Yes it is, and it’s a strong argument for parity, that is, treating and funding addiction services on par with other ‘biologic’ health services
By Pierre Bremond – About twenty years ago, I followed a university course on intervention in the field of addiction. After two years and the chance to meet truly remarkable teachers, I learned that addictive behaviours are determined by a set of causes that have to do with people’s vulnerability and protective factors, environmental factors, and substance-related factors.
To quote a French psychiatrist, addiction results above all from “the encounter between a product (or behaviour) and an individual at a given socio-cultural moment”.
In this triad, the notion of disease had in my opinion almost no place at all. After all, no one chooses to get sick. Illness imposes itself upon you. You “catch it” without having wanted to. A virus enters our respiratory system. Our body goes haywire. Our genes are responsible. Or it’s just bad luck. On the other hand, it is always a conscious person who takes the initiative to use a substance or to start gambling. When addiction occurs, it is only the consequence of their initial choice. Even though addiction has now obliterated their capacity for choice.
These two years had also made me somewhat suspicious of the medical profession and the pharmaceutical industry. Why? Because of what I thought was their tendency to try and pathologize (and therefore cure) all human behaviour that is a little out of the norm. Think of the exaggerated popularity of psychostimulants to treat children with attention deficit or behavioural problems. Thank you Ritalin ®.
(A quick look at) the science of addiction
One of the most depressing courses of these years of study was an introduction to behaviourism. I even hit rock bottom when I was led to believe that free will was just an illusion. I was wrong, of course. With our oversized prefrontal cortex, we humans have the ability (freedom) to choose not to respond the way, say, a mouse would in an experiment involving punishments and rewards.
After I became an addiction counselor, I realized that people with addiction had lost their fundamental freedom to live their lives as they see fit. And one of the most rewarding things I’ve ever done in my professional life was to help them regain that freedom.
Research has shown that a person’s inability to abstain from alcohol or other drugs (or to gamble) has to do with deficits in the functions of the prefrontal cortex. This is the part of our brain responsible for what scientists call executive functions. These are the functions associated with everything that makes us human. Managing time and space. Evaluating our environment. Delaying reward. Expressing our personality.
In people with addiction, the difficulty has to do with how the brain reacts to stress, when deprived of the drugs or behaviours it is accustomed to. This response is most often exaggerated negative emotions, or even feelings of utter despair.
Craving and triggers
In this setting, the potential presence of specific ‘triggers’ (i.e. learned environmental cues reinforced by years of addiction) exacerbates the craving to consume substances or gamble. For instance, a whiff of beer at a sporting event. An ad for a casino. The public bench where the drug dealer could be found.
Alcohol and other drugs (heroin, cocaine, ecstasy, cannabis, anxiolytic drugs and even tobacco) act in the same way on the brain. They increase the level of dopamine (mainly, but also other neurotransmitters) in the reward system, creating a feeling of pleasure that can turn into an addiction.
The problem is that the brain becomes unable to naturally produce enough of the brain’s chemical messengers or neurotransmitters. As a result, the brain becomes more or less insensitive to more usual sources of pleasure. Walking your dog in a forest. Watching a sunset. Holding hands with your lover. Chatting with a dear friend… For the person, these pleasures no longer matter. Nothing else matters but the object of their addiction.
Overcoming an addiction
Addiction causes chemical, structural and molecular changes that literally hold our brain hostage. The good news is that this process is reversible and with no after-effects mostly (for the brain). Contrary to popular belief, not all drugs are serial killers of neurons; in fact, THE ultimate drug, heroin, has a much lower neurotoxicity than alcohol.
The bad news is that this process requires a long road to complete rehab. A road fraught with obstacles, moments of doubt and sometimes relapse.
I’ve worked with many people who had been able to get rid of their addiction (at least temporarily). However, most of them still claimed that they had no taste for anything. That they didn’t want anything. And were not interested in anything. This is normal. The detoxification period (and even the months that follow) is undoubtedly a difficult stage, but it is only a small part of the rehabilitation process. The ultimate goal is to relearn how to enjoy life’s normal pleasures.
Parity and stigma
The American Society of Addiction Medicine (ASAM) defines addiction as a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviours that become compulsive and often continue despite harmful consequences (definition revised in 2019).
Actually, there are two very good reasons to focus on the biological basis of addiction. First of all, it makes a strong argument for parity; that is, treating and funding addiction services on par with other health services for ‘biologic’ diseases. This is the purpose of the international campaign launched last week by Dianova.
It is also a good way to address the stigmatization of drug and alcohol users. No, people with a substance use disorder or other addiction are not weak, immoral, or simply out for a good time at the expense of society!
Understanding that biology is involved in people’s addiction disorders can also help to alleviate the self-stigmatization they often inflict upon themselves. With a great deal of guilt and self-hatred.
Yes, addiction is a disease, but…
The new ASAM definition emphasizes the importance of the environment and lived experiences in the development of an addiction. This is a good thing. because if we want to grasp what the roots of addiction really are, we need to go beyond the medical field and enter the psychosocial field.
The person with an addiction is no longer an object of care, but a subject who speaks, thinks and decides. Addiction is always related to certain difficulties they encounter in their relationships with themselves or with others. Of course, addiction is a disease. However, far from being physiologically, genetically or hormonally inevitable, addiction is part of a physical and psychological dimension specific to each individual.