The Brain Disease Model of Addiction

Close to a quarter of a century ago, then director of the US National Institute on Drug Abuse Alan Leshner famously asserted that “addiction is a brain disease”, articulated a set of implications of this position, and outlined an agenda for realizing its promise [1]. The paper, now cited almost 2000 times, put forward a position that has been highly influential in guiding the efforts of researchers, and resource allocation by funding agencies. A subsequent 2000 paper by McLellan et al. [2] examined whether data justify distinguishing addiction from other conditions for which a disease label is rarely questioned, such as diabetes, hypertension or asthma. It concluded that neither genetic risk, the role of personal choices, nor the influence of environmental factors differentiated addiction in a manner that would warrant viewing it differently; neither did relapse rates, nor compliance with treatment.

However, some recent US data have found that girls ages years have rates of alcohol and illicit drug abuse or dependence equal to or greater than those for boys [123, 124]. Despite these differences, some gender-related differences appear relatively consistent across disorders. Differences in motivations for engaging in addictive behaviors also exist between females and males, with women more likely to participate to escape from negative mood states (negative reinforcement) and men more likely to participate to experience positive feelings (positive reinforcement) [ ]. First, they may relate to important differences in co-occurring disorders whereby addictive behaviors like gambling are more closely linked to depression in girls and women as compared to boys and men, respectively [130, 131]. Second, they suggest that differences exist in biological underpinnings of addictions in women and men, particularly with respect to responses to negative (stress/anxiety) and positive (addiction cue) responses. Third, these findings have treatment implications as interventions like mindfulness-based approaches that target stress reduction might be differentially helpful for women and men with addictions [133].

Methamphetamine Addiction:

Such prevention and treatment interventions would be most effective with policies and related resources that facilitate their enactment, and this may be particularly difficult in countries that devote limited resources to mental health interventions [5, 204]. Evidence that a capacity for choosing advantageously is preserved in addiction provides a valid argument against a narrow concept of “compulsivity” as rigid, immutable behavior that applies to all patients. If not from the brain, from where do the healthy and unhealthy choices people make originate? To resolve this question, it is critical https://www.excel-medical.com/5-tips-to-consider-when-choosing-a-sober-living-house/ to understand that the ability to choose advantageously is not an all-or-nothing phenomenon, but rather is about probabilities and their shifts, multiple faculties within human cognition, and their interaction. Yes, it is clear that most people whom we would consider to suffer from addiction remain able to choose advantageously much, if not most, of the time. However, it is also clear that the probability of them choosing to their own disadvantage, even when more salutary options are available and sometimes at the expense of losing their life, is systematically and quantifiably increased.

• For the foreseeable future, the main objective of imaging in addiction research is not to diagnose addiction, but rather to improve our understanding of mechanisms that underlie it.
• To reflect this complex nature of addiction, we have assembled a team with expertise that spans from molecular neuroscience, through animal models of addiction, human brain imaging, clinical addiction medicine, to epidemiology.
• Some of the substance-induced changes occur at the epigenetic level and may be transmitted to descendants.
• An improved understanding of genetic factors or related endophenotypes might help identify individuals with vulnerability factors that could be targeted preventively for interventions.
• The National Opinion Research Center at the University of Chicago reported an analysis on disparities within admissions for substance abuse treatment in the Appalachian region, which comprises 13 states and 410 counties in the eastern part of the United States.
• This model demonstrates how addiction is seen as a disease that impacts each individual differently.

In recent years, the conceptualization of addiction as a brain disease has come under increasing criticism. When first put forward, the brain disease view was mainly an attempt to articulate an effective response to prevailing nonscientific, moralizing, and stigmatizing attitudes to addiction. According to these attitudes, addiction was simply the result of a person’s moral failing or weakness of character, rather than a “real” disease [3].

Journal of Adolescent Health

Drugs or alcohol can hijack the pleasure/reward circuits in your brain and hook you into wanting more and more. Addiction can also send your emotional danger-sensing circuits into overdrive, making you feel anxious and stressed when you’re not using the drugs or alcohol. At this stage, people often use drugs or alcohol to keep from feeling bad rather than for their pleasurable effects. While the book is written from the perspective of a behavioral scientist, it also provides guidance to health and mental health professionals, social workers, public health officials, counselors, teachers, addiction educators, and treatment specialists.

The biological model shows that a human organism may be addicted to something during the whole life, and it is impossible to stop being addicted one day. In other words, the genetic model does provide people with a kind of hope that addiction may be controlled due to the investigation of the particular factors, and the biological model does not provide such a chance. This is why the chosen models identify an idea of medical treatment and group support during the whole life.

Changes That Occur in the Brain During Addiction

Introducing it to a mind-altering substance during this time could affect neurological pathways, making a person that much more susceptible to the possibility of long-term drug and alcohol abuse. Other considerations relevant to prevention, treatment and policy, such as the potential influences of low socio-economic status, may also be informed by biological advances. For example, early life adversity has been linked to altered brain structure and function [141, 142]. Additionally, individuals lower in social status show hypo-functioning striatal systems, and this may influence reward- and motivation-related behaviors including addiction propensity [205]. The extent to which this impact operates at a communal or national level warrants consideration.

Treatment provides education that helps people to understand and accept their genetic predisposition. Dr. Halkitis’s research examines how sexual and drug-related risk taking are influenced by interpersonal, intrapersonal, contextual, developmental, and cultural factors in the United States. In all cases, professional treatment and a range of recovery supports should be available and accessible to anybody who develops a substance use disorder. The similarities and differences of the chosen models prove that the etiology of addiction is a complex issue to deal with, this is why it is necessary to pay more attention to some other models and factors like neurobiology or physiology and gain better understanding of the matter.

Genome-wide association studies of complex traits have largely confirmed the century old “infinitisemal model” in which Fisher reconciled Mendelian and polygenic traits [51]. A key implication of this model is that genetic susceptibility for a complex, polygenic trait is continuously distributed in the population. 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. To achieve this goal, we first discuss the nature of the disease concept itself, and why we believe it is important for the science and treatment of addiction. This is followed by a discussion of the main points raised when the notion of addiction as a brain disease has come under criticism.