary connection to it,” she says. “This is everywhere, and it needs to be dealt with like the medical issue it is. We need to give it the same attention we give other diseases that are progressive, pervasive and potentially lethal.”

Last month, The American Society of Addiction Medicine (ASAM) made a big step toward widespread recognition of addiction as a medical issue rather than a behavioral issue or moral failing. It released a new definition which states addiction is a chronic, underlying, largely genetic brain disease.

“The disease is about brains, not drugs,” former president of ASAM Dr. Michael Miller stated in a press release. “It’s about underlying neurology, not outward actions.” Miller oversaw a four-year effort by more than 80 addiction experts and neuroscience researchers which yielded the new definition.

Dr. Ken Roy, medical director of Addiction Recovery Resources Incorporated in Metairie, calls it a game-changer.

“This is a definition based on a consensus of expert opinion and scientific literature that changes the understanding of addiction from a choice or a self-treatment to a condition of brain structures that basically compels behavior outside the ability to choose,” he says. “It’s also pivotal in the sense that it equates a compulsion to use chemicals with compulsions to have other kinds of behaviors such as food or gambling or sex. (It is) the same disease state. Addiction is not a choice.”

The new definition reveals addiction to be a primary disease, much like diabetes or cardiovascular disease. It can be a root cause behind other behavioral, social and psychological problems like depression, cognitive distortions, social isolation and anxiety. According to ASAM’s definition, “genetic factors account for about half the likelihood that an individual will develop addiction” — meaning if one of your parents is or was an addict, you are genetically predisposed to developing addiction.

Since addiction has physical, neurobiological causes, one would expect the brains of addicts to function differently than the brains of non-addicts. This is exactly what happens, says Dr. Howard Wetsman, medical director at Townsend, a network of local outpatient addiction treatment centers. Many (not all) addicts have a morphology (or mutation) in the genes associated with the production, release, reuptake and metabolizing of dopamine, a neurotransmitter associated with pleasure and reward. Wetsman refers to the intricate factors governing normal dopamine levels as “dopamine tone.”

“Generally, people who have a low dopamine tone are not able to make great attachments and feel rewards from normally rewarding activities, and that is when the drug or behavior comes along,” he says. ” Our society likes to think that drugs cause addiction. It’s actually the other way around for most people with addiction. The addiction causes the drug use,” he writes in his book, QAA: Questions and Answers on Addiction.

The genetic factor is so pervasive that Wetsman has instituted genetic testing as part of Townsend’s intake procedure. “The test identifies two dozen genetic mutations in the brain that relate to symptoms of addiction,” says John Antonucci, an intake coordinator at Townsend who also is recovering from addiction.

“This information helps fine-tune medical interventions, and it is amazing when you take a patient and their family members, and they realize it really is a biological brain disease. I like to equate it to seeing the X-ray when you have a broken arm. And I have seen family members break down and cry when they realize all this time, their kids weren’t doing this to spite them. They were doing it because they were sick.”

Though Antonucci says nine out of 10 of Townsend’s patients report addiction in their family trees, there are some addicts without a family history or genetic indication of the disease (but because addiction can express itself through many different compulsions, from overeating to compulsive spending, it can sometimes be hard to trace, Wetsman says). New Orleans native, Xavier University alumnus, father of five and recovering addict Darryl Rouson, now a Florida state representative, had no known family history of addiction.

“My mother was known to cut her beer with 7-Up, and my dad drank three or four times a year,” says Rouson, who began drinking and using cocaine in the ’80s. “I wasn’t drinking for the social nature, I wanted the effect, and I wanted it quickly, and for a long time. For me, it started out filling what I thought were voids in my life, low self-esteem: I never thought I was cute enough, strong enough, athletic enough or smart enough, and I was always doing things to compensate for these lacks.”

Rouson says he has been through eight treatment programs and is well-versed in the genetic component of addiction, but he has never been tested for the morphologies. Though genetic testing can provide clarity to a diagnosis of addiction, and a basis for what medications will best normalize individuals’ brain chemistry, neither testing nor medications are necessary for recovery. “There are millions of people who have gotten sober by going to 12-step meetings (like Alcoholics Anonymous or Narcotics Anonymous). For some people, that works,” says Jo Cohen, clinical director of New Orleans Bridge House and Grace House. “We support the science, but like everything else in treatment, it’s an individualized approach.”

Although people do not choose to become addicts, they do have choices over how they manage the disease. Addiction requires ongoing treatment, which varies from person to person — some may benefit from ongoing use of medications like Suboxone, some may require long-term inpatient treatment, others may stay sober simply by attending 12-step meetings. Antonucci stresses that a strong routine of recovery-related activities like meetings or volunteering helps people maintain sobriety, as does access to help from addiction doctors. “This is a chronic disease like diabetes or hypertension,” he says. “If you are diabetic, you get exercise and take insulin, but there are times you need to check up with your endocrinologist.”

Rouson manages his addiction by attending 12-step meetings, sponsoring other recovering addicts, reading Alcoholics Anonymous literature, and giving back to the community by sharing his story at prisons and recovery centers. He will speak at Xavier Wednesday, Sept. 14, to celebrate National Recovery Month.

“One of the critical reasons why I got clean was I was given a choice,” he says. “(My wife) Ruby was dead and I had taken her $80,000 life insurance policy and spent $60,000 on cocaine. I was in a courtroom with my wife’s family and they were trying to convince the judge to take my four-year-old son. The judge said I could either choose Daniel or drugs, but after today, I would not have both. I chose my son.”

Antonucci and Rouson both say their community outreach work, which is a tenant of Alcoholics Anonymous (the 12th step states, “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs”), is essential to their ongoing sobriety. And though there may seem to be a disconnect between the scientific, biologically based addiction definition and the spiritually based 12-step programs, ASAM’s research scientically supports the activities recovering addicts undertake in 12-step recovery programs as ways to maintain sobriety.

“Our medical approach to addiction dovetails very nicely into 12-step recovery, because there is a scientific basis behind how it works,” Antonucci says. “Part of my recovery is, I serve food to homeless people every Saturday night, and afterwards, I feel great. Why do I feel great? My hedonic tone has gone up. Doing something really healthy for the community has changed my brain chemistry.”

Wetsman agrees that engaging in charitable activities can normalize dopamine levels. “You get dopamine lowering from being isolated and feeling less-than,” he says. “You can’t feel isolated and less than when you help somebody else — dopamine receptors actually physically gain in number. The receptors are much more plastic than we think.”

Pederson, Antonucci and medical professionals across the board hope the new definition of addiction will serve to remove much of the shame and stigma surrounding the disease, which in turn will facilitate recovery for the millions who suffer from addiction.

“When people have a strong understanding about the disease, that’s when the miracles happen, and treatment can be extremely successful,” Antonucci says. “Don’t be afraid to get better. This can work for you, too. Give yourself a chance.”

What is Addiction?

Addiction is a chronic disease that affects the brain's reward system. It is characterized by compulsive drug-seeking behavior, despite the negative consequences. Addiction is a complex issue that involves both psychological and physical factors. It affects people of all ages, races, and socioeconomic backgrounds.

How Does Addiction Work?

Addiction is a complex and multifaceted issue that affects millions of people worldwide. It is not just a matter of willpower or moral failing, but rather a disease that involves a complex interplay between genetic, environmental, and psychological factors.

When a person uses drugs, it activates the brain's reward system, releasing a chemical called dopamine. Dopamine is a neurotransmitter that is responsible for feelings of pleasure and reward. This is why drugs can be so addictive - they hijack the brain's natural reward system, leading to a powerful craving for more.

Over time, the brain becomes desensitized to the effects of the drug, and the user needs more of the drug to achieve the same level of pleasure and reward. This is known as tolerance, and it is a hallmark of addiction.

But addiction is not just a physical dependence on a drug. It is also a psychological dependence, with emotional and behavioral components. People who struggle with addiction often experience intense cravings, mood swings, and other symptoms that can make it incredibly difficult to quit.

The good news is that addiction is treatable. With the right support and treatment, people can and do recover from addiction every day. But it takes time, effort, and commitment to overcome this disease. If you or someone you know is struggling with addiction, know that help is available and recovery is possible.

The Role of Genetics

Research has shown that genetics play a significant role in addiction. It is believed that some people may be more predisposed to addiction due to their genetic makeup. However, genetics alone do not determine whether a person will become addicted to drugs.

There are several factors that contribute to addiction, including environmental factors, social factors, and personal experiences. Some people may have a genetic predisposition to addiction, but it is not the only factor that determines whether they will become addicted to drugs.

It is essential to understand that addiction is a complex disease that affects people from all walks of life. While genetics may play a role in addiction, it is crucial to recognize that addiction is not a choice. It is a disease that requires treatment and support from healthcare professionals, family, and friends. Together, we can help those struggling with addiction to overcome their challenges and lead fulfilling lives.

Environmental Factors

Environmental factors play a crucial role in addiction, as they can often be the root cause of the problem. Stress, trauma, and peer pressure are all factors that can contribute to addiction. People who experience trauma or stress may turn to drugs as a way to cope with their emotions. They may feel that drugs provide a temporary escape from their problems or offer a way to numb the pain.

Peer pressure can also play a significant role in addiction. When people feel pressure to fit in with their social group, they may turn to drugs as a way to feel accepted. This can be especially true for teenagers, who are particularly vulnerable to peer pressure.

Moreover, the environment in which people live can also contribute to addiction. For example, people who live in areas with high levels of drug use may be more likely to start using drugs themselves. Additionally, people who grow up in homes with drug addiction may be more likely to develop addiction themselves.

It's important to understand the environmental factors that contribute to addiction so that we can take steps to prevent it. By addressing these factors and providing support to those who are struggling, we can help people overcome addiction and lead healthy, fulfilling lives.

The Brain's Reward System

The brain's reward system plays a crucial role in addiction. It is a complex system that involves various regions of the brain, including the prefrontal cortex, the amygdala, and the nucleus accumbens. When a person uses drugs, it activates the brain's reward system, releasing dopamine, which is a neurotransmitter that is associated with pleasure and reward.

Over time, the brain becomes desensitized to the effects of the drug, and the user needs more of the drug to achieve the same level of pleasure and reward. This phenomenon is called tolerance, and it is one of the key factors that contribute to addiction. Tolerance can lead to physical and psychological dependence, which can be extremely difficult to overcome.

Moreover, addiction is a chronic disease that affects not only the brain but also the body and behavior. It can have devastating consequences, such as health problems, social and economic problems, and legal problems. Therefore, it is important to understand the brain's reward system and the mechanisms of addiction, so that we can develop effective prevention and treatment strategies.

Treatment for Addiction

Treatment for addiction is a complex process that requires dedication and commitment from both the individual seeking help and their healthcare providers. Typically, treatment involves a combination of therapy, medication, and support groups.

Therapeutic intervention

Therapy can be immensely helpful for individuals struggling with addiction, as it allows them to learn coping skills and strategies to manage their addiction. In therapy, individuals can explore the root causes of their addiction, as well as any underlying mental health issues that may be contributing to their substance use.

Medication-assisted treatment

Medications, such as methadone and buprenorphine, can be used to reduce cravings and withdrawal symptoms, making it easier for individuals to stay on the path to recovery. These medications are often used in combination with therapy and support groups to provide a comprehensive approach to treatment.

Support groups

Support groups, such as Alcoholics Anonymous and Narcotics Anonymous, can provide individuals with the support and encouragement they need to stay sober. These groups offer a safe and supportive environment where individuals can connect with others who are going through similar experiences. They can also provide a sense of accountability, as individuals are encouraged to attend meetings regularly and share their experiences with others in the group.

Holistic approach

Overall, the treatment of addiction requires a holistic approach that addresses the physical, emotional, and psychological aspects of the disease. With the right combination of therapy, medication, and support, individuals can successfully overcome addiction and achieve long-term recovery.

Conclusion

Addiction is a chronic disease that affects millions of people worldwide. It is a complex issue that involves both psychological and physical factors. Genetics, environmental factors, and the brain's reward system all play a role in addiction. Treatment for addiction typically involves a combination of therapy, medication, and support groups. Understanding the science of addiction is the first step in addressing this complex issue.