Addiction is not an expression of bad behaviour or a lack of will power, according to a new definition of addiction released this week by a leading medical body. It's a chronic brain disorder.
Essentially, addiction is a primary disease, which means it's not the result of other causes such emotional or psychiatric problems. And like cardiovascular illness or diabetes, it must be treated, managed and monitored over a lifetime, says the American Society of Addiction Medicine, which represents about 3,000 physicians in the United States and Canada involved in the treatment and prevention of all types of addictions.
More than 80 experts spent four years working on ASAM's new definition that takes into account the latest advances in neuroscience. Research now suggests that addiction – whether it's alcohol, drugs, gambling or sex – involves several brain regions and the neurocircuitry governing reward, motivation, memory and impulse control, said Raju Hajela, a Calgary physician who chaired the committee that drafted the definition.
By shifting the emphasis to biological aspects of the disorder and away from the resulting behaviour, ASAM hopes to improve public understanding of a common problem, said Dr. Hajela, who is also past president of the Canadian Society of Addiction Medicine.
He noted that family and friends are often heartbroken by the self-destructive behaviour of addicts and baffled by their seeming inability to quit. "The reason they can't stop is that they have this altered brain circuitry," he explained. "The disease creates distortions in thinking, feelings and perceptions, which drives people to behave in ways that are not understandable to others around them."
Addicts can, however, overcome their affliction, he added. "Choice still plays an important role in getting help," Dr. Hafela said. "While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery."
ASAM concludes that beating an addiction may require a psychological or even a spiritual shift "of what is of value to you and what gives meaning to your life," said Dr. Hajela. "Each person needs to find their own spiritual connection, which is an important part of recovery."
He acknowledged that his organization's embrace of spirituality may be controversial. But it is far from the first to adopt such an approach. For instance, since its foundation in the 1930s, Alcoholics Anonymous had been based on a 12-step program of spiritual and character development.