A Matter of Addiction: Brain Disease or Moral Failing
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A Matter of Addiction: Brain Disease or Moral Failing
- 1. A Matter of Addiction: Brain Disease or Moral Failing Shirley Gedney-Rubel Southern New Hampshire University
- 2. A Matter of Addiction: Brain Disease or Moral Failing •Addiction is a serious public health issue •Addiction affects personal functioning in many areas
- 3. What is the Cost of Addiction? Figure 1. National Institute on DrugAbuse, 2008.
- 4. What is Addiction? • Addiction is a primary chronic disease of brain reward • Characteristics: Compulsive using and cravings with periods of recovery often followed by relapse • Addiction is progressive and may result in disability or premature death American Society of Addiction Medicine, 2015.
- 6. MoralTheories of Addiction • Proposes that addiction is a personal choice • Individuals lack willpower and moral principles • Emphasizes punishment over rehabilitation Capuzzi & Stauffer, 2012.
- 7. MoralTheories of Addiction • Heyman (2013) posits the brain disease model is not upheld by research, stressing behavior and choice in addiction disorders • Statistics show a low prevalence of addiction after the age of 30 • Therefore, most addicts quit because of cost/benefit analysis, without professional intervention • Dismisses the possibility of early mortality with little evidence
- 9. BiologicalTheories of Addiction •Genetic Models: Addiction is an inherited predisposition •Neurobiological Models: Substance use causes changes in brain structure and neurochemistry that lead to addiction Capuzzi & Stauffer, 2012.
- 10. BiologicalTheories of Addiction • There are many biopsychological theories of addiction • Commonalities include adaptations of neural pathways, changes in neurochemistry, craving, and relapse • Of particular interest is the reward pathway and the neurotransmitter dopamine Skinner & Aubin, 2010.
- 11. A Matter of Addiction: Brain Disease or Moral Failing • The moral model fails to account for physical symptoms • Brain imaging shows changes in structure and function • Empirical studies support a biological basis for addiction National Institute on DrugAbuse, 2012.
- 12. References • American Society of Addiction Medicine (ASAM). (2015). Definition of addiction. [Web]. Retrieved Feb. 1, 2015, from http://goo.gl/YXD01 • Capuzzi, D., & Stauffer, M. (2012). Foundations of addictions counseling (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc. • Heyman, G. M. (2013). Addiction and choice:Theory and new data. Frontiers in Psychiatry, 4. doi: 10.3389/psyt.2013.00031 • National Institute on Drug Abuse. (2012). Addiction science. [Web]. Retrieved Feb. 1, 2015, from http://goo.gl/HjBnY0 • National Institute on Drug Abuse. (2012). Drug abuse costs the United States economy hundreds of billions of dollars in increased health care costs, crime, and lost productivity (Chart). [Web]. Retrieved Feb. 1, 2015, from http://goo.gl/VTJnu9 • Skinner, M.D., & Aubin, H.-J. (2010). Craving’s place in addiction theory: Contributions of the major models. Neuroscience and Biobehavioral Review, 34, 606-623. doi:10.1016/j.neubiorev.2009.11.024
Editor's Notes
- Addiction is a serious public health issue affecting all segments of society; it burdens the social services, health care, and legal systems and damages families and communities. Addiction affects an individual’s functioning on many levels: Psychological, biological, economic, and social.
- From the NIDA website: “The total costs of drug abuse and addiction due to use of tobacco, alcohol and illegal drugs are estimated at $559 billion a year. Illicit drug use alone accounts for $181 billion in health care, productivity loss, crime, incarceration and drug enforcement.” These estimates are based on statistics from 2004.
- The American Society of Addiction Medicine defines Addiction as a “primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. “Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.” The etiology of addiction has spawned many theories. The moral model and the biological model are examined.
- The moral theory is based on judgments of right and wrong, believing there is no biological basis for addiction. Addiction is the result of personal choice and individuals are able to make alternative choices; the fact they do not is evidence of poor self-control and moral deficiency. The moral model is generally endorsed by religious groups which stresses repentance and the criminal justice system where the emphasis is on punishment. Addiction etiology is a consequence of sinfulness, laziness, and low character. Symptoms of craving and withdrawal are viewed as “excuses” for relapse.
- Heyman discusses the roles of behavior and choice in addiction disorders, asserting that the brain disease model is not upheld by research or logic. Based on statistics showing a low prevalence of addiction after the age of 30, the author concludes most addicts quit because of cost/benefit analysis, without professional intervention, and dismisses the possibility of early mortality (e.g., ODs, fatal infections, other drug-related deaths) with little supporting evidence.
- Statistical associations between genetic factors and alcohol abuse are significant. Twin studies support adopted children show correlation with their birth parents’ alcohol use. Children whose parents have alcohol use disorder are 7 times more likely to be addicted themselves. Geneticists speculate a metabolic defect may interact with environmental factors to induce alcoholism. While no single gene has been identified, research continues. Examination of neurobiological models has been enhanced by advance in brain imaging technology. MRI, CT scan and other imaging procedures have enabled scientists to visualize the brain and begin to identify areas that are affected by substance use.
- There are a number of biopsychological theories Common to most theories are adaptations of the neural pathways and changes in neurochemistry. Substance use alters cognition and behavior resulting in impaired decision-making. Craving is a common symptom of addiction. Many individuals in recovery are vulnerable to relapse long after withdrawal symptoms have resolved; relapse may occur months or years after recovery has begun. The reward pathway is a specific area of the brain associated with the neurotransmitter dopamine. Dopamine is closely associated with feelings of pleasure, satisfaction, and motivation. Some substances inhibit dopamine reuptake, flooding the reward pathway. After some time has passed, the euphoric feeling fades and some individuals become fixated on recreating it, and addictive behaviors become evident. Progressive substance use leads to tolerance and increased dosages. Eventually, some individuals report a lack of euphoria upon substance use, yet they experience craving and impulsive/compulsive behaviors that drive them to use.
- The moral model fails to account for cravings and vulnerability to relapse long after symptoms of withdrawal have resolved. Brain imaging shows adaptations in the neural substrate, neurocircuitry, and dopaminergic function correlating with addictive behaviors. While it is likely addiction is caused by a combination of genetics, environment, social pressures, and cultural influences, the biological model will likely produce the most effective treatments. Empirical studies support a biological basis for addiction. The National Institute on Drug Abuse includes “disease” in its definition and there is an abundance of literature to support this conclusion.