Opinion: We must rethink our attitudes toward addiction

drug or alcohol addiction is a chronic relapsing illness

Epidemiologically, it is well established that social determinants of health, including major racial and ethnic disparities, play a significant role in the risk for addiction [75, 76]. Contemporary neuroscience is illuminating how those factors penetrate the brain [77] and, in some cases, reveals pathways of resilience [78] and how evidence-based prevention can interrupt those adverse consequences [79, 80]. In other words, from our perspective, viewing addiction as a brain disease in no way negates the importance of social determinants of health or societal inequalities as critical influences. In fact, as shown by the studies correlating dopamine receptors with social experience, imaging is capable of capturing the impact of the social environment on brain function. This provides a platform for understanding how those influences become embedded in the biology of the brain, which provides a biological roadmap for prevention and intervention.

The authors outlined an agenda closely related to that put forward by Leshner, but with a more clinical focus. Their conclusion was that addiction should be insured, treated, and evaluated like other diseases. This paper, too, has been exceptionally influential by academic standards, as witnessed by its ~3000 citations to date. What may be less appreciated among scientists is that its impact in the real world of addiction treatment has remained more limited, with large numbers of patients still not receiving evidence-based treatments.

Symptoms and Causes

Critics further state that a “genetic predisposition is not a recipe for compulsion”, but no neuroscientist or geneticist would claim that genetic risk is “a recipe for compulsion”. However, as we will see below, in the case of addiction, it contributes to large, consistent probability shifts towards maladaptive behavior. As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn’t a cure. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients.

A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again. Unfortunately, chronic relapse is especially common among teens, more so in teen boys. Drug and alcohol use typically stems from peer pressure, and many young men experiment with substances because of pressure they feel to be cool. It’s common for them to want to fit in with a new crowd and prove they’re worthy to others.

drug or alcohol addiction is a chronic relapsing illness

In many other cases, it is a disorder that requires treatment and, when received, is successfully treated to full remission. As shown in Kelly et al., the vast majority of individuals who successfully achieve recovery do not require dozens or hundreds of treatment attempts to achieve success. For other individuals, addiction recovery may not require formal treatment at all, as in the case of maturing out or natural recovery. Consistent with this, in Kelly et al.’s findings, a notable portion of participants reported that they required zero serious treatment attempts to achieve success, apparently reflecting the natural recovery course.

Alcohol use and depression symptoms

This overestimation can also lead to unnecessary fear and anxiety surrounding drug and alcohol use, which can further contribute to the stigmatization of individuals struggling with addiction. Using alcohol during adolescence (from preteens to mid-20s) may affect brain development, making it more likely that they will be diagnosed with AUD later in life. However, most people with AUD—no matter their age or the severity of their alcohol problems—can benefit from treatment with behavioral health therapies, medications, or both. One of the hardest things for non-addicts to understand is that addiction is a lifelong problem, even after recovery.

drug or alcohol addiction is a chronic relapsing illness

This may seem antithetical to a view of addiction as a distinct disease category, but the contradiction is only apparent, and one that has long been familiar to quantitative genetics. Thus, as originally pointed out by McLellan and colleagues, most of the criticisms of addiction as a disease could equally be applied to other medical conditions [2]. This type of criticism could also be applied to other psychiatric disorders, and that has indeed been the case historically [23, 24]. Few, if any healthcare professionals continue to maintain that schizophrenia, rather than being a disease, is a normal response to societal conditions. Why, then, do people continue to question if addiction is a disease, but not whether schizophrenia, major depressive disorder or post-traumatic stress disorder are diseases? This is particularly troubling given the decades of data showing high co-morbidity of addiction with these conditions [25, 26].

How to Recognize Chronic Relapse

Likewise, if you’re diagnosed with one of these conditions, your doctor may ask about symptoms of the other. This is a common part of diagnosis because both so frequently occur together. However, the flip side is that people who frequently use alcohol are more likely to also be depressed.

  • Medications are also available to help treat addiction to alcohol and nicotine.
  • A reason for deterministic interpretations may be that modern neuroscience emphasizes an understanding of proximal causality within research designs (e.g., whether an observed link between biological processes is mediated by a specific mechanism).
  • We regularly see patients who resonate with treatment, get traction, and fundamentally change their lives in permanent ways.

It’s often a lifelong commitment, but one that can improve your life, health, and well-being in the long term. For family and friends of patients in recovery, addressing the addiction is one of the most difficult aspects of helping loved ones recover. Daily interactions with loved ones can inadvertently enable the addict, and many family members choose to ignore the problem out of fear that they will push away their loved ones if they confront them.

Mental health effects

Neurobiology has made great strides in understanding the impact of substances of abuse on the brain, and these findings have advanced a fundamentally biological explanation of addiction. However, as has been discussed eloquently by Kalant [13], there are limitations to how far neurobiology can take us towards understanding a problem that has social and psychological as well as biological roots. The neurobiological chronic relapsing disorder perspective tends towards reductionist rather than integrative conceptions of dependence.

Emotional relapse

Meanwhile, however, genome-wide association studies in addiction have already provided important information. For instance, they have established that the genetic underpinnings of alcohol addiction only partially overlap with those for alcohol consumption, underscoring the genetic distinction between pathological and nonpathological drinking behaviors [50]. The ambiguous relationships among these terms contribute to misunderstandings and disagreements.

So while acute conditions like a skin infection or appendicitis can be cured, chronic conditions like high blood pressure, asthma, low thyroid or addiction can only be treated. Drug and alcohol rehab programs have been shown to be effective tools for addiction recovery. For example, a person with frequent episodes of severe depression may turn to drinking to self-medicate.

If you were to go off your medicines or maybe your diet, your diabetes would spiral out of control, and you’d have to take steps to reign it back in. Despite the scientific understanding that addiction is a chronic disease of the brain, society tends to lag behind in their perception, and they still continue to see it only as a social problem or a choice. Many people who suffer from substance use disorders know they have a problem, https://rehabliving.net/ and they want to stop, but they can’t, and as their use continues, it causes problems in every area of their life. The changes that happen in the brain of an addict aren’t the same as the intoxicating effects of the drug. For example, you can feel drunk from alcohol, but this doesn’t mean your brain wiring is changed and that you’re an addict. The changes in the brains of addicts are much more long-term and difficult to treat.

For those with psychiatric problems, marijuana can worsen them and cause psychosis. The Indian Journal of Psychiatry states that addiction is a chronic disease, and relapse is common to the disease. The National Institute on Drug Abuse mentions that relapse often means a person’s treatment must be adjusted. Throughout the course of the disease, suffers will experience periods of abstinence and periods of symptoms. The symptoms may escalate to drug use, but they may also stop at cravings for those with good coping mechanisms.

Brief treatments offered by generalists for those with dependence are in need of further development [54], as are online treatment interventions [55]. The concept that a chronic relapsing disorder model will lead to more and more appropriate treatment is an assumption that needs open consideration. The notion of addiction as a brain disease is commonly criticized with the argument that a specific pathognomonic brain lesion has not been identified. Indeed, brain imaging findings in addiction (perhaps with the exception of extensive neurotoxic gray matter loss eco sober house price in advanced alcohol addiction) are nowhere near the level of specificity and sensitivity required of clinical diagnostic tests. However, this criticism neglects the fact that neuroimaging is not used to diagnose many neurologic and psychiatric disorders, including epilepsy, ALS, migraine, Huntington’s disease, bipolar disorder, or schizophrenia. Even among conditions where signs of disease can be detected using brain imaging, such as Alzheimer’s and Parkinson’s disease, a scan is best used in conjunction with clinical acumen when making the diagnosis.

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