Is Addiction a Brain Disorder or Behavior Issue?

For years, arguments have ranged over addiction as a disease or a behavioral issue. Even today, many people think addiction is simply a factor of a lack of self-control. They think the addict is just making poor choices, isn’t trying hard enough to get better, or is being selfish and choosing their addiction over family, job, or health. However, decades of scientific research support the belief that addiction is a chronic brain disease and not the result of simply choosing bad behavior.

What is Addiction?

The American Society of Addiction Medicine (ASAM) defines addiction as follows:

“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 an 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.”

Addiction and the Brain

ASAM confirms that something must be wrong with the brain function in order for addiction to form. This definition states that dependency issues are not just a behavioral problem. According to ASAM, the frontal cortex which is the area of the brain that controls impulse control and judgment is wired differently in addicts. They are compelled to seek drugs or alcohol with an uncontrollable craving. Addicts’ brains register a deep physiological and psychological reaction to their drug of choice. In the brain of the addict, these substances are perceived as “rewards” rather than the dangerous addictive substances they are.

Implications for Treatment

If this is true, then in order to treat addiction, we have to quit looking at it as a moral or criminal problem. Addicts do not simply choose addiction. This wiring in brain circuitry creates distortions in thinking, feelings, and perceptions. This is why addicts behave in ways that do not necessarily make sense to others. Whereas other people recognize impulsivity, poor decision-making, and irrationality as problematic, the addict sees these as normal functions of his or her life. Addicts’ drug use and drinking is the manifestation of the disease; it is not the cause of the disease.

Instead, Dr. Michael Miller, the past president of ASAM says, “It’s a brain problem whose behaviors manifest in all these other areas”. While the ASAM recognizes that choices and consequences are also involved in addiction, the basis of the disease is a problem with the brain. Dr. Miller goes on to say, “It’s about underlying neurology, not outward actions.”

ASAM goes on to call addiction as a primary disease which means it isn’t caused by another disease or factor like mental health problems. ASAM continues by relating the chronic condition of addiction to other diseases such as diabetes or heart disease. Addiction can be marked by cycles of relapse and remission. It is common for the addict to return to his or her drug or alcohol because the pull to abuse is so strong in their brain.

Rehabilitative treatment is necessary to prevent further progression of the disease. Otherwise, the individual’s condition will worsen over time and may eventually lead to death. The disease must be continually managed and monitored over the life of the addict.

Other Factors that Play a Role in Addiction

As with other diseases, addiction does not operate in a vacuum. Other factors can also play a role in addiction. These factors can also contribute to a dependency:

  • Genetics – certain genetics can predispose a person to addiction and can affect how strongly a person responds to drugs or alcohol.
  • Mental Illness – mental illness can drive a person to self-medicate in order to minimize the symptoms of his or her illness.
  • Family History and Culture – family history and culture can normalize addictive behaviors and open the door to abuse.
  • Trauma or PTSD – trauma or PTSD also often lead to drug and alcohol abuse to cope with the symptoms.
  • Adolescence – brain function is not fully developed until the mid-20’s, leaving teens especially vulnerable to dependency issues.

Further, it is common for the addict to struggle with other factors such as mental illness. A dual diagnosis of addiction and mental illness is common with dependency issues.

Recovery from addiction is possible. Through a combination of self-management, family and community support systems, and professional care provided by trained and certified professionals, the addict can achieve recovery and pursue a healthy, full life.