“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 (American Society of Addiction Medicine.) 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.”

Addiction is a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. About 40 to 60% of addiction is based on genetic vulnerability, but other factors are also at play. 90% of those who go on to develop an addiction problem started using drugs or alcohol as an adolescent. 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.

Two decades of advancements in neuroscience have revealed 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 individuals suffering with addiction, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.

A long-standing debate has roiled over whether those with addiction have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine. “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. Addictive behaviors are a manifestation of the disease, not a cause.” Even so, Hajela pointed out, choice does play a role in getting help. “Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.

This “choosing recovery” is akin to people with heart disease. They did not choose the underlying genetic causes of their heart problems which they were born with, but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions. “So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment and support for recovery,” Miller said.

Early recovery can be marked by periods of instability. Current research shows that about one-third of people initiating recovery achieve lifetime abstinence without relapse; another third have initial periods of abstinence interspersed with relapses but eventually achieve sustained recovery; and another third do not achieve sustained recovery over their lifetimes. For those achieving abstinence for a period of 4-5 years, risk of relapse drops to 15%. The good news is that research also shows that for those with substance use disorders:

• A comprehensive array of services assists recovery.
• Social supports improve recovery outcomes.