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(AP) — Addiction isn’t just about willpower. It’s a chronic brain
disease, says a new definition aimed at helping families and their
doctors better understand the challenges of treating it.
is about a lot more than people behaving badly,” says Dr. Michael M.
Miller of the American Society for Addiction Medicine.
whether it involves drugs and alcohol or gambling and compulsive
eating, the doctors group said Monday. And like other chronic conditions
such as heart disease or diabetes, treating addiction and preventing
relapse is a long-term endeavor, the specialists concluded.
generally is described by its behavioral symptoms — the highs, the
cravings, and the things people will do to achieve one and avoid the
other. The new definition doesn’t disagree with the standard guide for
diagnosis based on those symptoms.
But two decades of neuroscience
have uncovered how addiction hijacks different parts of the brain, to
explain what prompts those behaviors and why they can be so hard to
overcome. The society’s policy statement, published on its Web site,
isn’t a new direction as much as part of an effort to translate those
findings to primary care doctors and the general public.
behavioral problem is a result of brain dysfunction,” agrees Dr. Nora
Volkow, director of the National Institute on Drug Abuse.
welcomed the statement as a way to help her own agency’s work to spur
more primary care physicians to screen their patients for signs of
addiction. NIDA estimates that 23 million Americans need treatment for
substance abuse but only about 2 million get that help. Trying to add
compassion to the brain findings, NIDA even has made readings from
Eugene O’Neill’s “Long Day’s Journey into Night” a part of meetings
where primary care doctors learn about addiction.
Then there’s the
frustration of relapses, which doctors and families alike need to know
are common for a chronic disease, Volkow says.
“You have family
members that say, ‘OK, you’ve been to a detox program, how come you’re
taking drugs?'” she says. “The pathology in the brain persists for years
after you’ve stopped taking the drug.”
Just what does happen in the brain? It’s a complex interplay of emotional, cognitive and behavioral networks.
plays a role, meaning some people are more vulnerable to an addiction
if they, say, experiment with drugs as a teenager or wind up on potent
prescription painkillers after an injury.
Age does, too. The
frontal cortex helps put the brakes on unhealthy behaviors, Volkow
explains. It’s where the brain’s reasoning side connects to
emotion-related areas. It’s among the last neural regions to mature, one
reason that it’s harder for a teenager to withstand peer pressure to
experiment with drugs.
Even if you’re not biologically vulnerable
to begin with, perhaps you try alcohol or drugs to cope with a stressful
or painful environment, Volkow says. Whatever the reason, the brain’s
reward system can change as a chemical named dopamine conditions it to
rituals and routines that are linked to getting something you’ve found
pleasurable, whether it’s a pack of cigarettes or a few drinks or even
overeating. When someone’s truly addicted, that warped system keeps them
going back even after the brain gets so used to the high that it’s no
Make no mistake: Patients still must choose to
fight back and treat an addiction, stresses Miller, medical director of
the Herrington Recovery Center at Rogers Memorial Hospital in
But understanding some of the brain reactions at
the root of the problem will “hopefully reduce some of the shame about
some of these issues, hopefully reduce stigma,” he says.
most of the neuroscience centers on drug and alcohol addiction, the
society notes that it’s possible to become addicted to gambling, sex or
food although there’s no good data on how often that happens. It’s time
for better study to find out, Miller says.
Meanwhile, Volkow says
intriguing research is under way to use those brain findings to develop
better treatments — not just to temporarily block an addict’s high but
to strengthen the underlying brain circuitry to fend off relapse.
Miller’s wish list: Learning why some people find recovery easier and
faster than others, and “what does brain healing look like.”
EDITOR’S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press.