Understanding Addiction: A Disease that Alters the Brain and Requires Treatment

Substance use disorder (SUD), formerly known as addiction, is a chronic disease characterized by the persistent use of one or more substances despite the presence of severe health and social consequences. SUD affects various regions of the brain responsible for reward, motivation, learning, judgment, and memory.

The Disease Model of Addiction:

Medical associations, including the American Medical Association and the American Society of Addiction Medicine, define addiction as a disease. Similar to conditions like diabetes, cancer, and heart disease, addiction arises from a combination of factors such as behavioral, psychological, environmental, and biological influences. Genetic factors are also a contributing risk factor to an individual developing substance use disorder. Persistent addiction can lead to the manifestation of physical and mental health issues, becoming increasingly severe, disabling, and life-threatening over time.

The Impact of Substance Use on the Brain:

The brain experiences pleasure when basic needs like hunger and thirst are satisfied. This sensation of pleasure is often triggered by the release of certain chemicals in the brain, which reinforces behaviors associated with such rewards (e.g., eating and drinking).

Substance use prompts the brain to release excessive amounts of these pleasure-inducing chemicals. Prolonged substance use alters the brain's reward and motivation systems, as well as memory functions.

To counteract the overwhelming release of reward chemicals, the brain attempts to regain balance by reducing its response to these chemicals. Consequently, individuals may require higher doses of the substance to achieve the same level of satisfaction, a phenomenon known as tolerance.

People with addiction may experience intense cravings or urges to use substances despite the presence of harmful consequences. Their substance use often strains their relationships, and may disrupt daily responsibilities at home, school, or work. Further, certain substances including heroin, fentanyl, and opioids, may lead to withdrawal symptoms. Loss of interest in regular activities, hobbies, and interests is also common.

Those in SUD recovery face an increased risk of relapse triggered by various stimuli associated with substance use. These triggers can include people, places, and objects that were connected

to substance use experiences. Part of the recovery process is learning skills to help manage those triggers associated with relapse.

Is Substance Use a Choice?

Initially, the decision to engage in substance use is largely influenced by personal choice, although genetic, cultural and environmental factors can also play a role. Certain individuals are more predisposed to developing a substance use disorder due to factors such as a family history of addiction, trauma, untreated mental health disorders, and family conflict. Once addiction progresses, individuals lose control over their substance use, signifying a shift from choice to dependence. Loss of control is a fundamental sign of addiction.

Responsibility for Actions in Addiction:

A person does not have control over how their brain and body respond to substances. This explains why some individuals can manage their use while others cannot. Those with a substance use disorder can still exert effort to reduce their use or abstain, although the difficulty is significantly greater compared to individuals without addiction. Like any other disease, individuals with addiction require access to quality, evidence-based treatment and care.

With the proper program and support, individuals struggling with a substance use disorder can enhance their chances of being, and staying, in recovery and lead fulfilling lives.