A Non-Disease View of Addiction to Consider
Is addiction to substances and behaviors a brain disease?
Many professionals, especially in Canada and the U.S., believe it is, and maybe they are right.
The National Institute on Drug Abuse defines addiction as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.”
However, not everyone agrees with this definition. And until the world knows for certain what addiction is, it benefits us to remain open-minded and courageous enough to entertain different views.
The Non-Disease Model
Although addiction is like a disease, that does not make it one. Something that differentiates addiction from disease is the occurrence of spontaneous recovery. While some individuals have spontaneous recoveries from serious physical illnesses, not many do. Yet a significant number of addicts get better without utilizing prescribed treatment or after using conventional treatments unsuccessfully.
For instance, depending on your choice of statistics, 50 to 80 percent of alcoholics recover from the addiction independent of treatment. Their path to recovery can be looked at as a developmental change in motivation, in the ability to manage thoughts, feelings and impulses, and in economic and social factors.
It would be interesting to know how many of those 50 to 80 percent had used medically prescribed treatments or had gone to AA or NA meetings before recovering on their own. It seems that prescribed or traditional treatments might be considered part of their developmental journey even if they were not curative. Treatments might have stabilized and educated individuals until they reached a state of self-motivated recovery.
If Not a Disease, then What?
The brain is a highly plastic and adaptive organ. The connections between neurons are in a constant state of flux when responding to our daily experiences, and all of our emotionally packed experiences affect our brain’s pleasure center activity.
We experience good feelings when the pleasure center, or nucleus accumbens (NAC), takes in the neurotransmitter dopamine and goes, “Ahhh.” Like the rest of the brain, the NAC is very plastic and adaptable. Each pleasurable experience results in learning, or a network of active synapses within and around the NAC. This continuous, flexible process allows us to pursue different rewards as we develop during childhood and into adulthood.
Two Learning Scenarios
- Imagine at some point in an individual’s life he or she listens to recordings of music by Gershwin and enjoys a huge “Ahhh” experience. This pleasurable learning event has him or her listening to Gershwin frequently. Even anticipating the music makes this person smile. This may turn out to be a lifelong addiction to Gershwin music, or it may lose steam and be replaced by the more exciting musical experience of, say, Pink Floyd.
- Imagine at some point in an individual’s life he or she tries cocaine and enjoys a huge “Ahhh” experience. This pleasurable learning event has him or her using cocaine frequently. Even anticipating using makes this person smile – or something. This may turn out to be an addiction with a “life of its own” owed to the physical addictive properties of cocaine.
Professor and developmental neuroscientist Marc Lewis, PhD, calls addiction “an extreme form of learning.” He points out that physical changes in the brain are how it learns, remembers and develops. No matter what the brain learns, it is not a disease process.
There are natural brain changes, sometimes devastating ones, which occur with substance or other addictions. However, Lewis thinks we are remiss in calling addiction a disease because it is acquired by learning, a normal brain activity. Those individuals who recover naturally from their addictions (without prescribed treatment) are accomplishing this by using their brain’s capacity to learn.
Still, there are many brilliant doctors and scientists who sincerely believe addiction, because it alters brain functioning, is a disease. It is our job, as consumers of medical and mental health services, to be informed and consider options.