Addiction as a Brain Disease is NOT Big News in 2011

Addiction is now officially a brain disease according to a statement made by the American Society of Addiction Medicine (ASAM) this summer. This is big news, right? Well actually, no it’s not. Numerous organizations have been labeling, declaring, and defining alcoholism and addiction as diseases, illnesses, or disorders for a long time now. I suppose I should’ve written this post about 2 months ago when it was big in the news, but it’s so boring to me, and I’ve heard it so many times that I just thought it wasn’t worth discussing. My readers have thought different though, sending me the new disease classification and otherwise asking about it. So here’s my take on the significance of ASAM’s declaration that addiction is a brain disease.

Some History of Disease Definitions of Addiction

In 1954, by vote, the American Medical Association became the first modern day trade guild to secure their members new business opportunities by declaring “alcoholism” as an illness. They released a much more detailed definition in 1967, as follows:

Alcoholism is an illness characterized by preoccupation with alcohol and loss of control over its consumption such as to lead usually to intoxication if drinking is begun; by chronicity; by progression; and by tendency toward relapse. It is typically associated with physical disability and impaired emotional, occupational, and/or social adjustments as a direct consequence of persistent and excessive use.

Then in 1992, the AMA revised their definition of alcoholism, calling it:

a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. http://jama.ama-assn.org/content/268/8/1012.abstract

The World Health Organization (WHO) eschewed the terms addiction, habituation, and alcoholism, and opted to use the term “dependence.” Here’s how they define dependence in the ICD-10 (their big book of diseases, much like the APA’s DSM): http://en.wikipedia.org/wiki/ICD-10

A cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take psychoactive drugs (which may or may not have been medically prescribed), alcohol, or tobacco. There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals http://www.who.int/substance_abuse/terminology/definition1/en/

There have been plenty more definitions which pegged addictions as diseases along the way, but these few should suffice. Here’s what these all have in common:

  • AMA 1967 – “loss of control”
  • AMA 1992 – “impaired control over drinking”
  • WHO 1964 – “sometimes overpowering [desire]”

These descriptions of addiction are all problematic in too many ways to be fully described here (circular argumentation immediately comes to mind on the 1967 AMA version), but one word sums up their common thread: powerlessness. Alcoholism and/or addiction have been medicalized for a long time now, and the common thread is to say that alcoholics/addicts cannot control the intake of their preferred substance, due to some physiological and psychological factors. We’re now reaching back and seeing this through 57 years of history (and could go further, with Alcoholics Anonymous’ allergy model of the 1930‘s; or as the WHO mentions “alcoholism” was coined in 1849; and with the famous american medical figure Benjamin Rush, a signer of the Declaration of Independence, declaring addiction a disease in the 18th century), and my point regarding ASAM’s brain disease declaration released this summer is: so what. It’s nothing new. We’ve heard it all before, and the modern “brain disease” rhetoric has been around for 3 decades now anyways. The medical industry has been claiming addiction as their province for a long time now.

ASAM’s Latest Brain Disease Definition

The only thing that separates this newest disease classification from older ones is the addition of some slightly different jargon, but it’s essentially saying the same thing. Here’s ASAM’s definition, which became front page news back in August:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.  http://www.asam.org/DefinitionofAddiction-LongVersion.html

Again, what’s the common thread?

  • AMA 1967 – “loss of control”
  • AMA 1992 – “impaired control over drinking”
  • WHO 1964 – “sometimes overpowering [desire]”
  • ASAM 2011 – “inability to consistently abstain, impairment in behavioral control”

Again, we see powerlessness. ASAM has actually said it twice as many times in their definition than the others – but I’m sure the Big Book Of Alcoholics Anonymous has them beaten on mentions of powerlessness – and they first published in 1939.

There is no news here, and it saddens me to have to write about it. Powerlessness over substance use has yet to be objectively/scientifically proven – yet it’s the common thread which keeps appearing in every definition of addiction. Don’t be smoke-screened by jargon about brain processes, they only throw that language in there so that you will submit to their belief in powerlessness. You are not powerless over drugs and alcohol – you have the choice to change your behavior at any given moment.

Again, there is no news here, but the fact that the media made such a big brouhaha over this story is the only interesting point to this latest definition of addiction. Cancer isn’t redeclared as a disease every few years, nor is diabetes, or malaria, or any of the other real diseases with which addiction is constantly compared. The arguments supporting the disease theory are so weak, that the strategy for keeping the disease belief alive is a constant media blitz. That’s something to think about.

Comments

  1. Kelly says

    If addiction is a brain disease, then my brain should look different from that of my spouse or my children, who have never abused substances. I doubt it does! I am no different from them. That realization was my first step away from 12 step. I started to question them when I started to feel whole, part of my family, no different from them. I started to feel more like people outside the rooms, than the people inside the rooms.

    I have never seen proof that addiction can be predicted by looking at someone’s brain, nor that a brain is permanently changed after drug use. I dare you, scan my brain, and tell me if I ever used drugs, or for how long, or what kind. :)

    I read Nora Volkow’s stuff briefly, and I have not found any answer to why she considers addiction a brain disease, other than long-term sustance use changes the brain. Well, duh! I only found her images long-term cocaine users compared to their brains just shortly thereafter. Why not compare them to scans of those former addicts after a couple years? I have so many questions I would ask her. But mostly, maybe she is blindsided because if she were to declare addiction is a choice, would that jeopardize her research grants?

  2. Dawn says

    I think one of the good things about declaring addiction a disease of the brain, is that people who have struggled with addiction are not looked at as weak. There is a lot of shame attached to addiction. When society looks at those who suffer from addiction as sick, verses morally corrupt or weak, addicted people can feel better about coming forward and getting help to recover. If they can even find good help. It is my understanding that one of the reasons addiction is considered a disease is because there are certain biological factors at play, just like diabetes and heart disease. Compassion is key. Addiction does not discriminate.

  3. Matt says

    So you took the short version of the explanation for addiction ASAM provides and essentially ignore the fact that it was the short version. Do you have any idea how much science is crammed into that one first paragraph that you quoted? Are you aware of the implications behind said research and how your “jargon” is actually provided to put an extremely complex concept into layman’s terms? You may fool other people who come on this site that you have done your homework but I consistently find a lack of thorough research on your part, often in the context of you criticizing evidence-based research. You wrote an entire blog post about how a short answer doesn’t provide adequate understanding of an extremely complex concept. I simply can’t take this seriously anymore. Your personal agenda with this topic is quite apparent and you seem only interested in evidence that supports your own ideas while cherry-picking tidbits of your opposition’s arguments that are easy for you to attack. Good luck.

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