What exactly do we mean when we talk about ‘the disease of addiction’? Who, exactly, is an addict?
The answers to those questions are different now than they have been in the past. February of 2001 saw the release of “Definitions Related to the Use of Opioids for the Treatment of Pain”, a policy statement by ASAM and allied societies. Now, ten years later, that statement has been expanded, revised, and re-released this past April, finally giving doctors and healthcare workers a solid, detailed, agreed-upon definition of the word addiction.
This statement by the ASAM sums up the history of the new definition, and highlights one of the biggest problems that it will solve — the confusion between ‘addiction’ and ‘dependence’. This is currently the definition of ‘addiction’:
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationshpis, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”
(Italics original.)
This definition places emphasis on the behavioral symptoms of addiction, which are often related to the physical condition of dependence, but aren’t always necessarily caused by it. It’s possible for someone to show behavioral symptoms of addiction — lack of impulse control, significant problems with interpersonal relationships — under the influence of substances that don’t cause physical dependence, like steroids or cocaine.
On the flipside, there are many, many people who are taking substances which cause physical dependence, but who do not show the destructive and impulsive behavior characteristic of addiction. The stable buprenorphine patients we see at the Bel Air Center for Addictions fall into this category. I’m glad to see ASAM’s new definition because it has finally given doctors and patients a way to accurately describe the condition of these patients without subjecting them to the stigma and confusion of poorly-defined terms.
This definition isn’t the final word on the characteristics of addiction. The field of addiction medicine is still new, and I’m sure improvements will be made as we continue to learn about our patients and what works best to help them. But it’s a very good starting place as we set out, as doctors and patients, to get this illness the attention and scientific treatment it deserves.
This new era of addiction treatment also marks a change in this website. I’ve decided to return to active blogging, with a new post every week discussing issues related to addiction, addiction treatment, and care of patients who are suffering from substance abuse.