Addiction Is a Chronic Brain Disease

It's More Than Bad Behaviors or Bad Choices

Doctors with MRI Scans
Addiction Changes Brain Functions. © Getty Images

Addiction is a chronic brain disease that is more about the neurology of the brain rather than the outward manifestations of behavioral problems and poor choices, according to a group of addiction medicine professionals.

In August 2011, the American Society of Addiction Medicine (ASAM) released its new "The Definition of Addiction," which, for the first time, extended addiction to include behaviors other than problematic substance abuse.

A group of 80 addiction experts worked for four years to arrive at the new definition of addiction, and concluded that addiction is about brains -- not alcohol, drugs, sex or gambling. It's about the underlying neurology of the brain, not about outward behavior.

Addiction Alters Brain's Reward System

Addiction affects the brain's reward, motivation, memory and related circuitry to the extent that the addicted person's motivations are altered so that their addictive behaviors replace healthy, self-care behaviors.

The brain's reward system is also altered in such a way that the memory of previous rewards -- be it food, sex or drugs -- can trigger a biological and behavioral response to engage in the addictive behavior again, in spite of negative consequences, and sometimes even though the addict no longer finds pleasure in the activity.

Impulse Control Also Altered

Addiction also affects the frontal cortex of the brain in such a way as to alter impulse control and judgment.

This results in the "pathological pursuit of rewards," ASAM says, when addicts return to their addictive behavior in order to "feel normal."

The frontal cortex is involved in inhibiting impulsivity and delaying gratification. Because this area of the brain continues to develop into young adulthood, the ASAM experts believe this is why early onset exposure to substances is linked to the later development of addiction.

Characteristics of Addiction

According to the ASAM definition, addiction is characterized by:

  • Inability to consistently abstain;
  • Impairment in behavioral control;
  • Craving or increased “hunger” for drugs or rewarding experiences;
  • Diminished recognition of problems with one’s behaviors and relationships;
  • A dysfunctional emotional response.

Other Features of Addictive Behavior

These conditions are also commonly present in addicted persons:

  • External cues trigger cravings and addictive behaviors.
  • Risk of relapse even after long periods of abstinence.
  • Resistance to change despite increasing problems.

Impaired Control and Judgment Problems

ASAM says that behavioral manifestations and complications of addiction, due to impaired control, can include:

  • Engaging in more addictive behavior than the person intended.
  • Increased time lost from work or school.
  • Continued use despite physical or psychological consequences.
  • Narrowing of the addictive behavior repertoire.
  • Lack of readiness to get help, despite admitting a problem.

    Addiction Can Cause Cognitive Changes

    Cognitive changes in addiction can include:

    • Preoccupation with substance or addictive behavior.
    • Altered sense of pros and cons of addictive behaviors.
    • False belief that problems are not predictable consequences of addiction.

    Addiction Can Cause Emotional Changes

    ASAM believes emotional changes in addiction can include:

    • Increased anxiety, dysphoria and emotional pain
    • Situations seem more stressful than they really are
    • Difficulty identifying and expressing feelings.

    Why the New Definition of Addiction?

    In the past, diagnosis of addiction has focused on outward manifestations of a person's behaviors, which can be observed and confirmed by standardized questionnaires. The new definition of addiction instead focuses on what is going on inside the person, in their brain.

    The experts at ASAM hope their new definition leads to a better understanding of the disease process, which they say is biological, psychological, social and spiritual in its manifestation. Addiction can manifest itself in many behaviors beyond substance abuse.

    The Implications for Treatment

    Traditionally, people with addictions have sought and received treatment for a particular substance or behavior. This has sometimes resulted in the person substituting addictions -- what ASAM calls the "pathological pursuit of rewards" -- because the underlying cause was not treated.

    The group suggest that comprehensive addiction treatment should focus on all active and potential substances and behaviors that could be addictive. ASAM was careful to point out that the fact that addiction is a primary, chronic brain disease does not absolve addicts from taking responsibility for their behaviors.

    Just as people with heart disease or diabetes have to take personal responsibility for managing their illness, persons with addictions also must take the steps necessary to minimize their chance of relapse, ASAM said.


    American Society of Addiction Medicine. "The Definition of Addiction." 15 August 2011.

    American Society of Addiction Medicine. "Definition Of Addiction: Frequently Asked Questions (PDF)," 15 August 2011.

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