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The Brain Disease Model of Addiction
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Recognizing Addiction is a Disease Has Led to Advances in Treatment. • A person experiencing a heart attack is treated with respect by society. A person experiencing addiction generally isn’t. Do we need a culture shift? • by Chris Adams, National Press Foundation • The medical establishment recognizes that addiction is a disease, even if the broader culture has yet to do so. According to the American Society of Addiction Medicine, addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. There is a persistent risk of recurrence, as well as impaired executive function that hinders perception, learning, impulse control, compulsivity and judgment. Dr. Ruth Potee, the director of addiction services at the Behavioral Health Network in Massachusetts, said that she and her patients live in the world of the “four C’s” of addiction: compulsive use, loss of control, continued use despite harm and cravings to use. “If you have some of these C’s, or even all of them, or one of them, you’ve actually lost control of the drug,” Potee said. • Genetics is a main driver, but addiction involves an interplay of factors. A person’s genes account for 50% of their risk of addiction. But early trauma and poor mental health also play an important role. If those factors are present as a teen’s brain is still developing, the teen will be prone toward addiction. “Three things set you up for addiction,” Potee said. “One is the genetics of it, the second one is early exposure while your brain is developing. And the third is a history of trauma. Having poor mental health does not necessarily mean you’ll struggle with addiction – lots of us have poor mental health and do not struggle with addiction. But what we know is when you have poor mental health, you’re more likely to have these other things happen.” • Addiction is a developmental pediatric disease, and any ability to postpone using is worthwhile. Potee cited a study on alcohol use by 15-year-old children consuming two drinks a week. That wasn’t heavy l use, but 40% of those kids went on to have alcohol use disorders. “If you wait until age 21, the rate of alcohol use disorder goes down to 7%, which is lower than the national rates of alcohol use disorder. So it’s about postponing use. … What you need to be able to encourage all of our kids to do is to protect their brains.” • Recovery and treatment take time. Potee showed brain scans from a healthy brain, full of the yellow markers signifying activity. Images from brains 10 days into treatment are mostly void of yellow – not enough time has elapsed. At 100 days – far longer than most treatment protocols – the yellow is only starting to return. “It’s complicated to break your brain, and it takes a long time for you to get better,” Potee said. “But the treatments we offer most people in this country is a detox – in and out, five to seven days, spin dry cycle, and we expect them to get better. And that’s bananas because nobody gets better in these detox situations.” • People relapse during their addiction treatment, just as they do with other health conditions. “With addiction, we have this expectation that we’re supposed to fix people in short order,” Potee said. “It doesn’t work that way. It’s a chronic, remitting disease that will come and go over many, many years.” She said people are angry and judgmental toward those who relapse and slip into substance use disorders again. But ask the average high blood pressure person, “Do you take your medicine seven days a week?” The reality, Potee said, is that most don’t. • Speaker: Dr. Ruth Potee, Director of Addiction Services, Behavioral Health Network; Medical Director, Franklin County (Massachusetts) House of Corrections • This program is sponsored by the American Society of Addiction Medicine, with support from Arnold Ventures. NPF retains sole responsibility for programming and content. • More Opioid Addiction content from NPF: https://nationalpress.org/topics/opio... • National Press Foundation website: https://nationalpress.org/
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