U.N. Panel Unanimous: Addiction Is a Brain Disease
Substance Addiction and Behavioral Addiction
Substance addiction is the common term for any form of addiction that stems from the lasting brain changes triggered by repeated exposure to excessive amounts of alcohol or certain medications or drugs. Behavioral addiction is one of several terms used to identify brain and behavioral changes that, while similar to those found in people with substance addictions, don’t have any direct association with substance intake. Other terms used for this same type of condition include process addiction and addictive disorder. In the U.S., the American Psychiatric Association (the organization that sets the most widely used criteria for mental health issues) has a long history of recognizing the existence of substance addiction. However, the organization only officially acknowledged the existence of behavioral addiction in 2013.
At one point in time, the American Psychiatric Association maintained separate categories for diagnosing cases of physically dependent substance addiction and non-dependent cases of substance abuse. However, in response to science-based changes in the understanding of abuse and addiction, the organization established a joint diagnosis, called substance use disorder, which includes symptoms of both substance-related issues. This change also took place in 2013. Both substance use disorder and behavioral addiction now belong to a category of mental health concerns called substance-related and addictive disorders.
In addition to the director of the National Institute on Drug Abuse, participants in the Kavli Foundation discussion panel included the director of the Icahn School of Medicine’s Friedman Brain Institute and a prominent addiction researcher from Yale University. These panelists date the first wave of modern-day recognition of addiction as a brain disease to 1997, although preliminary work on the topic extends back to at least the 1980s. Critical to the understanding of addiction as a disease is an understanding of the involuntary changes in behavior that appear in addicted individuals. Once addiction-related changes arise inside the brain, they continue in persistent form for extended periods of time, even when ultimately effective treatment is available. These persistent changes literally alter the way an affected person approaches everyday life and can partially or completely interfere with the ability to control certain aspects of personal conduct, including continued substance use or continued participation in non-substance-based addictive behavior.
Essentially, the brain-related loss of voluntary control distinguishes addiction from a failure of willpower or moral imperative and makes the condition the effective equivalent of other chronic physical ailments. As is true with other chronic conditions, different people have varying levels of susceptibility to substance addiction and behavioral addiction. However, this varying susceptibility stems from a range of genetically inherited and environmental factors and has nothing to do with having a “strong” or “weak” personality.
Treatment and Management Issues
The members of the panel note that there are no uniform solutions for treating or managing addiction. For instance, while there are medications to treat certain forms of addiction (including nicotine/tobacco addiction, alcoholism and opioid addiction), doctors have no reliable medication options for addressing the effects of other forms of substance-based addiction. The panel members also note a disparity between the level of knowledge about potentially effective treatments and the development of such treatments by pharmaceutical companies: While addiction researchers have identified a large number of ways in which medications could help affected individuals, pharmaceutical companies have yet to introduce many specific products that take full advantage of the available pool of scientific knowledge.
The panel members also note that stigma regarding the effects of substance addiction is roughly equivalent to the stigma associated with obesity, another chronic condition that has at least a partial biological/genetic basis. This is an interesting overlap, since people affected by substance addiction experience some of the brain changes found in people who habitually overeat. Food addiction is the common behavioral addiction-related term used to describe compulsive participation in the excessive consumption of certain highly pleasurable foods.