Melony Hansen, MA, CSW, CSAC, IDP-IT, Substance Abuse Counselor at Family & Children’s Center
According to the American Society of Addiction Medicine, 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.”
Do people who have substance use disorders, those who are suffering from an addiction to drugs and/or alcohol, have a disease? The medical community generally agrees for something to be a disease it needs to be primary, progressive, chronic, have a genetic component (hereditability) and be potentially fatal. It also needs to be treatable and have relapse potential. When people think about what a disease is, things like cancer and diabetes come to mine. But, considering all of these above mentioned factors, one can certainly suggest addiction is a disease. And, based on what we now know about the brain and how chemicals alter and affect it, it can be considered a brain disease.
When people use drugs and alcohol, brain circuits are altered creating changes in the way the brain functions. The drugs (including alcohol) people consume disrupt the way nerve cells normally send, receive, and process information. In general, this disruption is caused by either imitating the brain’s natural chemical messengers (fooling or tricking the brain) or over stimulating the reward circuit of the brain; when this happens, chemicals such as dopamine are released in large quantities, which causes a euphoric feeling for the user. This process reinforces usage initially, but ultimately requires the user to use more of the drug to get the same “high.” Once this occurs, people become addicted to substances. Eventually, the goal or intent of their usage is to just feel “normal.”
Because addiction is a brain disease, ongoing usage affects a person’s judgement, ability to problem solve, learning, memory, and their ability to control behavior. Those who are addicted are often in denial about their usage and how it is affecting their lives and functionality; but, this denial is likely an accurate perception of their situation from their point of view. Because the brain has been altered and thinking is often skewed, people struggling with addiction are unable to accurately report information or understand their situation.
Generally, if someone is addicted to a substance they experience an array of similar symptoms. People who are addicted to substances often report feeling “out of control”. They are unable to manage their lives any longer. They also report or are observed to have pre-occupation; this means they are constantly thinking about getting intoxicated or high, about how they will get intoxicated or high, and/or when and where they will get intoxicated or high. This process of being pre-occupied actually alters the brains structure. They are unable to think about anything else or plan any other event in their lives. They start to experience cravings, urges and triggers to use substances, tolerance when they do use substances, and physical and psychological withdrawal when they aren’t using substances.
Probably the most noticeable characteristic of someone who is addicted to a substance though is their deterioration in functionality; we see significant changes in many aspects of the user’s daily life. When someone is addicted to a substance, they are more likely to get into trouble legally, to have issues in their relationships, to engage in dangerous and risky behavior, to struggle financially, to experience changes in their presentation (hygiene), and to negate their responsibilities. People who are addicted to substances are unable to be faithful partners, good friends, devoted parents, and reliable employees. Although those suffering from addictions often want to do what they say, and have good intentions, once they start using substances they lack follow through, no longer do what they say, violate others, hurt their loved ones, become what is identified as dishonest, and often compromise their own values and morals. With ongoing, long-term usage, those addicted to substances also start to experience emotional and mental health problems as well.
People addicted to substances struggle to explain their experience; they often talk about not understanding why they use, why they relapse, why they do the things they do when they are under the influence. The experience is confusing and overwhelming for the person addicted to a substance and those who have a relationship with that person. Despite the lack of understanding about the experience, people can express and explain they feel miserable, they experience shame and guilt, and they wish they could stop using and be “free” from their substance.
Logically, one can suggest the concept of choice may no longer be present when someone is addicted to a substance. Human nature would suggest people don’t chose or like to feel or behave this way. People desire to be happy and those who are addicted to substances rarely report feeling happy. This phenomenon (people’s experiences and feelings associated with using), reinforces the idea that substance use disorders are a brain disease and need to be treated as such.
Suggesting someone can just say “no”, can stop using substances because they want to, or the consequences of “bad” behavior while using will alter usage is not only untrue, but ignorant, based on what the research suggests. We now know being addicted to a substance is complex; addicted people can’t just will their way to sobriety. If they could, most, if not all, would. People who use substances report an ability to become “high” just by thinking about their substance of choice; this again suggests their brains have been rewired by their compulsive thoughts and actions. Usage alters the brain and people who are addicted to substances need to change not only the way they think, act, and behave, but also how their brain is wired.
Treatment and services are available though; sobriety is possible. If you know someone who is suffering from an addiction to a substance, or if you struggle with an addiction, seek services through your local human service departments which provide substance abuse counseling. Education, support groups, individual counseling, group counseling, medication, and family services have all been found to be beneficial in assisting in the search for and goal of recovery. New research allows professionals to understand the brain and this process better, which ensures evidence-based practices can be used to assist those in search of lifelong sobriety. No one deserves to feel what those who suffer regularly with addiction feel. Everyone deserves to feel “free.”