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Fraser Trevor Fraser Trevor Author
Title: If you look at the brain of an addict on a CAT scan, abnormalities show up in the same way tumors show up in the lungs of people with lung cancer.
Author: Fraser Trevor
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PET brain scans show chemical differences in the brain between addicts and non-addicts. The normal images in the bottom row come from...
PET brain scans show chemical differences in t...
PET brain scans show chemical differences in the brain between addicts and non-addicts. The normal images in the bottom row come from non-addicts; the abnormal images in the top row come from patients with addiction disorders. These PET brain scans show that that addicts have fewer than average dopamine receptors in their brains, so that weaker dopamine signals are sent between cells. (Photo credit: Wikipedia)

Over 80 experts from the ASAM spent four years developing the new definition, which is that addiction is a chronic brain disease. It develops from physical abnormalities in the reward circuitry of the brain, particularly in atypical differences in the way areas of the brain communicate regarding memory, emotional response and pleasure. If you look at the brain of an addict on a CAT scan, abnormalities show up in the same way tumors show up in the lungs of people with lung cancer. A drug addict spends most of his waking hours thinking about drugs, using them, and seeking them out because his brain has an abnormal circuitry, and his behaviors associated with addiction in turn make his abnormalities worse, according to the ASAM.
Here are the main features of the new ASAM definition of addiction:
All addictions are simply addiction. In other words, addiction to food and gambling is the same as drug addiction. This new way of thinking would change how doctors diagnose this category of disorders. In the Diagnostic and Statistical Manual of Mental Disorders, each kind of addiction is considered a separate behaviorally-based disease, i.e., substance abuse is not the same as alcohol abuse or pathological gambling.
Addiction is caused by imbalances in the brain’s reward system. This means addictions do not cause brain differences, although addictions reinforce them.
Addiction is a primary disease and not caused by other mental disorders. Depression, bipolar disorder, and other mental illnesses do not cause people to "self-medicate" and then to progress into addiction to food, drugs, and other substances and activities. Addiction is a primary or first disease with its own root causes in the brain.
Addictive behaviors are symptoms of the underlying disease. An addict’s neglect of social relationships, her seeking out the substance or activity involved, and her other compulsive behaviors are not her addiction but rather symptoms of an underlying brain disorder that is addiction.
Addiction is a chronic, lifelong disease. The disease of addiction is similar to diabetes, arthritis and other chronic, lifelong diseases that currently have no cures but can be managed through drugs, therapy, and behavior-based treatments such as losing weight, monitoring blood sugar, etc.
Like other chronic, lifelong diseases, addiction can cause disabilities and premature death if left untreated.
Addiction is a progressive disease. An addiction will get worse without treatment. Gamblers will gamble at higher stakes and drugs addicts will increase the amounts they use if they don’t receive treatment.
Although addiction is a disease like any other, psychological and spiritual approaches in treatment are needed. The ASAM notes that the "spiritual manifestations of addiction include distortions in the connection with … the transcendent (referred to as God by many, the Higher Power by 12-step groups, or higher consciousness by others." In this way, the ASAM is suggesting that spiritually-based support and psychotherapy is helpful in the treatment of addiction.
"At its core, addiction is not just a social problem or a moral problem or a criminal problem. It is a brain problem whose behaviors manifest in all these others areas," according to Dr. Michael Miller, a former ASAM president involved in the new definition. "The disease is about brains, not drugs. It is about underlying neurology, not outward actions."
Dr. Miller also said it is time to "stop moralizing, blaming, control or smirking at the person with the disease of addiction."
The ASAM definition is controversial because many doctors still consider addiction as based in behavior, and not in organic brain differences. Some experts say that although the ASAM may have the intention of removing the stigma from addiction, the notion may backfire. They point to studies that indicate that when people believe mental illnesses are caused by genetics and physical abnormalities, they can become more prejudiced because they believe the mentally ill are permanently out of control and dangerous. Also, some experts question why the ASAM brings spirituality into the definition, because doctors generally do not bring up God when they talk about diabetes and other diseases.
The ASAM, founded in 1976, is an association of 3,000 doctors who specialize in the treatment of addiction. The ASAM is a voting member of the American Medical Association (AMA) House of Delegates, even though the American Board of Medical Specialties does not recognize addiction medicine as one of its 24 major divisions of medicine.

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