The Disease Model of Addiction

The general public has two main views of addiction. The first group believes that addiction is a legitimate medical condition or a disease that is comparable to other chronic illnesses. The second group believes that addiction is a choice and that if a person wanted to stop using drugs, they would do so. Even though the American Medical Association formally classified alcoholism as a treatable disease in 1956, the misconception that addiction is a choice is still rampant in society today.[1]

In the early stages of substance abuse, many people do have control over the amount and frequency of substances they consume. However, as substance abuse progresses into addiction, people lose the capability of choice. Instead, their thoughts, behaviors, and emotions are driven by the disease of addiction.

Understanding the science behind the disease model of addiction and how addiction affects all areas of a person’s life is essential to providing effective treatment. It is also helpful in destigmatizing alcoholism and addiction. Treatment approaches that view addiction as a medical disease rather than a moral shortcoming are not only more effective but are also more humane. Those who struggle with addiction are not bad people. They are sick and need professional medical and psychosocial treatment.

What is a “Disease”?

Most people have a general idea of what a disease is. Common diseases people think of are cancer, chickenpox, the flu, and HIV/AIDS. But what exactly does it mean to have a disease?

A simple definition of disease is a sickness, illness, or medical condition that is characterized by unique signs and symptoms that affect one or more body systems. Some diseases are contagious, like the flu, while others are not, such as cancer and hypertension (high blood pressure). Diseases can be the result of a virus or other external stimuli like environment, trauma, and personal experiences. They can also be the result of an internal issue, such as mental illness or genetic factors.

Explaining the Disease Model of Addiction

The brain is a complex organ that consists of more than 180 distinct regions that control various bodily functions, such as thought, memory, motor skills, vision, breathing, emotion, hunger, temperature, and more.[2] Drugs and alcohol affect the brain and its various regions in many different ways. For example, prescription drugs that are administered by a doctor for a specific treatment can help normalize brain chemistry. Drug or alcohol abuse, on the other hand, can negatively alter brain chemistry and adversely affect areas of the brain that are vital for healthy, optimal functioning.

Unfortunately, long-term substance abuse can impact virtually every aspect of a person’s brain. In the end, addiction ends up affecting a person’s mental, physical, emotional, and social health.

Three Stages in the Brain Disease Model of Addiction

The disease model of addiction recognizes addiction as a repeating cycle that has three unique stages. Each stage of this cycle is known to affect specific regions of the brain. Since researchers have identified specific areas of the brain that are affected by addiction, as well as specific signs and symptoms, they are able to designate addiction or “substance use disorder” as a disease.

The three stages outlined in the disease model of addiction and the areas of the brain that are affected in each stage are:[3]

1. Binge/Intoxication and the Basal Ganglia

The binge or intoxication stage refers to when an individual uses drugs or alcohol to experience pleasurable or “rewarding” side effects. Pleasurable effects occur when an excess of dopamine, serotonin, or norepinephrine is released in the brain to produce a “high.”

The area of the brain that is affected by this stage of the addiction cycle is the basal ganglia. The basal ganglia is a region of the brain that experiences the rewarding effects of drugs and alcohol. It is also the region that is initially responsible for the development of compulsive or habitual drug/alcohol abuse.

Sometimes, this area of the brain is referred to as the “reward circuit.” This is because drug and alcohol abuse creates extra activity in this circuit and results in feelings of euphoria or pleasure. Repeated exposure to the same substance will cause this circuit to become used to the presence of that substance. And, in time, drug users will find that they must take higher doses of the same drug to feel the effects. This happens when the basal ganglia become tolerant to and physically dependent on drugs or alcohol.

2. Withdrawal/Negative Effect and the Extended Amygdala

The withdrawal or negative effect stage refers to the negative emotional, social, or physical withdrawal symptoms individuals experience when they aren’t using the substance. When someone who struggles with addiction doesn’t have the substance they are addicted to in their system, they may become irritable, upset, and even physically ill until they use the substance again.

The extended amygdala is the region of the brain that is affected in this cycle. This region is responsible for causing feelings of stress, unease, irritability, and anxiety that appear when the brain is in the absence of the addictive substance.

Increased drug and alcohol use makes the extended amygdala more and more sensitive. The longer a person abuses a drug, the worse their withdrawals or negative side effects will become. Eventually, people struggling with addiction will resort to using drugs or alcohol over and over again simply to experience relief from withdrawal. They aren’t trying to get high anymore–they are trying to not be sick.

3. Preoccupation/Anticipation and the Prefrontal Cortex

The final stage, known as preoccupation or anticipation, is when people begin seeking out their drug of choice after a period of abstinence. This period of abstinence could be a few hours, a couple of days, or even several months. This is the stage of the cycle of addiction that can be one of the most difficult to break because it is characterized by reduced impulse control and compulsive, obsessive substance abuse.

The preoccupation/anticipation stage affects the prefrontal cortex, the region of the brain that is responsible for executive function. The prefrontal cortex allows people to manage time, control their behaviors, organize their thoughts, and perform tasks in order of priority. When this region of the brain is affected, people lose control over their substance use. They also experience intense cravings for drugs or alcohol that trigger a relapse. In other words, people who struggle with addiction don’t choose to use substances–their disease drives them to do so.

The prefrontal cortex is the last region of the brain to fully mature. Because of this, people who abuse drugs and alcohol before this area matures, such as adolescents, teenagers, and young adults, are at an increased risk for addiction.

Risk Factors Identified With the Disease Model of Addiction

Another reason why addiction and alcoholism are considered diseases is that they are marked by distinct risk factors. There are various genetic, environmental, and social factors that can increase the risk of developing an addiction to drugs or alcohol. The most common risk factors are as follows.[4,5]

Genetic risk factors:

  • Genetics – studies suggest up to half of a person’s vulnerability to addiction depends on his or her genetic makeup.
  • Mental illness – people who struggle with mental health conditions are at an increased risk for addiction.

Environmental risk factors:

  • Home environment – children who grow up in homes with substance abuse, criminal behavior, mental illness, neglect, abuse, or divorce are more likely to use drugs and alcohol.
  • Trauma – experiencing one or more traumatic events and/or developing post-traumatic stress disorder (PTSD) makes a person more vulnerable to addiction.

Social risk factors:

  • Support systems – lack of a healthy support system as a child, teen, and even adult can increase the risk of substance abuse.
  • Social circles – exposure to high-risk social settings or spending time with people who use drugs or engage in illegal behaviors can increase the risk for addiction. Other social influences like bullying or gang affiliation can also increase the risk.
  • Family support – those who have unhealthy familial relationships or don’t have support from their families may be more likely to develop a substance use disorder.
  • Economic insecurity – those who come from lower-income families and neighborhoods may be more prone to substance abuse.

Addiction as a Chronic, Relapsing Disease

While addiction can be treated, it cannot be cured. It must be managed on a long-term, continuous basis. And, like other chronic diseases like heart disease, asthma, and hypertension, people who struggle with addiction may relapse one or more times in their recovery journey.

According to the National Institute on Drug Abuse, between 40-60% of people who seek treatment for substance abuse relapse at some point after receiving care.[6]

Relapse doesn’t mean treatment has failed or that a person is unable to stay sober. It simply means some area of the person’s recovery program needs to be adjusted. The individual may need to go back to rehab, start counseling sessions, or increase the number of peer support meetings they go to. If a person stops following their treatment regimen, they become susceptible to relapse.

Individually-Tailored Addiction Treatment With Moving Mountains Recovery Center in New Jersey

The best way to treat the cycle of addiction and prevent relapse is to provide those struggling with individually-tailored treatment. Each person who struggles with addiction has their own unique experiences and needs. In order for treatment to be effective, it must address the person’s substance abuse as well as their medical, psychological, social, vocational, and legal problems. Treatment must also match settings, interventions, and services to the difficulties the person experiences.[7]

Here at Moving Mountains Recovery, we recognize that no single treatment is appropriate for everyone. We also acknowledge the disease model of addiction and use our custom-tailored treatment programs to address the physical, mental, emotional, and social needs of each client who walks through our doors. Our evidence-based treatment program helps individuals overcome their difficulties, utilize their personal strengths, and heal the whole self.

If you or a loved one are struggling with addiction, please give us a call today. One of our dedicated admissions coordinators is ready to take your call.

References:

  1. https://www.ama-assn.org/delivering-care/public-health/court-listened-ama-defining-alcoholism-disease-not-crime
  2. https://www.hopkinsmedicine.org/health/conditions-and-diseases/anatomy-of-the-brain
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135257/
  4. https://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008086/
  6. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
  7. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
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