For decades, one of the most common misconceptions about drug and alcohol addiction is that it is caused by personality flaws; specifically, lack of willpower or moral weakness. Citing a growing body of scientific evidence, in 2011, the American Society of Addiction Medicine released its new “The Definition of Addiction,” which, for the first time, extended addiction to include behaviors other than problematic substance abuse.
The new definition was the product of four years of work by a group of 80 addiction experts who concluded that addiction is caused by neurology, not personality flaws.
Last year, three leading experts on addiction provided further clarification with a paper explaining how substance use affects the brain in the same way as similar diseases.
In an article published in the New England Journal of Medicine, National Institute on Drug Abuse Director Dr. Nora Volkow, NIAAA Director Dr. George Koob, and Treatment Research Institute founder Dr. A Thomas McLellan say they hope to reaffirm the brain disease model while simultaneously addressing common misconceptions about addiction.
“The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility that frame drug use as a voluntary, hedonistic act,” the authors write.
The authors argue that public skepticism about the brain disease model comes from researchers’ inability to articulately describe the relationship between changes in neurobiology and the behaviors associated with addiction. Although countless scientific studies have proven the brain disease model to be accurate and effective, the authors admit more work may be needed to change public perception.
“A more comprehensive understanding of the brain disease model of addiction may help to moderate some of the moral judgment attached to addictive behaviors and foster more scientific and public health–oriented approaches to prevention and treatment,” the authors write.
Still, the disease model does not remove individuals’ responsibility for their actions. While acknowledging the neurological causes of addiction – and addiction’s effects on the brain – treatment providers still need to emphasize the importance of each individual’s responsibility for his or her recovery.
“The messaging has to be sort of finessed,” says Bob Rohret, executive director of the Minnesota Association of Resources for Recovery and Chemical Health (MARRCH). “You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.”
Rohret says treatment providers need to educate those in recovery about the nature of their disease, while also making sure knowledge of that disease doesn’t become a crutch or an excuse for inaction.
When presented correctly, Rohret says patients should understand their addiction and responsibility toward it in much the same way someone with heart disease may understand their affliction. Although they cannot change the biological makeup of their body immediately, they can make behavioral changes and take actions that lead to better outcomes.
The scientific proof that brain chemistry can be altered by addiction can provide a needed explanation as to why people who want to get clean can still relapse.
“When you start to apply an explanation of why certain behaviors occur,” Rohret says, “it provides people some comfort in understanding why they’re doing what they’re doing.”