Addiction as a brain disease revised: why it still matters, and the need for consilience Neuropsychopharmacology

The view that substance addiction is a brain disease, although widely accepted in the neuroscience community, has become subject to acerbic criticism in recent years. We acknowledge that some of these criticisms have merit, but assert that the foundational premise that addiction has a neurobiological basis is fundamentally sound. We also emphasize that denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing access to healthcare and treatment, the consequences of which are catastrophic. Here, we therefore address these criticisms, and in doing so provide a contemporary update of the brain disease view of addiction. We provide arguments to support this view, discuss why apparently spontaneous remission does not negate it, and how seemingly compulsive behaviors can co-exist with the sensitivity to alternative reinforcement in addiction.

More recently, a reduction in these quantitative levels has been validated as treatment endpoints [113]. Addiction and physical dependence are often talked about as though they are interchangeable; however, they are separate phenomena that can exist without the other. 3 Someone using their opioid pain medications as prescribed can develop some physiological dependence but may not exhibit the compulsive behaviors of addiction. Conversely, some drugs may be used in a compulsive manner that indicates an addiction without physically relying on it to feel well. With repetition, these bursts of dopamine tell the brain to value drugs more than natural rewards, and the brain adjusts so that the reward circuit becomes less sensitive to natural rewards.

Disease or Choice, Does it Matter?

Finally, we argue that progress would come from integration of these scientific perspectives and traditions. Wilson has argued more broadly for greater consilience [109], unity of knowledge, in science. We believe that addiction is among the areas where consilience is most needed. A plurality of disciplines brings important and trenchant insights to bear on this condition; it is the exclusive remit of no single perspective or field.

First, the originators of the concept did not say that addiction is only a brain disease; we acknowledged how important behavioral and social elements are to its development and to recovery. His arguments ignore decades of biomedical and behavioral research that have taught so much about the nature of substance use disorder, as it is now called, and what to do about it. Among high-risk individuals, a subgroup will meet criteria for SUD and, among those who have an SUD, a further subgroup would be considered to be addicted to the drug.

Addiction relapses are a reality, but not failure

However, the boundary for addiction is intentionally blurred to reflect that the dividing line for defining addiction within the category of SUD remains an open empirical question. Some Sober Sayings and Sober Quotes say those who engage in substance abuse are in complete control of their actions. Ultimately, however, this study can’t conclusively answer on its own whether social media is addictive.

Most importantly, we argue that the brain is the biological substrate from which both addiction and the capacity for behavior change arise, arguing for an intensified neuroscientific study of recovery. More broadly, we propose that these disagreements reveal the need for multidisciplinary research that integrates neuroscientific, behavioral, clinical, and sociocultural perspectives. A premise of our argument is that any useful conceptualization of addiction requires an understanding both of the brains involved, and of environmental factors that interact with those brains [9]. These environmental factors critically include availability of drugs, but also of healthy alternative rewards and opportunities.

Disease, Disorder or Impaired Capacities?

The New England Journal of Medicine recently published a review of the “brain science” related to addiction and its management by Dr. Nora Volkow and her colleagues. The brain’s reward system activates when we do something we like—eating a piece of our favorite pie, hanging out with friends, or going for a run, for instance. The American Medical Association (AMA) classified alcoholism as a disease in 1956 and included addiction as a disease in 1987. I think we all know at this point that addiction is another major epidemic that is sweeping our country and the world, but there are few topics that are more misunderstood than addiction.

• Addiction changes the circuitry of the brain in ways that make it difficult for people to regulate through deliberative efforts the allure of a concentrated chemical rush of reward.
• Changes in neural circuitry make the reward extra compelling; it becomes difficult to pay attention to anything else and difficult to stop, even when use creates problems and there is a desire to quit.
• High-rent districts, “seedy” neighborhoods, age, race, sex or income—addiction weaves its way through all walks of life.
• Thankfully, successful recovery is possible for people with substance use disorders, and many programs have been carefully created to help rebuild the parts of the brain that were damaged by drug misuse.

The brain is altered by drugs, making poor choices more likely, but they believe that if the drugs are removed, the brain will eventually “remold” itself back to its normal shape. Eventually this leads to the development of dependence, which means that their body has been altered so much that it loses the ability to function normally without their chosen substance. If use stops, they will experience a series of painful side effects known as withdrawal, until either their body returns to its normal state without drugs or when they use again. The first option may take several days or weeks to accomplish, so many people opt for the latter as it is less painful. By choosing this option, the user becomes locked in a progressive cycle of addiction.

A look into the science of addiction

It’s legal and its use is widely accepted, but it is highly addictive and changes a person’s physiology and consciousness. According to the American Psychiatric Association (APA), the medical community no longer uses this term. Addiction or SUD both describe compulsive and habitual use of a substance. If you try to quit using substances, your brain tries to protect you from the pain and intensity of withdrawal symptoms. Addiction fuels your brain’s response to do whatever it takes to stop the cravings and discomfort.

Easier said than done, she admits, but a highly successful treatment strategy (and something every alcoholic knows) is that to not relapse into drinking, one should not visit a pub. For the foreseeable future, the main objective of imaging in addiction research is not to diagnose https://en.forexpamm.info/how-to-stop-drinking-out-of-boredom/ addiction, but rather to improve our understanding of mechanisms that underlie it. The hope is that mechanistic insights will help bring forward new treatments, by identifying candidate targets for them, by pointing to treatment-responsive biomarkers, or both [52].