Is Drug Addiction a Brain Disease?
This popular claim lacks evidence and leads to poor policy.
The notion that drug addiction is a brain disease has become axiomatic. Around the globe aspiring health professionals treating substance abuse are indoctrinated with this belief, especially after the idea became popular in the 1990s. Its popularity extends far beyond the hallowed halls of academia. Both the May 1997 Time and the September 2017 National Geographic magazines were dedicated to the brain science of addiction. Numerous other popular magazines have run similar cover stories over the past two decades.
But after 20 years of research, one of us (Hart) saw that paradigm yielding dismal results. Meanwhile, behavioral research on outcomes after providing both animals and humans with attractive alternatives to drugs has yielded positive results regarding effective treatments, despite the lack of mainstream attention.
Despite this seemingly solid scientific consensus, there are virtually no data in humans indicating that addiction is a disease of the brain in the way that, for instance, Huntington’s or Parkinson’s are diseases of the brain. The existing paradigm is based on intuition and political necessity, not on data and useful clinical results. Yet the diseased-brain perspective has outsized influence on research funding and direction, as well as on how drug use and addiction are viewed around the globe. This situation contributes to unrealistic, costly, and harmful drug policies: If the problem is a person’s neurobiological state after exposure to a drug, then either the drug must be eradicated from society through law enforcement or an individual’s brain must be treated. In such a myopic approach, the socioeconomic and societal factors that contribute to drug addiction are considered a footnote in research, clinical practices, and policy, despite their apparent importance. (see also DRR: Dealing With Addiction)
Alcoholics Anonymous and other 12‐step programs for alcohol use disorder - Cochrane Systematic Review 2020
Manualized AA/TSF interventions usually produced higher rates of continuous abstinence than the other established treatments investigated. Non‐manualized AA/TSF performed as well as other established treatments
Implications for practice: The evidence suggests that compared to other well‐established treatments, clinical linkage using well‐articulated Twelve‐Step Facilitation (TSF) manualized interventions intended to increase Alcoholics Anonymous (AA) participation during and following alcohol use disorder (AUD) treatment probably will lead to enhanced abstinence outcomes over the next few months and for up to three years. Findings also indicate AA/TSF may perform as well as other clinical interventions for drinking intensity outcomes; however, these results are based largely on low certainty evidence and so should be regarded with caution.
Economic analyses suggest probable substantial healthcare cost savings can be obtained when treatment programs proactively and systematically link people with AUD to AA using TSF strategies, such as those used in the studies included in this review. The analyses indicate that the reason for this benefit is due to the ability of the AA/TSF to increase AA participation, and thereby increase abstinence rates. Thus, a relatively brief clinical intervention (AA/TSF) can help people with AUD to become engaged in a long‐term, freely available, community‐based, recovery support resource that can help them sustain ongoing remission.
If people with AUD are opposed to attending AA, despite the strong evidence for its potential to aid recovery, clinicians might consider linkage to alternative mutual‐help organizations as they may confer benefits at similar levels of engagement. Alternatives might also be considered when a patient has made a sustained effort to engage AA, but not derived sufficient benefit from it.
There’s no such thing as a “functioning alcoholic” (or any other addict!)
But maintaining this difference between a functioning addict and a regular addict can be harmful to a person who truly struggles with a substance addiction. The term can act as a barrier to someone deciding to get help. If my drinking or drug use isn’t causing too much harm, and if we’re all casually joking about it, is it really that big of a problem?
The “functioning addict” idea can indeed fuel a lot of delusion. I used to convince myself opiates were performance enhancing for me to the extent I would look down judgmentally on colleagues who drank alcohol at lunch—“Don’t they consider the impact that will have on their work!?” Meanwhile, I’d just been taking heroin in the toilet.
A substance may be functional at first in the sense that it helps you cope. But the addiction is papering over the problem, which is growing and growing all the while. That’s partly why it can be so terrifying to quit—you are confronted with all the problems you tried to escape in the first place, many magnitudes greater by now, with your self-esteem in tatters. From this stems the belief “I can’t cope without it.”
Finally, all aspects of my life spiraled out of control. My performance plummeted, and progressive dysfunction set in…. Sometimes people cling to a romanticized idea of the functioning addict, the creative genius, etc. But the reality is most people’s output slides in quantity and quality as their addiction progresses.
An addict may be “functioning,” but at what cost? What cost to their physical and mental well-being, to their social and professional life, to the well-being of their family?
Prevalence and pathways of recovery from drug and alcohol problems in the United States population: Implications for practice, research, and policy
Conclusions: Tens of millions of Americans have successfully resolved an AOD problem using a variety of traditional and non-traditional means. Findings suggest a need for a broadening of the menu of self-change and community-based options that can facilitate and support long-term AOD problem resolution.
Breaking Free Companion Recovery App:
The app has been designed specifically to tie in with the Breaking Free Online treatment and recovery programme. Its main focus is on strengthening peoples recovery and resilience from drug and alcohol difficulties by using mobile technology to bring psychological techniques into real world settings.
To download the android version of the app click here or visit the Google Play Store and search for “Breaking Free Companion” app.
12 Step Program: An Overview
12 step programs continue to be the most successful vehicles for helping people get and stay substance free.
A great starting place for the help you need can be found here