Addiction is a Chronic Medical Disease. Let’s Be Sure to Treat it That Way.

Medical records - addiction is a medical disease

I want to talk about what alcohol and drug 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 helping increase acceptance of a medical approach to alcohol and drug addiction is the growing awareness that substance dependence is not a moral failure, but rather a chronic medical disease with similarities to other chronic medical diseases such as diabetes, hypertension, and asthma. It was only within the last 20 years that researchers began to realize substance dependence 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 stop. 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 by drugs of abuse. The limbic system is also responsible for other emotions which explains the mood-altering properties of many drugs.
  • Hippocampus — an 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 is an altered brain that’s learned to do the wrong thing, over and over again. Unfortunately, brain changes related to drug use and addiction are not “quick come, quick go” types of changes (otherwise known as an “acute” disease). 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’s 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 only possible, for the majority it is very likely to happen. This does not mean treatment has failed. It means, as with other chronic diseases, that treatment needs to be readjusted to understand the physiological and behavioral factors that contributed to the relapse. If we look at the relapse rates for other chronic disease 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 forgetting to take his or her 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 to slip up despite having a chronic illness, and we encourage them to take their medicines regularly and stick to a health-enhancing eating and exercise plan. We understand, in spite of the health consequences, people with chronic diseases such as diabetes, asthma, and elevated blood pressure often do neglect to follow their doctor’s orders. 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, according to the Institute of Medicine Study of Chronic Diseases. Why should we treat those with substance addictions 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 addictions will find it much easier to learn, remember, and focus on the cognitive and behavioral changes used in talking therapy and achieve longer-lasting sobriety.

But let me be perfectly clear about one thing: I’m not saying that the medicines are a magical cure or that we can forget the 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 healthful diet, exercise regularly, remain slim, 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.
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    We Do Recover

    September 17, 2012 at 9:52 PM

    Yes, I agree with that addiction is a chronic, relapsing brain disorder which responds to appropriate treatment in much the same way as other chronic illnesses like diabetes, hypertension and asthma. The disease concept does explain how an addict cannot stop drug abuse by force of will alone.

    I think people often assume that because we’re saying “addiction is a Brain Disease!” that this in some way makes the addict a helpless victim.

    This is NOT the case.

    Each individual needs to take responsibility for his or her own behaviour and recovery from addiction. Addicted people need comprehensive and appropriate treatment that gives them an acute awareness of their condition, it’s only then that they’ll begin to assume responsibility for their recovery. After all why make the required lifestyle changes if my condition isn’t really ALL THAT BAD!

    Whilst addiction may not meet the rigid classification of a disease it’s certainly useful to regard it as analogous to one if it helps the addicted patient structure their life around the problem and get into recovery.

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    Alcohol and Drug Addiction

    June 20, 2011 at 10:22 PM

    I think that looking at addiction as a disease increases the chances that people will start taking the issue serious and seek professional help. If someone knows they have a disease, they will know that they can’t fight it on their own. They are going to need some help.

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    brain disease

    October 7, 2009 at 12:32 PM

    It’s really cool going through the post. Thanks for sharing your views and information on addiction with special reference to the human brain.

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    Scott Elias

    October 3, 2009 at 5:44 AM

    You are so right about this. So many times, you will see an alcohol detox center offering a “cure” for addiction. Well, anyone who knows anything about drug or alcohol addiction treatment will tell you a) that there is no “cure” technically speaking, and b) that treatment requires the addressing of both the physical and psychological components of addiction. It is only through this comprehensive approach that the individual can begin to improve his or her life.

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