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Why Is Addiction Considered a Disease and Not a Compulsion/Compulsive Disorder?

Why Is Addiction Considered a Disease and Not a Compulsion/Compulsive Disorder?

Whether addiction is considered a disease or a compulsive disorder is highly debated. Some treatment specialists and psychologists consider addiction to be a compulsive disorder, and there are others who consider it a disease.

Regardless of what classification of addiction you subscribe to, those who suffer with it, as well as their family members, need exposure to treatment options. If you are suffering from an addiction, alcoholism, substance abuse or substance abuse disorder, you can get better through comprehensive, quality addiction treatment.

History of Addiction Classification

In the past, one reason holding back the labeling of addiction as a disease was due to the fact that the defect in the brain where the addiction arose was never found. When specialists couldn’t actually show the physical defect in the brain, they couldn’t classify addiction as a disease, like cardiovascular disease, for instance, that clearly can be seen on x-ray and imaging studies.

Early on, immaturity, intrinsic badness and/or irresponsibility were considered to be symptoms of a person who was addicted. The argument against labeling addiction as a disease was that users made the choice to use drugs and that their inability to stop using was immature and irresponsible behavior.

Today, however, after at least a decade has passed, a lot more is known about the brain and its relationship to addiction. Now, specialists know about a physical defect associated with addiction, and where it is located.

specials know about a physical defect associate with addiction, and where it is located
They know that there is a hedonic system (pleasure system) deep in brain area that also handles basic survival. This defect causes the person addicted to unconsciously think of the drug being life itself.

For example, heroin is not just heroin. The user needs the heroin in order to deal with life, and they actually crave it when it is unavailable. While the user can make a choice as to whether or not to use heroin, they don’t have a choice as to whether or not they crave heroin. While no one chooses to have a drug addiction problem or heart disease, they may choose behaviors that lead to these diseases.

For this reason, addiction is now widely viewed as a chronic, complex brain disease that causes compulsive drug-seeking behavior, despite the harmful — and sometimes fatal — consequences to the addicted person.

Understanding the Disease Model of Addiction

The disease model of addiction purports that addiction is a brain disease. It is characterized by abnormal brain functioning and altered brain structure. These brain alterations and abnormalities cause individuals to become addicted to substances once they are exposed to them.

The addiction disease concept describes addiction as being a disease with the following origins:

  • Neurological
  • Biological
  • Environmental
  • Genetic sources of origin

Because the disease has a chemical and biological component, and is progressive, it can ultimately be fatal if left untreated. This is similar to other major diseases, such as cardiovascular disease and diabetes. In other words, drug and alcohol addiction share many similar elements with other chronic diseases, including being influenced by environmental conditions and having a tendency to run in families.

According to the National Institute on Drug Abuse, most people don’t understand how or why people get this addiction to drugs. They feel as though the user lacks willpower or moral principles, and the user could simply choose to stop taking the drugs by changing their behavior.

Unfortunately, we know now that drug addiction is a complicated disease and involves multiple inputs into its development, progression and treatment. While a strong will and good intentions are absolutely required for recovery from drug addiction, scientific advances have suggested that quitting is difficult on your own because drugs alter the compulsory drug use behavior area of the brain.

Should Addiction Be Termed a Chronic Disease?

A chronic disease is thought of as a condition that is long-lasting and can only be controlled — not cured. Up to 50 percent of people who have problems with substance abuse seem to have a serious, chronic disorder. Addiction, for them, is progressive, and their disease relapses. This causes them to require intensive treatment and continuing aftercare, peer or family support, as well as monitoring to manage their recovery.

up to 50% of people who have problems with substance abuse seem to have a serious, chronic disorder

These people who suffer with the disease concept of addiction do make the choice to use drugs, but they don’t have a choice in how their body and brain respond to the drugs, which is what causes them to become addicted and unable to control their use like other people can. They are able to quit using — it’s just more difficult for them than other people who don’t have the addiction.

How Substance Abuse Alters the Brain

how substance abuse alters the brain

Drugs are chemicals that alter your brain’s communication system, leading to a disruption in how your nerve cells typically receive, send and process information.

The drugs can do this in two main ways:

  1. They overstimulate your brain’s reward circuit.
  2. They imitate your brain’s natural chemical messengers.

There are many parts inside your brain that work together, and these parts coordinate and perform specific functions. The important areas of the brain can be altered by drugs, which can be problematic since they are vital for life-sustaining functions and can accelerate addiction or compulsive drug abuse.

Parts of the Brain

parts of the brain

There are certain areas of your brain that can be substantially affected by drug abuse, including:

  • Brain Stem. This controls your basic life functions such as breathing, your heart rate and sleeping.
  • Cerebral Cortex. This is separated into areas of your brain that control certain functions. Some areas are responsible for processing information from our senses which enable us to feel, see, taste and hear. The front area of the cortex is your brain’s thinking center which enables us to plan, think, make decisions and solve problems.
  • Limbic System. This area holds your brain’s reward circuit. Different brain structures are linked together which regulate and control your process of feeling pleasure. When you feel pleasure, it motivates you to repeat those behaviors that are vital to your existence. Life-sustaining, healthy activities like socializing and eating activate your limbic system — but so do drugs. Our limbic system also controls our perception of our other emotions, either positive or negative, which is why the drug’s mood-altering properties is so effective.

How Drug Addiction Progresses

Drug addiction is considered a brain disease since abusing drugs can lead to changes in the functioning and structure of your brain. You voluntarily use drugs in the beginning. However, as time progresses, the repeated use causes changes in your brain, which affects your self-control and sends off intense impulses to continue taking the drugs. This is why it can be hard for you to stop abusing drugs when you become addicted.

repeated drug use changes your brain

You can characterize disease of addiction by:

  • Not being able to abstain from use.
  • Impairing behavioral control.
  • Increasing cravings for the drugs.
  • Decreasing recognition of serious issues with your behaviors or in your relationships.
  • Eliciting a dysfunctional emotional response to situations.
  • Having external cues that bring on cravings and drug use.

Types of Drugs

types of drugs

Certain drugs, like heroin and marijuana, have the same structure to chemical messengers known as neurotransmitters that your brain naturally produces. Because of this similarity, your brain’s receptors are actually ‘fooled’ by the drugs, and your nerve cells are activated into sending abnormal messages.

Other drugs, like methamphetamine or cocaine, cause your nerve cells to give off extremely large amounts of dopamine and other natural neurotransmitters. These drugs can also prevent your brain chemicals from recycling as they normally do, which is required for shutting off the neurons’ signals.

This leads to your brain being over-stimulated with dopamine, a particular neurotransmitter located in your brain regions that controls emotion, movement, feelings of pleasure and motivation. When your reward system is overstimulated, it produces euphoric effects, which then reinforces and teaches you to continue abusing drugs to reap the rewarding behavior.

As you continue to use drugs, your brain gets used to the overwhelming dopamine surges and either produces less of it or reduces the amount of dopamine receptors you have in your reward circuit. This lessens the impact of dopamine on your reward circuit, and it reduces your ability to get pleasure from the drugs — as well as the life events that brought you pleasure previously. You become compelled to continue abusing drugs in order to normalize that dopamine function. However, it takes larger and larger drug amounts to get that same dopamine high — a situation known as tolerance.

Recognizing that addiction is a brain disease doesn’t mean you are an unfortunate victim in the matter. Sure, you do make the conscious decision to use drugs, but recovering from the addiction means you have to take some significant responsibility and participate in your own recovery.

It also doesn’t absolve you from realizing you are responsible for your own behavior. However, it does it does explain why you are unable to just stop using drugs out of your own willpower alone.

Why Some People Get Addicted and Others Don’t

There isn’t just one factor that can predict whether you will become addicted to drugs or not. Your biology, age, social environment, genetics and other factors influence your risk for addiction. The more risk factors you have, the more chances that using drugs will result in you becoming addicted. Let’s take a closer look at the factors:

  • Biology and Genetics. Your genetics play a big role. Much like vision problems, male pattern baldness and heart disease, the disease concept of addiction also has a genetic component. Although there are other factors that can make you more susceptible to drug abuse and addiction, your genetic predisposition could be the most important. According to the American Psychology Association, genetic factors make up at least on half of a person’s vulnerability to drug addiction.

If you have a relative or parent who has shown some types of addictive behavior before, it is more likely you can develop drug dependence. This is not to say you are somehow drawn to drug abuse, but rather if you are exposed, it could be harder for you to control yourself around the addictive drugs.

genetic factors make up at least on half of a person's vulnerability to drug addiction

The genes you are born with can influence your addiction vulnerability. Also, your ethnicity, gender and if you have another mental disorder can play a role in your risk for addiction to drugs as well.

  • Environment. There are a variety of influences in your environment, including your friends and family, quality of life or your socioeconomic status. Things like sexual and physical abuse, peer pressure, parental involvement and stress can also have a huge influence on the course of your drug dependence.
  • Development. Environmental and genetic factors combine with crucial developmental stages in your life to affect the vulnerability of your addiction. Even though you can become addicted at any age, the earlier you start, the more chances there are of you seriously abusing drugs and becoming addicted. If you are an adolescent, your brain is still developing in certain areas that affect your judgment, decision making and self-control, and these areas are particularly prone to different types of risk-taking behaviors, like abusing drugs.earlier age that drug abuse starts the higher the chances for serious drug abuse and becoming addicted
  • Other Factors. There are other factors that weigh-in on addiction as well, and these include:
    • A reward circuit function biological deficit, such that you prefer and seek behaviors and drugs that enhance your reward function.
    • Repeated addictive behaviors and drug use that causes neuroadaptation in your motivation circuitry, which leads to a lack of control over engaging in addictive behaviors — like drug abuse.
    • Affective and cognitive distortions that compromise your ability to deal with your emotions and impair your perceptions, which leads to substantial self-deception.
    • Issues in interpersonal relationships and lack of healthy social support that impacts your resiliency or development.
    • Exposure to stressors or trauma that overwhelms your coping abilities.
    • Distortion in purpose, meaning and values that guide your thinking, attitude and behavior.
    • Distortion in how you connect with yourself, others and the higher power.
    • If you have a co-occurring psychiatric disorder.

What About Obsessive Compulsive Disorder and Addiction?

Over 25 percent of people who look for OCD treatment end up meeting the criteria for substance use disorder, according to the Journal of Anxiety Disorders. If you experience OCD symptoms during your adolescence or childhood for the first time, it’s possible you’ll develop a drug issue typically to cope with overwhelming fear and anxiety. Trying to treat an addictive disorder before the emotional OCD symptoms are addressed often proves ineffective.

over 25% of people who look for OCD treatment end up meeting the criteria for substance use disorder

It can be tiring having to cope with OCD obsessions. When you self-medicate with drugs, though, you are only giving yourself a short relief. However, because of this, it’s extremely tempting to repeat the use of drugs as your urges or unwanted thoughts arise. Your addiction to drugs can form with enough abuse and time.

OCD, Addiction and Social Isolation

When OCD leads to social isolation, it can also lead you to abuse drugs and become addicted. If you suffer with OCD, you might realize that your compulsions and obsessions do not make any logical sense. You might feel shame for acting or thinking the way you do.

Obsessive compulsive disorder, like being addicted to drugs, can leave you feeling isolated from the world outside. You might avoid social settings and important people to keep your compulsions and obsessions private. This loneliness, shame and physical isolation can easily lead to you abusing drugs.

Treating both these disorders together (dual-diagnosis) is the key to beating OCD and co-occurring addiction effectively. Cognitive Behavioral Therapy (CBT) is the gold standard for treating OCD, with or without a substance abuse addiction.

Cognitive Behavioral Therapy (CBT)

This therapy is often used for OCD and drug addiction and is an effective treatment. This type of therapy involves mental health counseling that teaches you how to cope with the unwanted feelings and thoughts from OCD that can result in drug abuse.

Antidepressant Medications

Antidepressants are often used as well to treat both disorders. Some of the common medications used include:

  • Paroxetine (Pexeva, Paxil)
  • Fluvoxamine (Luvox CR)
  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Clomipramine (Anafranil)

Keep in mind that your addiction is indeed a chronic illness. You can have your OCD symptoms treated with medication, but continued therapy will be required to overcome your addiction and keep you from relapsing.

Can Drug Addiction as a Disease Be Treated Successfully

Much like other chronic diseases where you can relapse, such as asthma, diabetes or heart disease, the disease model of addiction can also be successfully managed. However, as with other chronic diseases, you can relapse and start to abuse drugs again.

Relapse doesn’t necessarily indicate that you failed, though. Instead, it shows that you just need your treatment reinstated or adjusted. You might even require a different treatment plan to help you recover and gain control.

The relapse rates of drug addiction are fairly similar to the rates of chronic medical illnesses like asthma, diabetes and hypertension, which all have both behavioral and physiological components. Chronic disease treatment involves altering behaviors that are deeply engrained. When it comes to your relapse, it might mean your treatment protocol needs adjusted.

The good news is, these treatments help you to counteract the powerful and disruptive effects of your addiction and regain your control. In fact, combining behavioral therapy and addiction treatment medications is really the best way to ensure you are successful.

The type of treatment you require will be tailored to your own individual case and drug abuse patterns. It will depend on your concurrent psychiatric, medical and social issues as well, which will increase your chances of sustained recovery.

You might need to go to an outpatient treatment program in order to give yourself a great start at recovery. Or perhaps you require a higher level of care, which includes inpatient treatment and a long-term sober living home after. You might need inpatient detoxification and coping strategies to deal with cravings. Additionally, how long you spend in treatment may ultimately correlate with long-term abstinence. In other words, your treatment’s intensity, whether it be outpatient or inpatient, might not be as significant as adequate treatment length to realize a good outcome.

Drug addiction is a complex disease, and it takes much more than willpower and good intentions to stop taking drugs. Not to mention, since your brain is changed by drugs in ways that feed the drug addiction, it can be very difficult to quit even if you want to and are ready to. Thanks to advances in science, though, we now know how drugs affect the brain and how to successfully treat addiction so people can quit using and get back on living a more productive life.

When addiction is left untreated, there are various consequences including mental and physical health disorders that need medical attention. If you don’t have your addiction treated, it can become more disabling, severe and even life threatening.

Get Help for Addiction

If you think you might be at a higher predisposition for abusing drugs, it is vital to get help — especially since addiction is a disease with very negative consequences, including fatality. The only way you can break the addiction cycle is to stop abusing drugs or whatever behavior you are addicted to and never go back to doing it.

This is not so easy, however, and usually requires you to get into a 30-day inpatient/detox treatment (if you have a severe addiction) or outpatient therapy.

JourneyPure Emerald Coast offers treatment for drug addiction, alcohol addiction and mental health challenges, like obsessive compulsive disorder. You don’t have to live a life of addiction to prescription drugs, alcohol or other substances any longer. We know what it’s like to want to change, and our treatment facility offers you hope and help.

Whether you’re considering a long-term residential stay or an outpatient program, our knowledgeable and caring team at JourneyPure Emerald Coast is here to help. We understand what you’re going through, and we are ready to help you make the first step. Call us today at (800) 493-5253.