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Addiction now defined as brain disorder, not behavior issue
Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.
The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts.
"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," said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. "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."
The new definition also describes addiction as a primary disease, meaning that it's not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person's lifetime, the researchers say.
Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what's going on in the brain. For instance, research has shown that addiction affects the brain's reward circuitry, such that memories of previous experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of "rewards," such as alcohol and other drugs.
A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction's new definition.
"The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them," Hajela said in a statement. "Simply put, addiction is not a choice".
More from msnbc.com
Millions of Americans know all too painfully that alcoholism runs in families.
Children of alcoholic parents are four times as likely to develop drinking problems as the general population. Sons of alcoholic fathers face up to nine times the usual risk. Even babies of alcoholics adopted into non-drinking homes have nearly the same risk of alcoholism as they would if they'd stayed with their biological parents, studies have shown.
But untangling just which genes pass along the predisposition for problem drinking is devilishly difficult—largely because alcoholism itself is so complex. Genes that affect how fast the liver metabolizes alcohol and how the brain reacts to stress, reward and pleasure have all been implicated, as have genes for anxiety and depression. Some overlap with genes for nicotine, cocaine and other addictions.
About one in 10 Americans fit the criteria for alcohol dependence—mainly the inability to cut down—at some point in their lives. Environmental influences and social pressures also play complicated roles.
Who Is an Alcoholic?
If you've done any three of these seven, you meet the criteria for alcohol-dependent:
Drunk more or longer than you intended
Been unable to stop or cut down
Needed more alcohol to get the same effect
Had withdrawal symptoms without it
Spent an increasing amount of time drinking or recovering
Neglected other activities due to drinking
Continued to drink despite negative consequences
About 5% of Americans currently meet the criteria, and more than 10% do at some time in their lives, according to the National Institute on Alcohol Abuse and Alcoholism.
Source: The Diagnostic and Statistical Manual of Mental Disorders
"All too often, you read that they've found a gene for this and a gene for that, and it's very rarely that simple. We don't expect to find a single gene in everyone," says Howard J. Edenberg, a professor of biochemistry and molecular biology at the Indiana University School of Medicine. Dr. Edenberg is one of four principal investigators in the government-funded Collaborative Study on the Genetics of Alcoholism (COGA), which has been tracking alcoholism in families since 1989. To date, COGA researchers have interviewed more than 14,000 people and sampled the DNA of 262 families. They've found evidence for several alcohol-related genes—and are increasingly convinced that different types of alcoholics reflect many genetic variations.
That idea is already showing promise in one area: identifying drugs that can help treat alcoholics based on their individual DNA profile. Most of the drugs currently on the market aim to cut alcohol cravings but don't work on everyone and compliance is a problem. That could change, experts say, if drugs could be targeted to patients with specific types of alcoholism
Chalk Talk on Alcohol was produced in 1972 by Father Joseph C. Martin. It is considered a historic film, in that it offers one of the most effective descriptions of alcohol, alcoholism, and recovery from addiction.