New Definition of Addiction Released by ASAM

by Kathy Jones on  August 15, 2011 at 6:59 PM Alcohol & Drug Abuse News
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A new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling or sex has been released by the American Society of Addiction Medicine (ASAM).
 New Definition of Addiction Released by ASAM
New Definition of Addiction Released by ASAM

This the first time ASAM has taken an official position that addiction is not solely related to problematic substance use.

When people see compulsive and damaging behaviors in friends or family members—or public figures such as celebrities or politicians—they often focus only on the substance use or behaviors as the problem. However, these outward behaviors are actually manifestations of an underlying disease that involves various areas of the brain, according to the new definition by ASAM, the nation's largest professional society of physicians dedicated to treating and preventing addiction.

"At its core, addiction isn't just a social problem or a moral problem or a criminal problem. It's a brain problem whose behaviors manifest in all these other areas," said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. "Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It's about underlying neurology, not outward actions."

The new definition resulted from an intensive, four-year process with more than 80 experts actively working on it, including top addiction authorities, addiction medicine clinicians and leading neuroscience researchers from across the country. The full governing board of ASAM and chapter presidents from many states took part, and there was extensive dialogue with the National Institute on Drug Abuse (NIDA).

The new definition also describes addiction as a primary disease, meaning that it's not the result of other causes such as emotional or psychiatric problems. Addiction is also recognized as a chronic disease, like cardiovascular disease or diabetes, so it must be treated, managed and monitored over a life-time.

Two decades of advancements in neurosciences convinced ASAM that addiction needed to be redefined by what's going on in the brain. Research shows that the disease of addiction affects neurotransmission and interactions within reward circuitry of the brain, leading to addictive behaviors that supplant healthy behaviors, while memories of previous experiences with food, sex, alcohol and other drugs trigger craving and renewal of addictive behaviors. Meanwhile, brain circuitry that governs impulse control and judgment is also altered in this disease, resulting in the dysfunctional pursuit of rewards such as alcohol and other drugs. This area of the brain is still developing during teen-age years, which may be why early exposure to alcohol and drugs is related to greater likelihood of addiction later in life.

There is longstanding controversy over whether people with addiction have choice over anti-social and dangerous behaviors, said Dr. Raju Hajela, past president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on the new definition. He stated that "the disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause."

"Choice still plays an important role in getting help. While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary," Hajela said.

"Many chronic diseases require behavioral choices, such as people with heart disease choosing to eat healthier or begin exercising, in addition to medical or surgical interventions," said Dr. Miller. "So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment."

Source: Eurekalert

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I am so thankful that this country funnels billions of dollars into organizations like ASAM each year so they can define, re-define, characterize, classify and label our nation's #1 preventable health care issue [without supporting those attempting to cure it.] This "new definition" continues to omit ALL of the physical and medical aspects that commonly characterize addiction (a seemingly odd omission coming from an organization dedicated to Medicine.) When a family member is concerned for an addicted loved one's life, they never say "his behavioral control is impaired and his recognition of significant problems with his relationships is diminished." They DO say he's so thin. His stomach hurts all the time. He constantly craves sugar. He has rashes all over. Almost all say if you just look at him you can see how sick he is. It seems that the statements made by real patients and their families reflect real, organic problems in the BODY of an addict, not just in his hippocampal circuits or nucleus accumbens. While I have no doubt that these neurological parts are severely malfunctioning, I know through years of medical testing that his body is just as impaired if not more. I also know that he is deficient in most essential nutrients, his liver processes are operating out of balance causing a build-up of toxins that will quickly enter his brain and his gut is not able to absorb. Despite these proven medical issues in addicted patients, ASAM's definition reads like a prescription drug ad for depression (you know, the ones that list 800 side effects including suicidal ideation, stroke and PHYISCAL DEPENDENCE.) The extended form of this definition addresses NOTHING about the physical aspects of this VERY physical disease. I find it sad that our tax dollars are being wasted on organizations that remain short-sighted and stagnated in an archaic worldview that facilitates neglect of those suffering from addiction and infects our treatment industry with an ideological virus that prevents progress and success. Our trying economic times make this lack of sincerity and progress even more upsetting. I propose the American Society for Addiction Medicine be renamed the American Society for Addiction Behavior since there is no mention of anything medical in their perspective of this dynamic, expensive and deadly disease. Then take their funding and just pay addicts to stay off drugs. We might get better results and save paper.

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