“There is no war on drugs. You can’t war on inanimate objects. What there is, is a war on drug addicts” – Dr. Gabor MateAddiction is a disease. That statement does not fit with what most of society understands a disease to be. Society tends to have a view of addiction as a choice and one that stems from ‘moral failure’. Medical researchers are looking at neurobiological links to explain addiction, specifically in the deep brain structures of the basolateral amygdala which has a role in affective, motivational behaviour.
So what is the cause of addiction? According to Dr Gabor Mate, the major contributing factor is childhood trauma, which leads to stress later in life and addictive behaviour.
OK, so what is a ‘dis-ease’? The medical dictionary defines disease as: a noun, “A pathological condition of a body part, an organ, or a system resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.” The Wikipedia entry notes that it is often described, “more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories.”
According to research published in a Canadian Medical Association Journal article from February 2012, society should – “If we are to succeed in treating addiction as a disease — which it is […] acknowledge and overcome our negative attitudes so that we can help patients with addiction and guide how the public perceives them.”
Society does indeed have negative, disparaging attitudes towards those that are addicted, which allows medical professionals, police etc. to hold the same attitudes. For instance this comment came from a June 6th Globe & Mail article about Vancouver’s supervised injection sites, the reader of the article wrote that, “I am in favour of closing the clinics, I see no plausible reason for the taxpayer to foot the bill for someones drug habit. If their lives are at stake it is there [sic] choice, thew [sic] same as the fools that use tobacco. I understand the risk of sexual transmission may be down at bit with the clinics but perhaps the public should be more selective about the sex partners.” Here we can clearly see the view the reader has towards the addicted – as one of choice, blame and arguably hatred.
The conservative government’s position is expressed as, ““Our government believes that creating a location for sanctioned use of drugs obtained from illicit sources has the potential for great harm in the community,” Ms. Agglukaq said in a statement. “Accordingly, we believe that the application process needs to be changed to create formal opportunities for local voices to be heard and their views considered before an exemption would be granted.”” The government position is a political one that reflects, and perpetrates the wider views of a society which views addiction as the fault of the addicted, which according to the research evidence, is like blaming the rape victim for being raped, or faulting an abused child for being abused.
Evidence seems to indicate that childhood trauma actually alters the way the young brain develops that leaves one more susceptible to behaviour that leads to addiction and dependence. From that viewpoint addiction is rooted in psychosocial events whereas the new DSM-5, (Diagnostic and Statistical Manual of Mental Disorders), views addiction as a biological brain disease, taking the focus away from the psychosocial aspects of addiction.
The director of the American National Institute on Drug Abuse Dr. Nora Volkow believes that, “The better we all understand addiction (whether it’s to drugs or alcohol) for what it is — a brain disease — the more able we will be to prevent and/or intervene in the progression of the brain disease of addiction.” Some would argue that such an approach is treating the symptoms and not the disease but that, it seems, is the best society can do. The new DSM-5 combines abuse and dependence into one category. And gambling disorder and tobacco use disorder were added as mental disorders. ‘Craving or a strong desire or urge to use a substance’ was added in place of ‘recurrent legal problems’ as one criteria for addiction. The DSM manual is published by the American Psychiatric Association, it claims to cover all (officially recognized), mental health disorders for both children and adults.
Addiction is a form of a ‘maladaptive’ coping mechanism for stress relief.
Recent concepts of addiction to drugs (e.g. alcohol) and non-drugs (e.g. gambling) have suggested that these behaviors are the result of an imbalance between three separate, but interacting, neural systems: an impulsive, largely amygdala–striatum dependent neural system, which promotes automatic, habitual and salient behaviors; a reflective, mainly prefrontal cortex dependent, neural system for decision-making, forecasting the future consequences of a behavior, and inhibitory control; and the insula that integrates interoception states into conscious feelings and into decision-making processes that are involved in uncertain risk and reward. These systems account for poor decision-making (i.e. prioritizing short-term consequences of a decisional option) leading to more elevated addiction risk and relapse. Here the research focus is on the biological aspects of addiction as a brain disease regardless of how it came about, which is arguably the best way forward.
The ‘advanced’ scientific thought is to identify the addictive circuits and look for ways to sever the connections that are involved in drug-seeking or addictive behaviour. A 2007 study from the Department of Experimental Psychology at the University of Cambridge in the UK noted that “by using an intrastriatal disconnection procedure that combined a selective, unilateral lesion of the nucleus accumbens core, […] We show that this disconnection selectively decreased drug-seeking behavior in rats extensively trained under a second-order schedule of cocaine reinforcement.
To turn the meaning of Pink Floyd’s Brain Damage on its head, (pun intended), “You raise the blade, you make the change You re-arrange me ’till I’m sane.”
Although brain surgery for psychiatric disorders is beginning to gain some momentum as a treatment option, as found in a Quebec study reported in the Journal of Neurology for OCD. Currently science is some ways away from psychosurgery for addiction by ‘raising the blade’ – for now, the circuits are being ‘cut’ with the use of psychotherapy and – drugs. Methadone, buprenorphine are used for opiate addiction, and naltrexone is used for alcohol and opiate addiction.