Understanding Why We Call Addiction a “Disease”

Psychiatrists – because they are doctors – rely on categories to understand people’s problems. Every mental and emotional problem fits a medical label, from borderline personality disorder to autism to depression to addiction.

These conditions are listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders)

The idea that addiction is a type of disease or disorder has a lot of support being that addiction is a brain disease. It is a condition that changes the way the brain works, similar to how diabetes changes the way the pancreas works. Specifically, the dopamine system is altered so that only the substance of choice is capable of triggering dopamine release to the nucleus accumbens (ventral striatum), while other potential rewards do so less and less. The nucleus accumbens (NAC) is responsible for goal-directed behavior and for the motivation to pursue goals.

Different theories view dopamine differently. For some, dopamine means pleasure. The object of addiction become “sensitized,” so they greatly increase dopamine and therefore attraction…which turns to craving when the goal is not immediately available. But pretty much all the major theories agree that dopamine metabolism is seriously altered by addiction, and that’s why it counts as a disease. The brain is part of the body, after all.

The definition, “disease” is pretty accurate. It accounts for the neurobiology of addiction better than other definitions. It explains the helplessness addicts feel: they are in the grip of a disease, and so they can’t get better by themselves. It explains the incredible persistence of addiction, its proneness to relapse; and why “choice” is not the answer (or even the question), because choice is governed by motivation, which is governed by dopamine, and your dopamine system is “diseased.”

An individual with diabetes can’t recover from their disease unless they are given the proper tools of how to maintain a healthy diet, insulin and treatment to help them improve their illness. Similarly, an addict can recover from their disease with talk therapy, recovery meetings, proper nutrition and medication. Drug addiction and alcoholism are deadly if not treated.

Recovering from substance use disorders is a challenging journey that feels more doable in an environment that tends to each individual’s complex needs and strengths. Our goal is to foster a treatment experience that is built on compassion, hope, and caring, and fueled by excellence in the provision of evidence-based and trauma-informed care.

– - Anonymous