The Disease Model of Addiction

addiction brain disease model of treatment

Is Addiction a Disease?

The disease model defines addiction as a medical condition rather than a personal failure. It emphasises that addiction is not a choice or lack of willpower, but an illness that requires treatment.

The Disease Model of Addiction views addiction as a chronic, relapsing brain disease, characterised by compulsive use of mood-altering substances, despite negative consequences. Scientific research shows that drug and alcohol misuse alters dopamine neurotransmitters, causing changes to the brain’s reward systems.

This page will explain The Disease Model in more detail, as well as addiction’s impact on the brain and the most effective treatments available.

Key Takeaways

  1. The Disease Model of Addiction suggests that the brain’s circuits, particularly the reward pathways, are fundamentally responsible for addiction.
  2. Addiction alters the brain’s neurotransmitters, leading to a chronic brain disorder characterised by distorted perception and intense cravings.
  3. The Disease Model acknowledges addiction as a relapsing disease, where relapse is seen as a signal for treatment adjustment, not a failure.
  4. Treatment under this model requires an individualised approach, combining medical interventions, therapy, and aftercare plans tailored to the person’s unique needs.

What is The Disease Model of Addiction?

The Disease Model of Addiction considers addiction a chronic illness, comparable to diabetes or heart disease, rather than a lapse in willpower or moral failing.1 According to this model of addiction, you’re not at fault for succumbing to substance abuse. Rather, changes in the brain are responsible, similar to how genetic predisposition plays a role in other chronic diseases.

The Disease Model of Addiciton reflects advancements in neuroscience and brain imaging that reveal observable changes in the brain. This understanding aligns with the American Society of Addiction Medicine (ASAM) definition:

“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 behaviors that become compulsive and often continue despite harmful consequences.”2

Addiction is sometimes described differently in European healthcare settings. For instance, the NHS refers to addiction as a “condition” characterised by a lack of control over actions to the point of harm. Their definition refers to genetic, psychological and environmental factors, as well as craving and withdrawal symptoms. Despite these differences, the core concepts remain similar.

The Disease Model Reduces Stigma

The disease model reframes addiction, defining it as a medical condition rather than a personal failure. This disease concept emphasises that addiction is not a choice, but a disorder that requires treatment.

This model provides a compassionate lens through which to view addiction, allowing you to extend empathy instead of judgment to those struggling. So, as you explore the complexities of addiction, keep this model in mind. It might help you make sense of this challenging issue.

DSM-V Diagnosis of Addiction

Patients are formally diagnosed using ICD-10 or DSM V classifications, such as ‘alcohol dependence’ or severe ‘alcohol use disorder’. They learn that they meet diagnostic criteria even if their substance use is episodic or predominantly psychological. Understanding addiction as a primary illness helps patients focus on their recovery, rather than just personal and social problems.

Brain Activity and Reward Pathways

Often, the Disease Model of Addiction spotlights the critical role of brain activity and reward pathways in developing and sustaining addictive behaviours. This model suggests that addiction is, fundamentally, a brain disease because alterations in brain activity and function underpin addictive behaviours.11

Addiction typically follows a cycle with three stages:

  • Binge/Intoxication – using the substance and feeling its pleasurable effects,
  • Withdrawal/Negative Affect – feeling bad when not using the substance,
  • Preoccupation/Anticipation – craving the substance after a period of not using it.

These stages involve different brain regions: the basal ganglia (reward and habit formation), the extended amygdala (stress and withdrawal feelings), and the prefrontal cortex (decision-making and impulse control).

The Role of Neurotransmitter Dopamine in Addiction

In understanding addiction, it is important to understand the role of the neurotransmitter dopamine in the brain’s reward system and how drugs and alcohol manipulate, alter, and change the brain’s reward pathways.

The mesolimbic pathway, often referred to as the brain’s “reward pathway,” is a key component of the brain’s reward system. This pathway runs from the ventral tegmental area (VTA) of the brain to the nucleus accumbens, a region in the basal ganglia, and further extends to other areas such as the amygdala and prefrontal cortex.

It is a dopaminergic pathway, meaning it primarily 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 feel pleasure. It acts as a chemical messenger between neurons.9

Normally, these reward pathways are stimulated to produce dopamine when you do something enjoyable, for example eating, sex, socialising, shopping, listening to music we enjoy and this creates a feeling of pleasure, encouraging us to repeat the behaviour.

However, addictive substances and behaviours such as alcohol, cocaine and gambling, can cause an artifiicially high surge of dopamine in the brain, 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.3

Over time, substance use disorders alter the brain’s reward system, leading to decreased sensitivity to dopamine. This means that more of the drug or behaviour is needed to achieve the same pleasurable effect, contributing to the cycle of addiction.4

This can be seen through brain imaging which shows changes in specific brain regions. These alterations can lead to:

  • Distorted perception of reality,
  • Intense cravings for the drug or behaviour,
  • Impaired judgment and decision-making abilities,
  • Uncontrollable behaviours despite negative consequences,
  • Difficulty in experiencing pleasure from other activities.

These changes are not just temporary; they can persist long after the substance use stops. That’s why addiction is considered a chronic disorder. It’s not about a lack of willpower or moral weakness. It’s a complex interplay of genetic, environmental, and psychological factors that result in a disease of the brain. This model highlights the biological underpinnings of addiction, emphasising the need for medical and therapeutic interventions.

What Other Factors can Increase Vulnerability to Addiction?

Beyond neurobiological changes, the brain disease model of addiction recognises that genetic, environmental, and social factors significantly contribute to the likelihood of someone starting to misuse drugs and going on to develop addiction. These factors include unaddressed trauma such as sexual abuse, violence, and adverse childhood experiences, lack of social support, easy access to alcohol and drugs, as well as a family history of drug and alcohol use. Early exposure to alcohol and drugs, particularly during adolescence, is a critical period of vulnerability. Certain mental health disorders, including mood disorders, ADHD, psychoses, and anxiety disorders, also elevate the likelihood of addiction.10

Disease Model and Relapse

People affected by severe alcohol use disorder may have significant health problems as the result of long-term alcohol misuse, and so it is important to explain the chronic, progressive, relapsing and ultimately fatal nature of addiction.

Much like other chronic diseases such as diabetes or heart disease, addiction is also a relapsing disease. This means that after a period of improvement, it’s possible to see symptoms reoccur. The disease model reinforces this reality, emphasising that relapse isn’t indicative of failure, but instead, it’s a part of the illness. It’s a signal that your addiction treatment plan may need to be adjusted or intensified.5

Understanding addiction as a disease can help you understand why relapse may occur, reducing self-blame and promoting self-compassion.

How can we Treat Addiction as a Brain Disease?

Addiction is a multifaceted illness that requires a holistic treatment approach, addressing psychological, social, biological, and spiritual factors. Patients at Castle Craig learn that addiction is 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.

Managing addiction, much like managing other chronic diseases, requires a comprehensive and all-encompassing approach, tailored to the patient’s unique needs and circumstances.

When it comes to treating addiction, it’s important to remember that there’s no one-size-fits-all solution. Addiction medicine is a complex field and what works for one individual might not work for another. That’s why it’s vital to work with a multidisciplinary team of professionals who are able to assess and build an understanding of the patient’s unique situation, guidling them towards the most effective treatment options for their specific needs.

Common strategies for managing addiction as part of an integrated Rehab programme:

  1. Individualised treatment plans: These are designed to address your specific addiction, including any co-occurring mental or physical health issues.
  2. Medical interventions: Addiction medicine may include medications to manage withdrawal symptoms or reduce cravings.
  3. Therapy: Various forms of therapy are used to help patients understand their addiction and develop healthier coping mechanisms. This includes 12 Step Programmes, Cognitive Behavioural Therapy, Dialectical Behaviour Therapy and Motivational Interviewing as well as complementary therapies.
  4. Support groups: Groups such as Alcoholics Anonymous and Narcotics Anonymous provide a community of individuals who can share experiences, offer encouragement, and provide accountability.
  5. Aftercare and relapse prevention: These are essential elements of any treatment plan and can include ongoing therapy, support groups, and more.

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Dual Diagnosis Therapy and Addiction

For those struggling with other mental health conditions alongside addiction (dual diagnosis), specific interventions like Eye Movement Desensitisation and Reprocessing (EMDR) or Cognitive Behavioural Therapy (CBT) are employed. These interventions, typically delivered in a series of structured sessions, are designed to address conditions such as anxiety and trauma. Importantly, the focus of these sessions is on cognitive or memory reprocessing, and / or learning new behaviours and coping strategies rather than self-exploration or insight.

CBT is a hands-on approach that requires active participation. Through regular sessions with a therapist, you will learn to recognise the triggers that contribute to addiction. You will also develop effective coping strategies to counter these triggers, reducing your reliance on drugs or alcohol.6

12 Step Treatment and the Disease Model of Addiction

The brain disease model of addiction highlights that while addiction can be managed, it is a chronic illness that cannot be completely cured.

In 12 Step rehab programmes or fellowship groups participants become familiar with terms from Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) literature, such as “alcoholism,” “addiction,” “sickness,” “illness,”. Recognising addiction as a primary illness allows patients to concentrate on treating their addiction directly.

The 12 Step model of treatment guides individuals through the recovery process and fosters individual maturity and spiritual growth by encouraging those in recovery to help others. These 12 Steps include admitting powerlessness over substances, conducting a moral inventory, acknowledging past wrongs, creating a list of people harmed, and making amends to them.

Support Groups

Turning to support groups, such as Alcoholics Anonymous and Narcotics Anonymous, provides a safe space where you can share experiences, gain insights, and draw strength from others who are battling addiction.7

In these groups, you will find:

  • A sense of community, where everyone understands the struggle of substance dependence,
  • Shared experiences and coping strategies can be very enlightening,
  • A non-judgmental environment that encourages harm reduction over perfection,
  • Opportunities to celebrate progress, no matter how small, fostering hope and positivity,
  • A network of friends who genuinely understand what you are going through.

Individualised Addiction Treatment Programmes

Individualised treatment plans offer numerous benefits, particularly in addressing substance use disorders. These plans provide personalised care by tailoring treatment to the specific circumstances of each patient, ensuring that all aspects of their physical, mental, and emotional well-being are addressed.

By considering factors such as the type of substance, duration of use, and co-existing medical or psychological conditions, individualised plans apply the most effective therapies, interventions and medical treatments, leading to better outcomes.8

addiction brain disease model of treatment

Is it Possible to Cure Addiction?

Addiction is chronic, progressive, and potentially fatal. Thus, a lifelong recovery program based on abstinence is crucial. Those who maintain abstinence and recovery for two years are considered in stable remission. As with other chronic diseases such as diabetes or hypertension, addiction cannot be completely “cured” in the traditional sense. Instead, it can be effectively managed through a lifestyle of abstinence from mood-altering substances.

Critiques of the brain disease model of addiction

Despite scientific evidence to support the brain disease model, there are arguments that point out its limitations when confronted with the everyday realities of addiction. Some aspects of addiction and recovery that are cited as limited by the brain disease model include:

Personal Responsibility: Critics, such as Gene Heyman, argue that drug use, like all choices, is influenced by preferences and goals.12 Others believe that the disease model may reduce individuals’ sense of responsibility for their actions, potentially hindering motivation for treatment.

Addiction as a Coping Mechanism: Some experts view addiction not as a medical condition, but as a coping mechanism for trauma or mental health issues. People may use drugs to escape emotional distress such as grief, anxiety, and depression. Dr. Gabor Mate13 suggests that early childhood experiences, including trauma and adversity, affect brain development, making individuals more vulnerable to addiction. This perspective implies that treating addiction should focus on healing underlying issues, thus eliminating the need for drug use. Recognising the role of trauma, many rehab centres, including Castle Craig, incorporate trauma-informed practices and therapies such as EMDR.

Reductionist View: Critics have said that the disease model reduces us to a product of our brain chemistry and that this model oversimplifies what is a complicated subject, overlooking the significant role of environmental, social, and cultural influences in addiction recovery.

However, viewing addiction as merely a symptom can lead to rationalisations for continued substance use and increase the risk of relapse. Recognising addiction as a primary illness helps patients concentrate their efforts on overcoming the addiction itself, leading to more effective and sustained recovery.

Integrating Psychosocial Factors in the Brain Disease Model

Contrary to the criticisms, research supports the brain disease model by demonstrating how it incorporates environmental and individual differences in the development of addiction. This model does not disregard psychosocial factors; instead, it explains how these elements contribute to addiction as a brain disease. The model emphasises that addiction is influenced by a complex interplay of biological, psychological, and social 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.

How has the Brain Disease Model Influenced Understanding of Addiction?

The brain disease model of addiction has significantly influenced our understanding of what addiction is and how it impacts the brain. By studying the neurobiological alterations in the brain, researchers have been able to develop innovative intervention and prevention strategies, which also help in reducing stigma. Ongoing advancements in neuroscience are expected to yield new and more effective approaches to tackling substance use disorders.

Understanding and Treating Addiction as a Primary Illness

At Castle Craig, we understand that addiction is a primary, chronic brain disease that affects the body, mind and spirit. Our treatment programme follows what is known as a ‘biopsychosocial’ model, with 12 Step model as the main pillar and a focus on abstinence. Our treatment is comprehensive and person-centrered addiction treatment programme.

The Addiction Treatment Programme at Castle Craig

At Castle Craig, a crucial concept patients learn is that addiction is a primary illness. While various factors may contribute to the onset of addiction, over time, addiction develops its own momentum and becomes an independent condition. This means addressing the initial causes alone won’t resolve the addiction. This perspective differs from therapeutic and social models that often view addiction as a symptom of underlying issues.

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 must make the decision to seek help and actively engage in the recovery process. Continuous abstinence and active recovery over a period of two years are indicators that a patient is in stable remission from addiction.

This specialised programme provides personalised care tailored to the needs of each patient ensuring that they receive the support necessary to combat the disease of addiction effectively.

At Castle Craig we provide the following:

If you are struggling with addiction, or know someone who needs help, contact us today to discuss our addiction treatment programme and book a pre-admission assessment. Our admissions team can answer any questions you have about treatment at Castle Craig, and advise you on the next steps.

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