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.