I want to talk about what addiction really is: a chronic medical disease of the brain. I believe if we treat the disease as such, long-term success rates of getting into and staying in recovery will greatly improve in most cases.
One of the positive trends that is increasing acceptance of a medical approach to treatment is the growing awareness that addiction is not a moral failure, but a chronic medical disease with similarities to diseases such as diabetes, hypertension, and asthma. It was only within the last 20 years that researchers began to realize that addiction is a brain disease, a medical condition with a neurobiological basis that causes lasting changes in the brain —- changes that don’t go away, sometimes for months or years, even after recovering patients have stopped using substances. Alcohol and drug use can cause changes in the brain’s structure and functioning. For example, the brain’s communication system is impacted by drug use, interfering with the way nerve cells send, receive and process information. There are many other areas in the brain that are impacted by drug use, including:
- Cortex — the outer area of the brain, which contains the most highly evolved cells, where abstract thinking and higher cognitive processes occur, allowing us to think, learn and understand.
- Limbic Region — the brain’s reward circuit that links together different brain structures that control and regulate our ability to feel pleasure. The limbic system is activated when we perform activities that help us feel pleasure — and also activated by drugs and other substances. The limbic system is also responsible for emotions, which explains the mood-altering properties of many drugs.
- Hippocampus — the area adjacent to the limbic region where many long-term memory cells reside, all of which are “plugged in” to the limbic region’s emotional circuits.
The result of all this is an altered brain. Unfortunately, brain changes related to drug use and addiction are not “easy come, easy go” types of changes, which come with acute diseases. Like diabetes, asthma and other chronic diseases, addiction is a chronic disease. Your diabetes is not cured simply because you’re taking your medicine and watching your diet; it may be managed, but it’s still present. It is the same with the disease of addiction; it can be managed successfully, but it is a chronic disease.
Because addiction is a chronic disease, relapse is not just possible — for the majority it is very likely to happen. This does not mean that treatment has failed. It means, as with other chronic diseases, that treatment needs to be readjusted in order to understand the physiological and behavioral factors that contributed to the relapse. If we look at the relapse rates for other chronic diseases such as diabetes (30 to 50 percent), asthma (50 to 70 percent) and hypertension (50 to 70 percent), we see similarities.
There are no quick fixes for any chronic illness, including addiction, which is why patients deserve sympathy and support even when they relapse. We don’t condemn a diabetic for having a sugary dessert or for forgetting to take their medicine; we don’t revile the person with hypertension who gains weight instead of losing it. Instead, we sympathize with and try to understand what caused them to slip up, and we encourage them to take their medicines regularly and stick to a health-enhancing diet and exercise plan. We understand, in spite of the health consequences, that people with chronic diseases such as diabetes, asthma, and elevated blood pressure can, and often do, neglect to follow their doctor’s orders. According to the Institute of Medicine’s study of chronic diseases, less than 50 percent of patients with these diseases take their medicines as prescribed, and less than 30 percent comply with lifestyle changes recommended by their doctors. Why should we treat those with substance use disorder differently?
Another key component to addiction treatment is the anti-craving medications designed to re-balance the brain’s biochemistry. These medications help correct imbalances in dopamine and other essential neurotransmitters, and accelerate healing of the physical damage in both the limbic region and the cortex. Once this damage has been repaired, a person with addiction will find it much easier to learn, remember and focus on the cognitive and behavioral changes used in talk therapy and to achieve longer-lasting sobriety.
But let me be perfectly clear about one thing: I’m not saying medication is a magical cure, or that we can forget other treatments. Therapies are still essential to the recovery process, as are mastering new coping skills and making permanent lifestyle modifications. Insulin alone isn’t the solution for a diabetic, who must also learn how to eat a healthy diet, exercise regularly, check his feet for cuts and sores that may become infected, and otherwise adhere to a good-health program. Neither are medications a simple solution to addiction. Successful addiction treatment requires a comprehensive approach, just like any other chronic medical disease.
The good news about all of this is that once we understand this extremely important information and treat alcohol or drug addiction like a chronic disease, then patients can start to have long-term, successful recovery.
Some material from this post is excerpted from the book Healing the Addicted Brain.