Addiction is a Chronic Disease, Not a Moral Weakness
In 2016, former Surgeon General Vivek Murthy, M.D. released the office’s historic, first-ever report titled Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. The report publicly confirmed what researchers have known for years: addiction is a chronic illness that is accompanied by significant changes in the brain.
Murthy said, “We have to recognize (addiction) isn’t evidence of a character flaw or a moral failing. It’s a chronic disease of the brain that deserves the same compassion that any other chronic illness does.”
He went on to recommend evidence-based early interventions for young people, expansion of treatment programs that are proven to work, and investment in substance use prevention and treatment research.
Breaking the Stigma of Addiction
The Surgeon General’s report signified an important shift in the way addiction should be perceived: as a chronic, but treatable, disorder. Activists and experts have long supported this shift, but the stigma attached to substance use disorders remains. Unfortunately, many people still cling to the notion that addiction is caused by moral weakness, a lack of willpower, or an unwillingness to stop.
Nearly 20 million Americans suffer from substance use disorders, but only a small percentage of them receive treatment. Part of the reason many people don’t seek treatment is directly related to stigma; they’re ashamed of their disease.
At SaVida Health, we believe understanding the brain’s role in addiction can help to break the stigma surrounding this disease and encourage more people to seek help.
Addiction and Its Impact on the Brain
Over time, alcohol and drug abuse alters the way your brain functions and processes information. Impacted areas of the brain can include:
- Cortex: This is the outer area of your brain that contains the most highly evolved cells. It is where abstract thinking and higher cognitive processes occur, allowing you to think, learn, and understand.
- Limbic Region: This is your brain’s reward circuit; it links together the different brain structures that regulate emotions and the ability to feel pleasure. The limbic system is activated when you perform activities that create feelings of pleasure. It is also activated by drugs of abuse, responsible for the mood-altering properties of many illicit substances.
- Hippocampus: This area is located within your brain’s medial temporal lobe, and it forms an important part of the limbic system. The hippocampus is mainly associated with memory, but particularly long-term memory. These long-term memory cells are all “plugged in” to the limbic region’s emotional circuits.
- Cerebellum: This part of the brain is located at the back of the skull. It receives information from sensory systems, the spinal cord, and other parts of the brain, then regulates voluntary movements such as posture, balance, coordination, and speech. Recent research shows the cerebellum is co-responsible for the brain alterations associated with addictive consumption of drugs.
Addiction exerts a long and powerful influence on the brain that manifests in three distinct ways: craving for the object of addiction, loss of control over its use, and continuing use of the drug despite adverse consequences. Simply put, to the addicted brain, obtaining and taking a drug of choice can literally feel like a matter of life and death.
Addiction and the Chronic Disease Model
Similar to diabetes, hypertension, and asthma, addiction is a chronic disease. If you have diabetes, for example, taking your medicine and watching your diet doesn’t mean you’re cured. Even if you adequately manage your diabetes, the disease itself is still present. It’s the same with the disease of addiction – it can be successfully managed, but it is still a chronic disease. Left untreated, it becomes more severe, disabling, and life-threatening.
It’s also important to note that the chronic nature of addiction makes relapse likely. A relapse doesn’t mean that treatment has failed, however. It simply means that, as with other chronic diseases, the treatment plan needs to be readjusted. According to research, the relapse rate for substance use disorders is 40 to 60 percent. In looking at the relapse rates of diabetes, asthma, and hypertension, there are striking similarities.
Critics of the chronic disease model often point out that a percentage of people who develop addictions recover without medical treatment. The neurobiological factors that leave some people better equipped to recover than others are still largely unknown. However, when people recover from addiction on their own, it’s often because quality treatment options are not available or affordable. Far too many people do not recover without help, while some never even get a chance to recover. It would be medically irresponsible to assume that, because some people can recover on their own, addiction should not be classified as a chronic disease.
The Role of Medication Assisted Treatment
Medication-assisted treatment (MAT), which combines the use of FDA-approved medications and counseling, is now a key component in the treatment of addiction.
While these medications can’t take the place of willpower, they have been shown time and time again to reduce cravings, along with helping to correct imbalances in dopamine and other essential neurotransmitters in the brain. They can also help to accelerate healing of physical damage in the brain. Once the damage has been repaired, it becomes much easier to learn, remember, and focus on cognitive and behavioral skills in group and individual therapy.
We know that insulin isn’t a cure-all for diabetes. In addition to taking insulin as prescribed, the successful management of diabetes means learning how to eat healthy, exercising regularly, and maintaining a healthy weight.
Similarly, we know that medication alone is not a “cure” for addiction. In addition to taking a MAT medication as prescribed, the successful management of addiction means participating in therapy, developing new coping skills, and making positive lifestyle modifications.
All in all, successful addiction treatment requires a comprehensive approach…just like any other chronic medical disease.