Why Is Addiction a Disease?
Medically reviewed by Elle Markman, PsyD, MPH
Often, an addictive disorder may be referred to as a habit, compulsion, or dependency on a particular substance or action. However, the American Medical Association and the American Society of Addiction Medicine classify addiction as a disease. Clinical understanding of addiction continues to improve as the stigma surrounding these behaviors is addressed.
This article discusses what addiction is, when and why it is considered a disease, and actionable steps that can be taken to initiate treatment.
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Medical Definition of Addiction
An addiction is a chronic disease that involves brain chemistry, genetics, and environmental factors. Addiction also involves the biological or psychological need or compulsion for a specific substance, such as alcohol, or an activity, such as gambling.
These behaviors can become compulsive and continue despite harmful consequences.
How Is Addiction a Disease?
Many factors go into determining whether something can be described as a disease. When it comes to substance use and addictive disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria include:
Hazardous use
Social/interpersonal problems
Neglecting major roles to use
Withdrawal symptoms
Tolerance
Using larger amounts for longer periods of time than intended
Repeated attempts to quit or control the use
Spending a lot of time obtaining, using, or recovering from a substance
Developing physical or psychological problems related to use
Giving up activities in order to spend that time using
Craving
Addiction Is More Than Just a List of Criteria
While these criteria determine what can be considered a substance-related or addictive disorder according to the DSM-5, they do not take into account how addiction develops and what makes it a true brain disease.
Disease Model vs. Opposing Theories
The disease model of addiction is based on a collective agreement among various medical and addiction associations and organizations. These state that addiction is a disease because of the way it rewires the brain’s response to a substance, behavior, or activity. Those responses are involved in the way a person experiences stress, reward, or self-control practices.
The disease model for addiction states that these brain changes can persist after the person has stopped using a substance.
There are opposing theories surrounding addiction that push the narrative that it is, in fact, a choice and should not be characterized as a disease at all. These opposing theories emphasize that unlike other medical diseases, addiction:
Is not contagious
Is not related to autoimmunity or degeneration
Is self-acquired, meaning a person causes themselves to become addicted to certain substances or behaviors
Instead of thinking about the psychological or physiological aspects of addiction, the opposing theory focuses solely on a person’s social and environmental factors that lead to addiction.
Issues With Opposing Theory
Stating that addiction is a choice disregards certain elements of addiction that have been clinically proven, such as brain changes in people who become addicted to certain substances or behaviors.
The Brain and Addiction Disorder
Research on the brain and substance use and addictive disorders has concluded that these conditions involve more than simply choosing to engage in harmful behaviors.
When talking about substance use disorders specifically, three main brain neurocircuits that have been studied. A neurocircuit consists of neurons, which are brain messengers that relay information to drive certain functions.
The neurocircuits in regions of the brain affected by addiction include:
Basal ganglia: Basal ganglia are groups of neurons that help to refine muscle communication. They are tied to the binging and intoxication stage of addiction. During this stage, there is an increase in brain chemicals, such as dopamine, that are associated with pleasure, motivation, and satisfaction.
Amygdala: The amygdala is the part of the brain associated with processing emotions. It is often involved in the withdrawal and negative effects stages of addiction.
Prefrontal cortex: The prefrontal cortex plays a role in planning and personality development. It is involved in the preoccupation or anticipation stage of addiction. When a person is looking for or planning their use, the brain begins to develop both positive and negative cues that drive a person to continue seeking out their addictive substance.
The Brain's Role in Addiction Development
When a person engages in an addictive behavior or uses a substance, their brain begins to experience feelings of pleasure caused by surges in dopamine. Those experiences then drive repeated use. After a while, the brain will need greater and greater amounts of dopamine to get the pleasurable experience or even feel "normal." This is known as tolerance.
Related: The Effects of Drug Addiction on the Brain and Body
Signs and Symptoms of Addiction
There are many signs and symptoms of addiction. While some signs are universal to all types of addiction, some can differ depending on the specific disorder.
Drug addiction and behavioral addictions will present with some similar and different signs and symptoms.
Possible Signs of Substance Addiction
Being secretive or lying about drug use
Stealing to fund drug use
Hanging out with new people and neglecting old relationships
Going out and not being able to explain where or for what reason
Financial irresponsibility or unpredictable finances
Rapid changes in mood or behavior (i.e., going from happy to mad in an instant)
An increase in risky behaviors, such as driving under the influence
Possible Signs of Behavioral Addiction
Depression
Social anxiety
Withdrawal from friends or family
An increase in conflict in both personal and professional relationships
Neglecting personal responsibilities
Financial irresponsibility as it pertains to their addiction
Substance dependance on top of their behavioral addiction
Symptoms of addiction may also vary depending on whether it is a substance addiction or a behavioral addiction. Generally speaking, symptoms may include:
Tolerance: Tolerance involves needing more to get the same effect. This could apply to both substances and behaviors.
Withdrawal: Irritability or feeling ill can occur when a person does not engage in their addiction.
Mood changes: People with an addiction often experience drastic changes in mood. They may develop new anxiety, depression, or feelings of worthlessness because of their addiction.
Weight changes: A person may experience rapid weight gain or loss depending on their addiction.
Sporadic unwellness: A person dealing with an addiction can present with general swings of wellness and unwellness related to use.
Are Energy Changes a Sign of Addiction?
A person may experience drastic swings in energy and go from sleeping a lot more than usual to being more awake and lively. These changes may occur much like wellness, in the sense that they can swing from one extreme to the other.
Risk Factors
There are various risk factors that are involved in the development of addiction. They include:
Genetics: Although addiction can happen to anyone, people with family members living with an addiction are more likely to experience it.
Environmental: Factors such as a lack of parental guidance, neglect, peer pressure, and availability can all play a role in addiction.
Underlying mental health disorders: People who have other mental health disorders, such as depression or anxiety, are more likely to become addicted to substances or other behaviors.
Age: If a person engages in a specific behavior earlier in their lives, they are more likely to become addicted.
Trauma: People subject to traumatic experiences as children are more likely to engage in addictive behaviors.
Related: How Addiction Is Diagnosed
Accepting Treatment
Coping with addiction is hard, and many people find it difficult to accept treatment because of factors that hold them back. When it comes to substance abuse, people may forgo treatment because they have felt withdrawal symptoms in the past and don’t want to go through that again, or there may be shame and stigma around accepting they have an addiction.
Someone with a behavioral addiction may not accept treatment because it takes time to acknowledge that they have a problem.
Learn More: Signs of Addiction Denial
Where to Go
Deciding to seek treatment is the most critical step. That being said, it might be difficult to determine where to go for help with your specific addiction.
The Substance Abuse and Mental Health Services Administration has resources available on its website to help locate treatment centers in a person's area.
If you are coping with addiction, you could also reach out to your primary healthcare provider. They will be able to direct you toward the right people or organizations that can assist you in your treatment search.
How to Help Someone Battling Addiction
If someone you love is dealing with the disease of addiction, it’s important to treat it as such: a disease. They are not a bad person, nor are they doing it on purpose. The best thing you can do is be there for them, offer compassion, and help them find the right support outlets. Although it's important to establish healthy boundaries and limits in a relationship with a loved one with an addiction, criticizing or shaming them for their addiction may deter them from seeking help.
Before and After a Relapse
A relapse is when someone returns to using a substance after having achieved a period of sobriety or abstinence. Relapses are very common; by some estimates, more than 75% of people with an addiction will relapse within the first year of their treatment.
There are signs to look for that may indicate a relapse, including:
Positive discussion of prior experiences surrounding the addiction
Hanging out with the same people they did when they were using or engaging in addictive behaviors
Sudden changes in their behavior, such as isolating themselves or not engaging in activities they got into to refrain from using or participating in addiction
Feeling doubtful about their recovery
What Should You Do If Someone You Love Relapses?
Following a relapse, it’s important to refrain from judgment and encourage your loved one to begin the process of treatment again. While it may seem difficult, it’s the only way to get a person to try again.
You could also try to use certain prevention techniques to help a person with an addiction prevent their next relapse. These include:
Helping them develop coping skills they can use during times of high stress
Use positive reinforcement to keep them motivated in their treatment efforts
Boost their confidence, so they feel good about themselves and the future of their treatment
Offer a change in environment could help them refrain from addiction associations that might drive relapse (i.e., take them out to a new restaurant as opposed to one that they used to hang out at when they were using)
Related: What Is a Relapse After Recovery?
National and Local Resources
There are several national and local resources available for people with an addiction. They can be found in person, online, or through medical facilities.
Some resources include:
Any of these resources is a good place to start when looking for assistance with addiction.
Emergency Assistance
If you are battling an addiction and are experiencing an overdose or medical crisis, contact 911 for emergency medical assistance.
Summary
The debate surrounding whether addiction is a disease has been going on for decades. More and more clinical research confirms that addiction is a disease instead of a choice or moral failure.
Seeking help for addiction can be difficult, but there are various resources available for people that would like to overcome their disease in a healthy and long-lasting way. In addition, the stigma surrounding addiction is also slowly lifting, allowing people who have an addiction to feel more comfortable seeking help.
A Word From Verywell
Coping with an addiction can be very difficult, as there is still a lot of stigma and shame around people with addictions. While this can be hard to overcome, knowing that it's a disease and there are treatment options available may be helpful when you do decide to seek treatment. Overcoming addiction is a challenge, but you can heal with the right support and proper treatment.
Frequently Asked Questions
What is the psychology behind addiction?
Addiction is heavily influenced by psychological factors. Things such as stress, trauma, developmental issues, and social pressure are contributing factors to why someone may develop an addiction. Addiction often co-occurs with other mental health conditions.
Does the CDC classify addiction as a disease?
According to the Centers for Disease Control and Prevention (CDC), “addiction is a disease, not a character flaw.” The CDC recognizes addiction for what it is, based on clinical evidence surrounding addiction. In addition, the organization aims to reduce the stigma so that people with addiction diseases can find proper treatment without fear of judgment.
Are brain changes from addiction permanent?
Addiction changes the brain in ways that can lead to long-term and even permanent issues. That being said, in many cases of addiction, brain changes can be corrected. For example, the changes in dopamine production have been shown to potentially return to normal given enough time.
What are non-drug types of addiction?
Non-drug-related addictions are considered behavioral. For example, the one behavioral addiction recognized by the DSM-5 is gambling. However, recent research sheds light on other possible behavioral addictions, including shopping, food, the internet, and smartphone addiction.
What is harm reduction?
Harm reduction is a method of treating addiction without requiring full abstinence from a substance or behavior. Harm reduction can include reducing intake or replacement with a less harmful substance, like Suboxone for opioid addiction. For many, this is a more appropriate treatment approach to addiction.
Read the original article on Verywell Health.
