Is Addiction Really a Disease?

Is addiction really a disease or a matter of choice? Ask the mother who lost her 19-year-old son — the laughing family prankster who earned a full-ride college scholarship as a solid student and star second baseman — to drugs.

The moody, angry dropout who survived overdoses to get caught breaking into cars wasn't the boy she raised. What she knew, like the families and friends of the more than 15,000 Hoosiers who've died due to overdose since 1999, is that addiction's not a life anyone would choose.

Most medical professionals agree. The American Medical Association (AMA) classified alcoholism as a disease in 1956 and included addiction as a disease in 1987.

In 2011 the American Society of Addiction Medicine (ASAM) joined the AMA, defining addiction as a chronic brain disorder, not a behavior problem, or just the result of making bad choices.

Research and input from top addiction authorities, addiction medicine doctors, neuroscientists and experts from the National Institute on Drug Abuse agree in classifying addiction as a disease. Like other chronic diseases such as diabetes and heart disease, experts are still learning about how and why the disease develops. This blog post will help you understand addiction and how IU Health addiction treatment can help those struggling.

What is addiction?

Alcohol or drug addiction, also known as substance use disorder, is a chronic disease of the brain that can happen to anyone. Severe substance use disorder happens when substance use becomes an uncontrollable habit that hurts your day-to-day life, showing up as struggles at work or in school, conflicts with relationships, legal or money problems.

Addiction changes the brain

Addiction changes the way the brain works, rewiring its structure. Drugs and alcohol hack into your brain's communication system and interfere with how nerve cells send, receive and process information.

The brain’s reward system activates when we do something we like—eating a piece of our favorite pie, hanging out with friends, or going for a run, for instance. That reward comes in the chemical dopamine. Drugs or alcohol trigger the release of dopamine.

Addiction causes the brain to ask for more

Dopamine makes us feel good and want to keep doing what we're doing. It also teaches the brain to repeat the behavior. Cues trigger the reward system, fuel cravings and create a habit loop. The smell of pie baking can make you salivate in anticipation of the taste. Addiction fuels habits too—craving a cigarette every morning with coffee or wanting a hit when you drive past the house where you used to do drugs.

When you take a drug, your brain releases a flood of dopamine, much more than it would when you're eating your favorite pie. Your brain overreacts and cuts back on dopamine production to bring it down to a normal level.

As you continue to use drugs, your body produces less dopamine. Things that brought you pleasure—that pie, friends, and even drugs—don't anymore. Once you're addicted, it takes more and more drugs just to feel normal.

An addicted brain impacts behavior

Research has shown how addiction changes the areas of the brain in charge of judgment, decision making, learning and memory, and controlling behavior. Those changes can lead to a good student flunking out, a wife lying about draining the family savings account or an overdose in a grocery parking lot, with kids watching from their car seats.

Once substance use changes the brain, willpower changes too. If you try to quit using substances, your brain tries to protect you from the pain and intensity of withdrawal symptoms. Addiction fuels your brain's response to do whatever it takes to stop the cravings and discomfort. That can mean overruling the will to "just say no" by taking a drink or using a drug.

Addiction is a disease with complex risk factors

Addiction doesn't discriminate. High-rent districts, "seedy" neighborhoods, age, race, sex or income—addiction weaves its way through all walks of life. No one thing can predict your risk of developing a substance use disorder. But researchers agree there are a combination of factors involved that can increase your risk.

Risk factors for drug or alcohol addiction:

• Genetics—Yes, if addiction runs in the family, the National Institute on Drug Addiction says you have up to a 60% greater risk of becoming addicted too.
• Environment—Just like growing up in a home where fried foods, soda and sugary sweets increase your risk for heart disease and diabetes, growing up in a home with adults who use drugs increases the risk of addiction.
• Development—Using drugs as a teenager up to age 25 when the brain is still developing increases your chances of addiction and can cause serious, lasting damage.

Addiction is a chronic disease

A disease is a condition that changes the way an organ functions. Chronic disease can be treated and managed, but it can't be cured. Addiction is a chronic disease of the brain the way diabetes is a chronic disease of the pancreas, and heart disease is one of the heart.

Getting treatment for addiction is a choice

Everyone makes a choice about using drugs or taking a drink for the first time. You don't have a choice about how your brain reacts, however. Willpower and shaming won't undo the changes in the brain and cure addiction. There is no cure, but treatment helps you manage and successfully live with the disease.

Just as someone with diabetes or heart disease has to choose to exercise and change to a healthy diet to control their disease, someone with addiction has to choose treatment. A court order or family's ultimatum may be behind that choice. But often, someone chooses on their own, wanting a life without addiction and the problems that come with it more than the drugs.

Scientists don't know why some people can successfully quit using drugs on their own, and others can't. For most people, recovery takes intervention with things like Indiana inpatient substance abuse treatment, behavioral therapy, and medications to help control cravings and encourage the brain to adapt to functioning without drugs.

Addiction relapses are a reality, but not failure

Getting sober is hard. Staying on track is too. That's the nature of living with a chronic disease. Success takes managing the changes in the brain and learning how to change deeply rooted behaviors. And then the toughest part for many: committing to managing new behaviors for the rest of your life.

Sometimes it's too much. Relapses happen, often many times. They're not a treatment failure, but a cue to get back on track. That can mean making adjustments with or changing treatment.

Find hope and help for drug addiction in Indiana

Addiction is treatable and it is never too early or too late to ask for help. There are Indiana opioid treatment programs, inpatient or outpatient alcohol rehab, and many other options throughout Indiana, like several IU Health locations, including Indianapolis, Bloomington and Muncie.

How to find addiction help in Indiana

• Call 211 for help 24 hours a day, 7 days a week, or connect with help online.
• Visit the Indiana Addiction Treatment website for resources in Indiana.
• Learn more about Addiction Treatment services available at IU Health.

Outpatient drug and alcohol treatment at IU Health

IU Health provides full-service drug and alcohol treatment designed for the individual. We offer virtual and in-person visits for substance abuse treatment. Options include withdrawal and detox, ongoing treatments such as medications and therapy, and intensive outpatient programs. In some locations, crisis appointments are available. Find an IU Health addiction treatment and recovery center near you.