Disease Model of Addiction

Substance Use is Not a Moral Failure

Addiction is a Brain Disease, and It Matters

Disease Model of Addiction

Substance Use is Not a Moral Failure

Addiction is a Brain Disease, and It Matters

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Addiction is defined as a disease by most medical associations, including the American Medical Association and the American Society of Addiction Medicine.1

Partnership to End Addiction

What is the Disease Model of Addiction?

Defining Addiction

According to the National Institute on Drug Abuse (NIDA), “addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.”2

What is Disease?

For this article, we define disease as the impairment of an organism’s normal functioning.3 However, note that defining disease is controversial and ever-changing. In an article titled “What is a disease?” Jackie Leach Scully states:

At first sight, the answer to “What is a disease?” is straightforward. Most of us feel we have an intuitive grasp of the idea . . . [b]ut a look through any medical dictionary soon shows that articulating a satisfactory definition of disease is surprisingly difficult . . . [w]hat counts as a disease also changes over historical time, partly as a result of increasing expectations of health, partly due to changes in diagnostic ability, but mostly for a mixture of social and economic reasons.4

Learn More About Healing the Brain

  • Holistic Approach
  • Brain Chemistry
  • Positive Psychology

Support for the Disease Model of Addiction

Alan I. Leshner was one of the first people to write about addiction being a brain disease. In 1997, he published an article titled “Addiction Is a Brain Disease, and it matters,” in which he outlined the specific effects drugs have on the brain.5 Because addiction creates physical and chemical changes to the brain, Nora Volkow, Director of the NIDA, and many other researchers support the brain disease model of addiction.

The Brain’s Reward System

Drugs change the brain by affecting a brain pathway called the mesolimbic reward system that impacts the limbic system and the orbitofrontal cortex.”5 The activation of this reward system by substances causes drug users to continue taking drugs. Every time they take a drug, the brain rewards the behavior with euphoria, relaxation, calmness, or highness. The brain then seeks more of these rewards, causing the individual to crave more of the substance that leads to addiction.

Persistent Changes to the Brain

Another argument for the disease theory of addiction is that even after individuals stop using drugs, their physical and chemical brain changes persist.5 Leshner explains that there are diagnosable differences between an addicted brain and a non-addicted brain, as evidenced by changes in “brain metabolic activity, receptor availability, gene expression, and responsiveness to environment (sic) cues.” 5

Effect of Medical Condition vs. Moral Failing Debate

Most importantly, for drug treatment and recovery, the disease concept of addiction supports the idea that addiction is a medical condition and not a moral issue. Individuals may not have the free will to stop their drug use. Understanding addiction as a disease highlights the difficulties substance users go through and provides scientific evidence that it is not easy to stop using drugs.

Brain Imaging

Brain imaging studies show the large role the neurotransmitter dopamine plays in addiction. More recently, imaging shows specific dopamine receptors (“D2 Receptors”) influence addiction. The studies show that normal levels of D2 receptors correlate with the ability to delay gratification. Conversely, low levels of D2 receptors correlate with impulsivity and a higher risk of addiction.6

These brain images show neurochemical and functional changes that support the disease model of addiction.

Criticisms of the Disease Model of Addiction 

The main argument against the disease model of addiction is that merely proving that drugs change the brain does not qualify addiction as a disease. This theory states that for addiction to be considered a brain disease, two conditions must be met: first, that “its neural correlates are pathological,” and second, that that pathology is sufficient for the person to suffer from the disease in almost any accessible environment.7 In other words, this theory believes that for addiction to be considered a brain disease, it must be pathological and persistent regardless of the environment. The theory posits that addiction will not persist in an environment without drugs, and other brain diseases, such as Alzheimer’s, stroke, or schizophrenia, will.8

Addiction’s Path Through the Brain

Proponents of the disease model of addiction divide it into three stages:

Stage One: Binging and Intoxication

In the first stage, the drug activates the brain’s reward circuit by causing a dramatic increase in the release of dopamine.9 This increase in dopamine induces a reward signal that “triggers associative learning or conditioning.”9 Thus, the brain begins to relate the drug experience with the reward, and eventually, reward signals are triggered merely in anticipation of drug use.9

Stage Two: Withdrawal and Negative Affect

During the second phase, withdrawal, drug users tend to experience adverse effects and increased stress. Continuously exposing the brain to dopamine-enhancing drugs causes adaptations that increase sensitivity to stress and negative emotions.9 For this reason, many drug users continue to use; to escape the negative feelings associated with withdrawal.9

Stage Three: Preoccupation and Anticipation

In the third stage of addiction, preoccupation and anticipation, the “impaired signaling of dopamine and glutamate in the prefrontal regions of the brain weaken [the] ability to resist strong urges or to follow through on decisions to stop taking the drug.”9 Thus, users will indulge, and the cycle continues with binging and intoxication.

Physical Brain Changes to Heal Addiction

Amino Acids

Neurotransmitters are brain chemicals that send information to our bodies. Neurotransmitters all produce different effects on the brain; some make us feel energized while others make us feel calm.10 When we eat proteins, they get broken down into amino acids during digestion. These amino acids help neurons in our brain to create neurotransmitters that control how we feel.11 The amino acids tyrosine and tryptophan are two amino acids that support dopamine and serotonin production that typically associate with feeling good.12

How Can an Amino Acid Infusion Help Someone Recover from Addiction?

Because substance use disorders cause an imbalance among neurotransmitters, an amino acid infusion can help create neurotransmitters, restoring the brain to its normal state faster.13, 14 One method of doing this is intravenous amino acid therapy that includes a combination of amino acids, vitamins, and minerals injected straight into the bloodstream. They travel into the brain, where they assist in creating new neurotransmitters. Clients typically complete intravenous amino acid therapy in ten days.

Neuroplasticity and Amino Acids

Neuroplasticity is the brain’s ability to restructure itself by creating new neural connections throughout our lives.15 Neuroplasticity allows the neurons/nerve cells in the brain to change in reaction to injury and disease and to adjust their activity to accommodate new situations or changes in the environment.15 Amino acids support neuroplasticity to improve brain functioning during recovery.15

Free Will and the Disease Model of Addiction

The concept of addiction has been controversial for decades. Even today, many people believe that addiction is a moral wrong that stems from one’s free will and choice in choosing to use substances.16 These individuals do not believe in addiction as a brain disease because they think it takes away the individual’s responsibility for choosing to use substances and places the responsibility on the brain.

On the other side of the argument are people who believe that addiction takes away free will and the ability to abstain from substances.17 For that reason, individuals are not to blame because their disorder takes away their ability to choose a life without substances.

Addiction Stigma

What is now understood is that the stigma around addiction and the negative connotations that arise from the judgment that society passes onto substance users is not healthy. People fall into substance abuse for multiple reasons, of which none tend to be that they “choose” to do it for fun.18

Struggles and Challenges

Individuals who turn to substance use are typically struggling in one or more aspects of their life.19 They may have suffered some form of trauma, abuse, or extreme stress and feel as though substances are the only thing that will help them feel better. Executives that get passed over for a promotion, and those trying to advance their careers may struggle with work issues. Stress from high-pressure careers is another issue high-achieving individuals struggle with.

Loss Drives Addiction

They may have suffered a loss and feel in such deep despair that their only hope is that a substance might make them feel better, even temporarily.20

Key Takeaways

  • Disease is hard to define.
  • Research and diagnostic imaging support the disease model of addiction.
  • Neurotransmitters play a large role in addiction.
  • Amino acid infusions can help create new neurotransmitters.
  • Neuroplasticity allows the brain to bypass damaged areas.
  • Amino acids help neuroplasticity.
  • Addiction still comes with stigma.
  • Addiction is not a moral failing.

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