Addiction – Moral Deficit or Brain Disorder?

Why can’t people addicted to alcohol or other drugs use their will power to stop? Why do they return to destructive behaviours over and over, again and again? Aren’t they intrinsically bad? Morally flawed? Weak characters?

Albert Einstein is quoted as saying “Any fool can know. The point is to understand”

According to the American Society of Addiction Medicine (ASAM) – addiction is classified as a chronic, primary brain disease and not simply a behavioural issue. As with cardiovascular disease and diabetes, addiction is a chronic illness and must be monitored over a life time.

Addiction is clinically known as substance-use disorder (SUD) and a key feature of the illness is continued use despite the often-negative consequences.

Two important parts of our brain get hijacked once addicted;

  • Our limbic system, the primitive brain that controls survival instincts and fight or flight response and;
  • The neocortex, the modern part of our brain that is responsible for our “yes, no and maybe” responses.

In addition, the brain is manipulated into creating a new operating system.

With continued use of substances, the survival requirements change from eating, drinking, sleeping and procreating to using drugs and alcohol more and more. When these basic, instinctual survival needs are overrun by the obsession and compulsion to drink and use drugs – the brain has been HIJACKED.

The new operating system has altered the structure and function of the brain.

The DSM 5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) uses the following 11 criteria to determine Substance Use Disorders:

  • Taking the substance in larger amounts or for longer than you planned to.
  • Wanting to cut down or stop using the substance but being unable to.
  • Spending a lot of time getting, using, or recovering from use of the substance.
  • Cravings and urges to use the substance.
  • Being unable to do what you should at work, home, or school because of substance use.
  • Continuing to use, even when it causes problems in relationships.
  • Giving up important social, occupational, or recreational activities because of substance use.
  • Using substances again and again, even when it puts you in danger.
  • Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
  • Needing more of the substance to get the effect you want (tolerance).
  • Development of withdrawal symptoms, which can be relieved by taking more of the substance.

This allows clinicians to gauge whether the addiction problem is mild, moderate or severe depending on how many symptoms are identified. Two or three symptoms indicate a mild problem; four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe addiction.

It is important to understand that not everybody will become addicted to substances; factors such as age, health, family history and environment do play a part in a persons predisposition to addiction.

The symptoms of substance use disorder manifest as a physical compulsion and a mental obsession and left unchecked the illness is progressive. As the patient spirals out of control with increased use, the pieces of their lives begin to unravel. Often addicted people experience problems as their families become more aware of just how bad the problem is. Frequently addiction rehabs are contacted by family members and not the patient themselves as the patient is in denial.  LINK Addicted people’s behaviour often sounds an alarm bell for the family as they no longer care about health or hygiene and keeping a job can be difficult. The need for drugs or alcohol is all consuming. Addicted people live in an altered reality.

Imagine a mother with a newborn baby. Her brain is flooded with oxytocin and totally wired to protect, provide and care for her offspring. When a person who suffers from addiction runs out of drugs or alcohol and the resources have diminished, they will lie, cheat and steal to get what they need – it is a matter of survival.

Addiction due to its psychological and physiological nature, left untreated will result in issues within the family, the community and possibly even with the law. Addiction may lead to an untimely death if the disease is not treated.