Addiction is a brain disease, experts declare

Addiction is “not simply a behavioral problem involving too much alcohol, drugs, gambling or sex,” the American Society of Addiction Medicine declared this week. Instead, the society notes, “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.”

In other words, addiction is not just about the actof raising a bottle to the lips, drawing deeply on a cigarette or bingeing guiltily in chocolate bars in private. There just might be something amiss in your head that compels you to behave that way.

“The disease is about brains, not drugs. It’s about underlying neurology, not outward actions,” said Michael Miller, past president of the ASAM who oversaw the crafting of the society’s new definition, in a statement.

No kidding. Well do I recall that time as a kid when I caught my mom crawling around on all fours with a herniated disk trying to find a cigarette somewhere in the house. Out of intellectual curiosity I asked her (kids are so cute) whether -- right at that moment-- she’d rather have a huge bowl of lovely ripe strawberries with lots of sugar and lashings of whipped cream all over them or a stubbed-out cigarette covered in mud rescued from a rainy gutter. “The cigarette end,” she said, and shot me a dark look.

“This is the first time ASAM has taken an official position that addiction is not solely related to problematic substance use,” a statement from the society notes. The association’s new definition of addiction can be read in its entiretyat the ASAM website.


The move would seem not exactly radical. Neuroscientists have been saying for years that addiction is a chronic disease of the brain. There are stacks of studies to back up the chronic-disease theory – changes in brain circuitry, changes in the way that genes in the brain are turned on or turned off. Some of these changes may persist for years – possibly forever — even after a person has given up a habit.

But just because something’s widely accepted professionally doesn’t mean it’s widely accepted out there in the world. At the website of the National Institute on Drug Abuse, you’ll see colorful PET scan images that attempt to drum home the point: One is of a normal brain and one of a cocaine abuser: metabolically, they look quite different. Right next to that pairing is another set of images, of two hearts – one healthy, one diseased. Again, the images look quite different. There would be no controversy over declaring one of the hearts physically diseased. That can’t be said for addiction, even in the face of all the evidence.

To craft their statement, the American Society of Addiction Medicine received input from 80 experts and consulted with the National Institute on Drug Abuse. The process took four years.