Addiction, clinically referred to as a substance use disorder, is a complex disease of the brain and body that involves compulsive use of one or more substances despite serious health and social consequences. It disrupts regions of the brain that are responsible for reward, motivation, learning, judgement, and memory.
What is a Disease?
Simply put, a disease is a medical condition that prevents the body from functioning normally. Diseases such as type one diabetes, lupus, rheumatoid arthritis, and other chronic conditions have effects that affect individuals on some level for their entire lives. Similarly, addiction can have long-term effects on all areas of living.
Many diseases are considered incurable, but people do experience “remission” and alleviation of disease symptoms. Substance use disorder follows this pattern. Individuals who have experienced a substance use disorder will always be at risk of relapse and may share the predilection for substance misuse with their children. Just like any other disease, addiction requires ongoing care or “check-ups” to prevent relapse.
The Disease Model of Addiction
The science behind addiction has come a long way in the past 20 years along with the growing prevalence of substance use disorders around the world. Many people still want to believe that substance use disorders only affect the weak-willed. They see it as a character flaw instead of an actual disease.
However, when looking more closely at the science explaining the way substance misuse affects the human brain, it’s undeniable that it acts and affects people in the same way as many other diseases. It is important to understand this while participating in recovery. This is why addiction is defined as a disease by most medical organisations, including the Canadian Medical Association.
Like diabetes, cancer and heart disease, addiction is caused by a combination of behavioural, psychological, environmental, and biological factors. Genetic risk factors account for about half of the likelihood that an individual will develop addiction.
The consequences of untreated addiction often include other physical and mental health disorders that require medical attention. If left untreated over time, addiction becomes more severe, disabling, and life-threatening.
Most professional organisations call addiction a disorder or a disease because:
- Addiction changes how the brain responds in situations involving rewards, stress, and self-control.
- These changes are long-term and can persist well after the person has stopped using drugs.
Comparing substance addiction to heart disease may help illustrate why it is defined as a disease by so many:
- Both addiction and heart disease disturb the regular functioning of an organ in the body – the heart for heart disease and the brain for addiction.
- They both can lead to a decreased quality of life and increased risk of premature death.
- Addiction and many types of heart disease are largely preventable by engaging in a healthy lifestyle.
- They are both treatable to prevent further damage.
How Addiction the Disease Alters the Brain
People feel pleasure when basic needs such as hunger, thirst, and sex are satisfied. In most cases, these feelings of pleasure are caused by the release of certain chemicals in the brain, which reinforce these life-sustaining functions by incentivizing the individual to repeat the behaviours that produce those rewarding feelings. Examples of such activities include eating, drinking, and procreating. Most addictive substances cause the brain to release high levels of these same chemicals that are associated with natural pleasure or reward.
Over time, continued release of these chemicals causes changes in the brain systems involved in reward, motivation, and memory. The brain tries to get back to a balanced state by minimising its reaction to those rewarding chemicals, or by releasing stress hormones. As a result, a person may need to use increasing amounts of the substance just to feel closer to normal. The individual may experience intense desires or cravings for the substance and will continue to use it despite harmful or dangerous consequences.
The person may also prefer the substance to other healthy pleasures and may lose interest in normal life activities. In the most chronic form of the disease, a severe substance use disorder can cause a person to stop caring about their own or others’ well-being or survival.
These changes in the brain can remain for a long time, even after the person stops using substances. It is believed that these changes may leave those with addiction vulnerable to physical and environmental cues that they associate with substance use, also known as triggers, which can increase their risk of relapse.
Why Willpower is Not Enough
The initial and early decisions to use substances are based in large part on a person’s free or conscious choice, often influenced by their culture and environment. Certain factors, such as a family history of addiction, trauma, or inadequately treated mental health disorders such as depression and anxiety, may make some people more susceptible to substance use disorders than others. Once the brain has been changed by addiction, that choice or willpower becomes impaired. Perhaps the most defining symptom of addiction is a loss of control over substance use. Once the brain has been affected, you will need addiction treatment.
People do not choose how their brain and body respond to substances, which is why people with addiction cannot control their use while others can. People with addiction can still stop using substances — it’s just much harder than it is for someone who has not become addicted. People with addiction should not be blamed for having a disease, but rather be able to get quality, evidence-based care to address it.
With the help and support of family, friends, and peers to stay in addiction treatment, people with addictions can increase their chances of recovery and survival.
Is Addiction a Chronic Disease?
A chronic disease is a long-lasting condition that can be controlled but not cured.
Most people who engage in substance use do not develop addiction. And many people who do so to a problematic extent, such as young people during their high school or college years, tend to reduce their use once they take on more adult responsibilities. Still, about 25-50% of people with a substance use problem develop a severe, chronic disorder. For them, addiction is a progressive, relapsing disease that requires intensive treatments and continuing aftercare, monitoring, and family or peer support to manage their recovery.
The good news is that even the most severe, chronic form of the disease can be managed, usually with long-term addiction treatment and continued monitoring and support for recovery.
Why Some Say Addiction is Not a Disease
Some people think addiction cannot be a disease because it is caused by the individual’s choice to use substances. While the first use (or early-stage use) may be by choice, once the brain has been changed by drug use, most experts believe that the person loses control of their behaviour.
Choice does not determine whether something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, and sun exposure. A disease is what happens in the body as a result of those factors.
While no one forced an addicted person to begin misusing a substance, it’s hard to imagine that someone would willingly ruin their health, relationships, and other major areas of their lives. Surely, if overcoming addiction were as easy as simply choosing to stop, the problem of addiction would be much easier to address, and relapse would not be as common.
Proponents of this way of thinking put much more emphasis on the social and environmental factors of addiction—one proponent claims that addictions may be “cured” by locking addicts in a cell where there is no access to substances—instead of on the brain changes that occur as a result of substance abuse.
Some schools of thought view treatment for addiction as little more than the individual making the decision to stop using.
Others argue that addiction is not a disease because some people with addiction get better without treatment. People with the most serious form of addiction usually need intensive addiction treatment, followed by lifelong management of the disease.
However, a few people with milder addiction may stop drinking or using other substances without treatment. Others achieve recovery by attending self-help meetings such as Alcoholics Anonymous (AA) without receiving much, if any, professional treatment. Regardless of severity, professional treatment and a range of recovery supports should be available and accessible to anybody who develops a substance use disorder.
Addiction is a treatable disease.
Addiction Treatment Options
If you or your loved ones are abusing alcohol or other drugs, it is never too early or too late to ask for help. Professional treatment for addiction is an effective way to address both your physical and psychological dependence. These programs don’t view the people who ask for help as “addicts” but as individuals struggling with a chronic disease affecting every aspect of their lives.
At the earliest stages of addiction treatment, a professional will conduct a thorough assessment to identify your current status, symptoms, and the most appropriate course of action to manage your recovery. Based on the information gathered during this assessment, you will be referred to a level of addiction treatment that best fits your condition.
At the outset of addiction treatment, many people require a period of professional detoxification to allow the body to readjust to the lack of the drug (withdrawal) while under supervision. Professional detox is a necessary first step in treatment for many people getting sober, because quitting certain substances will bring about a range of distressing withdrawal symptoms that may venture into life-threatening territory.
During medical detox, medications may be used to manage withdrawal. Where medication is not required, the emphasis is on support and encouragement in a safe environment.
The treatments that follow detox can occur in inpatient or outpatient settings:
- Inpatient treatment is any addiction treatment requiring the individual to live at the facility while receiving services. Inpatient programs are often housed in hospitals or standalone treatment centres and vary in duration, with longer inpatient treatment often referred to as residential treatment. Inpatient treatment programs offer more intense services for people with greater symptoms and a lack of healthy support at home.
- Outpatient addiction treatments permit the individual to attend sessions during the day and sleep in their own bed at night. Outpatient is usually a better fit for people with less severe addictions and/or strong social networks. Outpatient treatments may continue for years, and levels of care include:
- Partial hospitalisation programs (PHPs): the highest level of outpatient, that includes many hours of services each day for at least five days per week.
- Intensive outpatient programs (IOPs): slightly less intensive than PHPs, IOPs provide between six and nine hours of treatment each week.
- Standard outpatient: the least time intensive outlet for outpatient care, offering hour-long sessions weekly.
For many, addiction treatment is a lifelong process with ongoing professional treatment and aftercare options to maintain recovery. Since longer periods of treatment are linked to longer periods of recovery, staying in treatment for an adequate amount of time (as recommended by your treatment staff), engaging in aftercare, and participating in recovery groups can be extremely beneficial.
Whether you think addiction is a disease or not, everyone can agree that addiction is a serious problem that adversely affects the lives of the people using substances as well as their loved ones. The suffering that comes along with addiction can be immense, but treatment offers a ray of hope for the future.
At Addiction Rehab Toronto, we will provide you with a treatment program tailored to your unique needs and circumstances, and a safe place for recovery.