Seeing addiction as a brain disease is key to successful treatment.
Although research in the past few decades has increasingly supported the view that substance use disorder (SUD) or addiction should be understood and treated as a disease of the brain, the concept continues to be questioned largely because of the stigma around the behavioural problems that form an intrinsic part of the condition. This stigma is a major obstacle to individuals with SUDs and their loved ones seeking help, decreasing the changes CHANCES of them receiving proper and sustained treatment.
According to this model of addiction, SUD is a chronic, relapsing brain disease similar to other medical conditions such as diabetes and hypertension that have multiple causes including biological, behavioural and environmental ones.
“Over the years, clinical research has proven that the brains reward, memory and learning centres are affected by addiction which may explain why patients relapse after a period of recovery and returning to persisting in addictive use despite the negative consequences and compelling reasons to quit. The thinking that addiction is purely a behavioural problem caused by the voluntary decision of an individual to continue the use of an illicit substance is wrong. This is very much a brain disorder and should be regarded as a chronic illness,” says Gareth Carter, an internationally accredited addiction counsellor and founder of WeDoRecover*, an organisation offering screening, assessment and intake co-ordination services to addiction treatment and psychiatric centres in a number of countries including South Africa.
“We can see on brain scans that the structure and the function of the brains of people with SUD are different, which like any other chronic disease such as diabetes, hypertension or asthma require medical intervention. It is therefore imperative that both the person, his/her loved ones and healthcare professionals understand that SUD is an illness and that the consequences of leaving it untreated could be potentially deadly,” explains Carter.
“If families understand that they are dealing with an illness and not a moral failing – then it makes sense to them that the sick person needs treatment. When patients understand that they have a chronic illness, they can start structuring their lives around the problem, which makes it easier to assume responsibility for their recovery,” Carter notes.
In an article published in the Journal of Nursing Regulation, the authors note that “the disease of chemical dependency can be traced to neural pathways in the brain predating a diagnosis of addiction. A genetic predisposition alone is not enough to predict addiction. Typically, psychological and social influences drive the person to use the addicting substances, and the combination of genetic predisposition and these influences triggers the disease”.
Adding that alcohol and drug addiction are primary, chronic, progressive, and often fatal health problems for all of society, the authors emphasised that understanding the biological mechanisms underlying addiction can help others recognize and treat the problem with more empathy, less stigmatisation, and more effective outcomes.
The American Psychiatric Association points out that brain imaging studies show how SUDs change the areas in the brain that relate to judgment, decision making, learning, memory and behavioural control and that it is these changes in the brain’s wiring that cause people to have intense cravings for the substance, making it hard to stop using the drug.
In an article published in The New England Journal of Medicine (NEJM), the authors review recent advances in the neurobiology of addiction to clarify the link between addiction and brain function and to broaden the understanding of addiction as a brain disease. They point out that as in the case of other medical conditions in which voluntary, unhealthful behaviours contribute to disease progression (e.g., heart disease, diabetes, chronic pain, and lung cancer), evidence-based interventions aimed at prevention, along with appropriate public health policies, are the most effective ways of changing outcomes.
“A more comprehensive understanding of the brain disease model of addiction may help to moderate some of the moral judgment attached to addictive behaviours and foster more scientific and public health–oriented approaches to prevention and treatment,” they wrote.
Behavioural and medical interventions
Neurobiological research shows that addiction is a disease that emerges gradually and that has its onset predominantly during adolescence when the still-developing brain is particularly sensitive to the effects of drugs, a factor that contributes to adolescents’ greater vulnerability to drug experimentation and addiction. Studies have also shown that children and adolescents with evidence of structural or functional changes in frontal cortical regions or with traits of novelty seeking or impulsivity are at greater risk for substance-use disorders. Awareness of individual and social risk factors and the identification of early signs of substance-use problems make it possible to tailor prevention strategies to the patient. According to research related to the brain disease model of addiction, preventive interventions should be designed to enhance social skills and improve self-regulation.
When prevention has failed and there is need for treatment, research based on the brain disease model of addiction has shown that medical treatment can help to restore healthy function in the affected brain circuitry and lead to improvements in behaviour. During treatment, medication can assist in preventing relapse while the brain is healing, and normal emotional and decision-making capacities are being restored. This should be accompanied by behavioural interventions to help restore the balance in brain circuitry that has been affected by drugs. These could include improved social contact and exercise and strategies that addresses responses to stress and negative emotions and helping patients to avoid situations where they are vulnerable to substance use.
WeDoRecover.com was founded by Gareth Carter in 2009 and provides information on the best and most suitable rehab centres in the whole of South Africa, the UK and Thailand. It is a one-stop service which provides advice on all aspects of addiction, interventions, treatment, costs and all other issues the addicted person and family members need answers to. For more information, go to WeDoRecover.com
The National Treatment Helpline for WeDoRecover.com in South Africa is 081 444 7000.
Volkow ND, et al. Neurobiologic Advances from the Brain Disease Model of Addiction. New England Medical Journal. Published 28 January 2016. https://www.nejm.org/doi/full/10.1056/nejmra1511480
Bettinardi-Angres K, et al. Understanding the Disease of Addiction. The Journal of Nursing Regulation. Published July 2010. https://www.ncsbn.org/Understanding_the_Disease_of_Addiction.pdf
Volkow ND. What Does It Mean When We Call Addiction a Brain Disorder? Scientific American. Published 23 March 2018. https://blogs.scientificamerican.com/observations/what-does-it-mean-when-we-call-addiction-a-brain-disorder/
Crapanzano KA, et al. The association between perceived stigma and substance use disorder treatment outcomes: a review. Substance Use and Rehabilitation. Published December 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311321/