Calling addiction a brain disorder is ‘over-simplification’

AN IRISH psychiatrist has disputed four-year research emerging from the US which claims addiction is a chronic brain disorder.

Prof Patricia Casey said the new definition was an “over-simplification” of the problem.

The new definition by the American Society of Addiction Medicine says addiction is not simply a behavioural problem involving alcohol, drugs, gambling or sex.

It describes addiction as a primary disease — that it is not the result of other causes, such as emotional or psychiatric problems.

“By speaking of addiction as simply a brain illness we are in danger of being over-simplistic and of removing choice from our understanding,” said Prof Casey.

“It is important that those who are addicted accept that they have a choice and realise that, unlike certain mental illnesses, such as schizophrenia, their behaviour is not in the first instance determined by the neurochemistry,” she said.

The new definition of addiction was released by the American Society of Addiction Medicine following a four-year process involving more than 80 experts.

It is the first time that the society has taken an official position that addiction is not solely related to problematic substance use.

It also sees addiction, like cardiovascular disease and diabetes, recognised as a chronic disease to be treated, managed and monitored over a person’s lifetime.

“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviours manifest in all these other areas,” said ASAM’s past president, Dr Michael Miller, who oversaw the development of the new definition.

“Many behaviours 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.”

Two decades of advancements in neuroscience convinced ASAM that addiction needed to be redefined by what was going on in the brain of addicts.

Research has shown that addiction affects the brain’s reward circuitry, with memories of previous experiences with food, sex alcohol and other drugs triggering cravings and more addictive behaviours.

Brain circuitry that governs impulse control and judgement is also altered in the brains of addicts, resulting in the pursuit of “rewards” such as alcohol and other drugs.