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How Addiction Is a Brain Disorder

Addiction is a brain disorder. That finding is still relatively new within the scientific community, having only really emerged during the last two decades of research—but it should be a source of consolation for anyone living with a substance use challenge. Why? Because a brain disorder is medically treatable. And with ongoing advances in addiction science, brain disorders will only become more medically treatable in the future. That’s good news.

The disease of addiction still carries a negative stigma, after all. Much of that stigma, I suspect, stems from a misconception that addiction is purely a bad choice, habit, moral failing or lack of self-control. By the same rationale, people who struggle with addiction only need more self-discipline.

If only it were that simple.

The reality is that substance use changes the brain, creating long-lasting impairments to key regions and functions. These changes are what constitute the “brain disorder” that makes drugs and alcohol so painfully hard to kick.

How Addiction Changes the Brain

How, then, does addiction change the brain? A 2016 article in The New England Journal of Medicine helped to answer that question. In a review of recent findings from neurobiology, the researchers concluded that substance use:

  1. Desensitizes the brain’s reward circuit, dampening the brain’s ability to feel pleasure and motivation in everyday activities
  2. Increases the strength and intensity of conditioned responses, including reactivity to stress, which in turn produces stronger cravings for alcohol and other drugs—as well as negative emotions when cravings go unsatisfied
  3. Weakens regions of the brain involved in executive functioning, like decision-making, impulse control and self-regulation—all of which increase your relapse potential

How Addiction Is “About Brains, Not Drugs”

Similar findings were what ultimately convinced the American Society of Addiction Medicine (ASAM) to redefine addiction as primarily a brain disorder rather than a behavioral problem, in 2011. At the time, former ASAM president Dr. Michael Miller gave this explanation in an August 2011 NBC News report:

“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. 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.”

Understanding how drug and alcohol addiction is a brain disorder is a big step forward in helping to end the stigma of this complex disease and encouraging people to choose treatment. In this sense, knowledge isn’t just power; it’s responsibility. The fact that substance use disorders are brain disorders means that people with addiction or other forms of mental illness can take responsibility for their health, by accepting treatment that can help.

Anna Ciulla is the Clinical Director at Beach House Center for Recovery, where she is responsible for designing, implementing and supervising the delivery of the latest evidence-based therapies for treating substance use disorders. Anna has a passion for helping clients with substance use and co-occurring disorders achieve successful long-term recovery. 

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