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Addiction Update

Health professionals consider addiction a brain disease, more specifically a disorder of the reward center. Personality and social circumstances greatly influence the experience of substance use and other addictive behavior. These factors contribute to the widely held theory that addiction is a bio-psycho-social disorder in etiology, expression, treatment, and recovery. In August 2011, the American Society of Addiction Medicine (ASAM) advanced a definition of addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Currently clinicians use the DSM-IV-TR to diagnose substance abuse and substance dependence, pathological gambling, and related disorders. The proposed DSM-V, scheduled for release in 2013, does not differentiate between substance abuse and dependence but suggests a continuum for substance use disorders using the number of criteria to determine moderate to severe problems. Craving has been added as a diagnostic criterion for substance use disorders. Pathological gambling has been reclassified from an impulse-control disorder in the DSM-IV-TR to the category Addiction and Related Disorders in the DSM-V. The proposed DSM-V, especially the idea of a diagnostic continuum, supports well the idea of recovery as a process.

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