Is Addiction a Disease?
Table of Contents
Key Takeaways
- The disease model of addiction recognises addiction as a chronic disease and suggests that it is primarily caused by structural and functional changes in the brain
- Addiction alters the brain’s neurotransmitters and circuits, which can lead to development of long-term changes in the brain. These changes can alter brain functioning, impacting learning, memory and decision-making processes
- Neuroscientists supporting the disease model recognise that genetic, psychological and environmental factors feed into development of addiction. They support a multidisciplinary approach and personalised treatment plans for managing addiction and supporting recovery
- Alternative models of addiction exist, including the biopsychosocial model and models viewing addiction as a choice or coping mechanism
- The disease model acknowledges addiction as a complex and potentially relapsing disease, where relapse is seen as a signal for treatment adjustment, not a failure
- Treatment under the disease model requires an individualised approach, combining medical interventions, therapy and aftercare plans tailored to the person’s unique need.
What is The Disease Model of Addiction?
The disease model of addiction recognises addiction as a chronic illness, comparable to diabetes or asthma, rather than a lapse in willpower or moral failing.
According to this model, addiction is a brain disease, arising due to structural and functional changes in the brain. This view is supported by neuroscience and brain imaging studies which have demonstrated changes in the brain among people with addiction disorders.
The disease model reframes addiction as a medical condition, rather than a personal choice or weakness. In this view, stigma and barriers to treatment can be overcome by viewing addiction through a more compassionate and less judgemental lens.1
How Has the Disease Model Influenced Understanding of Addiction?
The disease model of addiction has significantly impacted understanding of what addiction is and how it impacts the brain. It has also aided the development of evidence-based interventions and prevention strategies. By studying the neurobiological alterations in the brain and adopting a multidisciplinary approach to treatment, addiction can be holistically understood and managed.
The disease model recognises that the brain is highly significant in the development of addiction but also acknowledges the role of other psychological, social and environmental factors. The model emphasises that addiction is influenced by a complex interplay of these factors, providing a comprehensive understanding that includes the impact of the environment and individual variability.
This holistic approach acknowledges that while addiction manifests as a brain disease, it is shaped by various external and internal influences, making it a multifaceted condition requiring integrated treatment strategies.
Future neuroscientific studies could focus on enhancing understanding of the underlying mechanisms of addiction, recovery from addiction and translation of research to real-world addiction treatment.1
Support for the Disease Model
The disease model is widely accepted in the neuroscience community.1 It also aligns with the American Society of Addiction Medicine (ASAM) definition of addiction:
“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviours that become compulsive and often continue despite harmful consequences.” 2
Furthermore, the National Institute on Drug Abuse (NIDA) recognises addiction as a:
“Chronic, relapsing disorder characterised by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control” 3
In the UK, the NHS refers to addiction as a “condition” characterised by a lack of control over actions to the point of harm. Their definition acknowledges risk factors, such as genetic, psychological and environmental factors, and identifies cravings and withdrawal symptoms as hallmarks of addiction. This definition, similar to the disease model, emphasises that addiction is a treatable condition.4
Criticisms of the Disease Model
Despite scientific evidence supporting the disease model of addiction, it has received criticism since its conception. Historically, the disease model of addiction was scrutinised by the general public, healthcare professionals and policy-makers who felt that addiction was not a treatable medical condition.
More recent criticisms of the brain disease model come from the scientific community, who argue that this view is unhelpful to people experiencing addiction and is not supported by data.
Some aspects of addiction and recovery that are cited as limited by the brain disease model include:
-
Addiction as a Chronic, Relapsing Condition
Critics of the disease model claim that study data contradicts the view of addiction as a chronic, relapsing disorder. They argue that significant proportions of people with addiction achieve remission without formal treatment.
-
Personal Responsibility
Critics argue that substance use, like all choices, is influenced by personal preferences and goals.5 They feel that the disease model could reduce individuals’ sense of responsibility for their actions, potentially hindering motivation for treatment.
-
Reductionist View
Critics contend that the disease model reduces us to a product of our brain chemistry and that this model oversimplifies what is a complicated subject.
-
Deterministic View
Similar to the reductionist view, some critics claim that the brain disease model predicts global outcomes based on neurobiology alone.
Some of the above criticisms have been refuted by neuroscientists. They contend that the disease model does not negate the importance of genetic, psychological, social and environmental risk factors. They also recognise that global prediction of outcomes is unattainable and that individual variability should be recognised and personalised treatment plans formulated for effective addiction treatment.1
Diagnosing Addiction
Addiction, like other long-term conditions, can be clinically diagnosed. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) aids diagnosis of substance use disorders (SUDs), which are characterised by impaired control, physical dependence, social issues and risky use. The term, substance use disorder, encompasses misuse of a variety of addictive substances, including illicit drugs, prescription drugs and alcohol.
Severity of SUDs ranges from mild to severe, depending on the number of symptoms experienced.6 Addiction is perceived to reflect high severity, so is typically more consistent with moderate or severe DSM-5 grading.
The International Classification of Diseases (ICD) system can also support formal diagnosis of addiction. It describes two severities of substance misuse; low (harmful use) and high (substance dependence). The more severe diagnosis, substance dependence, is closely consistent with a moderate-to-severe SUD, as diagnosed in DSM-5.1
Addiction and the Brain
The majority of misused substances influence the brain’s reward system, leading to feelings of intense pleasure or euphoria. An influx of the chemical messenger, dopamine, in the reward circuit leads to behaviour reinforcement. This can make people want to use substances repeatedly to gain pleasurable effects, sustaining addictive behaviours.7
The disease model of addiction suggests that addiction is, fundamentally, a brain disease as alterations in brain activity and function underpin addictive behaviours. Changes in brain structure and function can impair self-control and behaviour regulation, which are hallmarks of addiction.1,3
Substance use and addiction affects specific regions of the brain, principally frontal brain areas, including:
- Nucleus accumbens: Involved in the reward pathway
- Orbitofrontal cortex: Influences motivation
- Amygdala and hippocampus: Key players in memory processing
- Prefrontal cortex and cingulate gyrus: Govern cognitive functions
Each of these regions plays a pivotal role in addiction and are all activated during cravings and substance intoxication.8
The Role of Dopamine in Addiction
In understanding addiction, it is important to appreciate the role of the neurotransmitter, dopamine, in the brain’s reward system and recognise the impact of addictive substances on dopamine release.
The brain’s reward system is a dopaminergic pathway, meaning it involves the neurotransmitter, dopamine, which is a chemical messenger that transmits signals across the neural network allowing us to process and feel pleasure. Dopamine is a neurotransmitter that plays a key role in how we experience reward from various stimuli.9
Normally, the reward pathways in the brain are stimulated to produce dopamine during enjoyable activities, for example eating or socialising. This creates a feeling of pleasure, encouraging us to repeat the behaviour.
Addictive substances and behaviours such as alcohol, cocaine and gambling, can produce surges of dopamine in the brain which are much higher than what is typically released during natural rewards. This intense, overwhelming flood of dopamine creates a strong association between the substance or behaviour and pleasure, driving compulsive use despite negative consequences.10
Studies have demonstrated that the use of addictive substances can lead to rapid and significant increases in dopamine levels. However, following chronic substance use and during withdrawal, function of dopamine in the brain is profoundly reduced. This is likely related to reduced sensitivity to natural reinforcers.
Neuroadaptations and Relapse
Over time, these effects lead to a shift from intentional, goal-directed behaviour to compulsive, habitual actions that are resistant to change. This is not merely a matter of will but a reflection of profound neuroadaptations, including:
- Increased motivational salience, i.e., reward value, for the substance
- Decreased reward circuit sensitivity
- Loss of inhibitory mechanisms
- Compromised cognitive function
These changes are not just temporary; they can persist long after the substance use stops. This is why addiction is considered to be a chronic, relapsing disorder.8
Relapse refers to symptom recurrence following a period of improvement. The disease model of addiction reinforces that relapse isn’t indicative of failure, but instead, it’s a part of the illness.
Relapse rates for substance use disorders have been reported as being around 50%, which is comparable to other chronic health conditions, such as high blood pressure or asthma. Occurrence of relapse suggests that addiction treatment plans may need to be adjusted or intensified.11,12
Alternative Models of Addiction
The disease model represents one model of addiction. There are others which complement or challenge the views expressed in the disease model.
-
The Biopsychosocial Model of Addiction
This addiction model considers addiction to be influenced by an intricate interplay of biological, psychological and social factors. This model also emphasises the importance of individualised treatment plans featuring long-term access to both professional and social support to aid and sustain recovery.13
-
Addiction as a Choice
The choice model of addiction presents a counter-narrative to the disease model, citing that addiction is a matter of personal choice and voluntary behaviours. This model recognises that a biological component of addiction exists but contends that individuals have control over their substance use and, by extension, the power to decide to stop.14
-
Addiction as a Coping Mechanism
For many, addiction can serve as a coping mechanism against life events such as trauma and mental health concerns such as anxiety, stress and low mood. This psychological model of addiction views addiction as a coping strategy; an attempt to manage stress and reduce tension.15
Treating Addiction as a Brain Disease
The brain disease model of addiction highlights that while addiction can be managed, it is a chronic illness that cannot be completely cured.
Addiction is a multifaceted illness that requires a holistic treatment approach, addressing biological, psychological, social and spiritual factors. Managing addiction, much like managing other chronic diseases, requires a comprehensive and all-encompassing approach, tailored to the patient’s unique needs and circumstances.
As part of an individualised approach, the following treatments may be used:
- Medications: Medical treatments may be used to support patients during withdrawal, to reduce cravings and to manage relapse triggers
- Behavioural Therapies: Therapies such as cognitive behavioural therapy, contingency management and 12 step programmes can empower patients to modify their behaviours and develop strategies for coping with substance use triggers. These approaches can enhance the effectiveness of medical treatments and help maintain treatment compliance
- Support Groups: Groups such as Alcoholics Anonymous and Narcotics Anonymous provide a community of individuals who can share experiences, offer encouragement and provide accountability
Individualised treatment plans are essential in treating the whole person and managing the complex consequences of addiction. They are designed to address a person’s specific addiction, including any co-occurring mental health conditions (also known as dual diagnosis). By applying relevant evidence-based treatments and providing personalised care, individualised approaches can bring about improved outcomes for patients. The journey to recovery can be a long process and ongoing support is key in maintaining sobriety and preventing relapse.12
Download Our Brochure
The Addiction Treatment Programme at Castle Craig
The disease model of addiction emphasises that while addiction is considered a “no-fault” disease, it does not absolve individuals of responsibility for their recovery. Patients are encouraged to understand that they should seek help and actively engage in the recovery process.
At Castle Craig, we recognise addiction as a primary illness that takes on its own momentum over time, independent of its initial causes. This approach contrasts with models viewing addiction as merely a symptom of underlying problems.
The multidisciplinary team at Castle Craig understands that addiction is a primary, chronic brain disease that affects the body, mind and spirit. This holistic view of addiction feeds into our treatment programme, which empowers patients to manage their addiction directly, as a primary illness. We recognise that there is no one-size-fits-all approach to managing addiction and realise that addressing initial causes in isolation won’t resolve the condition.
Our treatment programme follows a biopsychosocial model, featuring a 12-Step approach and a focus on abstinence. This specialised programme provides personalised care tailored to the needs of each patient ensuring that they receive comprehensive support to manage addiction effectively.
Castle Craig Provides
- A medically-managed detoxification process at our on-site detox facility, led by a consultant psychiatrist and multidisciplinary team of clinicians
- An evidence-based and personalised 12 step treatment approach. Featuring CBT, dialectical behaviour therapy, motivational interviewing and trauma therapy as needed.
- Intensive individual therapy sessions to address the psychological aspects of addiction and manage any underlying mental health issues
- Group therapy to promote shared support and communication, reduce isolation and stigma and practice recovery-oriented coping strategies with group members
- Complementary therapies and wellness activities to help repair the mental and physical damage caused by substance use
- Family therapy to strengthen and enhance family dynamics and relationships
- A 24-week continuing care programme after you leave, to support long-term recovery
If you are struggling with addiction, or know someone who needs help, contact us today to discuss our addiction treatment programme and book a free assessment. Our admissions team can answer any questions you may have and provide helpful advice regarding next steps – Call 01721 546 263 today.
Free Confidential Addiction Assessment
Taking the first step towards seeking help can be very difficult, our team is here to help you.
-
References
- Heilig M, et al. Addiction as a brain disease revised: why it still matters, and the need for consilience. Neuropsychopharmacology. 2021;46(10): 1715–23.
- American Society of Addiction Medicine (ASAM). Definition of Addiction.
- National Institute on Drug Abuse. Drug Misuse and Addiction.
- National Health Service (NHS). Addiction: what is it?
- Heyman GM. Addiction: A Disorder of Choice. Harvard University Press; 2010.
- Hartney E, Gans S. DSM 5 Criteria for Substance Use Disorders: How substance use disorders are diagnosed.
- National Institute on Drug Abuse. Understanding Drug Use and Addiction DrugFacts.
- Volkow ND, Fowler JS, Wang GJ. The addicted human brain: insights from imaging studies. J Clin Invest. 2003;111(10): 1444–51.
- Wise RA, Robble MA. Dopamine and Addiction. Annual Review of Psychology. 2020;71: 79–106.
- National Institute on Drug Abuse. Drugs and the Brain.
- Alcohol and Drug Foundation (ADF). Relapse.
- National Institute on Drug Abuse. Treatment and Recovery.
- Wangensteen T, Hystad J. A Comprehensive Approach to Understanding Substance Use Disorder and Recovery: Former Patients’ Experiences and Reflections on the Recovery Process Four Years After Discharge from SUD Treatment. J. Psychosoc. Rehabil. Ment. Health.
- Heyman GM. Addiction and choice: theory and new data. Front. Psychiatry. 2013;4(31): 1–5.
- Sinha R. Chronic Stress, Drug Use, and Vulnerability to Addiction. Ann N Y Acad Sci. 2008;1141: 105–30. doi: 10.1196/annals.1441.030.
- Alcoholics Anonymous (AA). Who We Are.
- Narcotics Anonymous in the United Kingdom (UKNA). Welcome to UKNA.
Experts You Can Trust
With a wealth of knowledge and services to help you regain control of your life, request a call-back from one of our professionals today. The choice you make today could change your life forever.