The age-old question: Is addiction a choice or is it a brain disorder of some type?
Addiction now defined as brain disorder, not behavior issue
Decades of research convinced American Society of Addiction Medicine to change definition
Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.
The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts.
”At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”
The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person’s lifetime, the researchers say.
Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what’s going on in the brain. For instance, research has shown that addiction effects the brain’s reward circuitry, such that memories of experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.
A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition.
“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,” Hajela said in a statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”
Even so, Hajela pointed out, choice does play a role in getting help.
“Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.
This “choosing recovery” is akin to people with heart disease who may not choose the underlying genetic causes of their heart problems but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions, the researchers said.
“So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment,” Miller said.
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How does addiction still affect those who are sober?
As you know, if you follow this blog, I had an accident roughly a year ago. I was attempting to put the screen on our balcony window back into its track, when I turned just a bit too much, and BOOM next thing I knew I was on the ground 3 floors down which a right kneecap shattered into 14 pieces.
Unfortunately, there are only three medications that work on bone pain. These medications are all narcotics, all opiates.
So what does a recovering addict do when faced with immense pain and having no choice but to take drugs?
Well, he takes them of course, but he/she must pay very careful attention and take the medication under the strict supervision of both his doctor and his family.
For example once my knee healed to the point of no longer needing the opiate medications, I took the rest of the Fentanyl (opiate) patches that I was using, balled then up, and ceremoniously burned them, in celebration of my recovery.
Now, because I had never used Heroin during my career as an addict, I did not know about withdrawal, or its horrible symptoms. So, two days later I found myself stiff as a board, shaking uncontrollably, and going through momentarily changing conditions of both feeling ice-cold, and burning.
Obviously I needed to find a solution but was committed to not returning to the patches. I fund a clinic in Tel Aviv that is certified by the medical association of Israel, and totally on the level, that provided a medication called Subutex.
Buprenorphine (sold under the trade-names of Subutex, Suboxone – high-dose tablets used for the treatment of addiction.
I had essentially become addicted to Heroin, in the form of Opium. The Subutex tablets immediately stopped all of the withdrawal symptoms that I was experiencing, within minutes.
The problem is, then, that one becomes addicted to Subutex and must come off of it very slowly (as I should have done with the Fentanyl patches originally).
Once a week, I travel to Tel Aviv to get a month-long prescription for Subutex. The patient is only allowed to have a week of medication at a time, so even though the prescription is at the pharmacy, I must return each week to get the next weeks allotment, and then once a month I visit the Doctor for a new months’ prescription.
So what is the problem?
The problem is that I fell again, landing directly on my bad knee. I was on the bus with my son, the driver took off, my son flew, and of course, without thinking I caught him, unfortunately landing on my knee.
Because Subutex is a type of opiate, no other pain reliever works, and I am therefore tempted to take more of the Subutex which of course as an opiate, is also a pain-killer.
So what do I do?
I have my wife hold my medication for me, and each night, leave out two tablets (my prescribed dosage), for me to take in the morning, and then hide the Subutex so that even if I were tempted to take extra for pain relief, I would not be able.
A good solution?
I think so.
Thanks,
Mordechai