Addiction is a brain disease

Alcoholism, chemical dependency or drug addiction are all terms for the same illness. It has many different manifestations. What many see as voluntary actions by the affected individual are actually the result of a compulsion to use or drink that is embedded in a psycho-social context. The behavior that is actually seen is the son that continues to drink despite mounting legal and financial consequences or the wife that shops doctors for her pain pills despite being seen to be sleepy and unsteady on her feet in the middle of the day with unremitting claims of pain. On the inside, these decisions to use or drink represent involuntary acts to continue to supply the drug to the brain and a persistent search for ever fleeting periods of euphoria or to simply prevent painful withdrawal. The actual drinking or using appears to be a voluntary act but it actually is an involuntary act that represents an overwhelming compulsion to use or drink as the result of dramatic changes in the reward center of the brain known as the meso-limbic system.

The amount of time required to develop these changes may be weeks to years depending on the drug and whether, yet to be precisely identified, pre-existing genetic abnormalities exist. Family history is an important risk factor. If an individual has one parent with a history of alcoholism that person’s risk of developing alcoholism or drug addiction is more than doubled. If both parents were affected the risk is more than tripled. Nonetheless, many addict/alcoholic individuals have no immediate family with alcoholism/addiction.

One feature of the disease of addiction is that of denial. Denial is a term that indicates the affected person’s refusal to admit he/she has an abnormal relationship with a drug/alcohol despite overwhelming evidence that ongoing use is causing multiple problems (legal,financial,medical,relationships). The presence or severity of the illness is not self-evident to the affected individual. Despite our best efforts to convince that son or mother that that he or she is dependent or addicted, they cannot see the damage that is being done and explain these major problems away with excuses that do not hold water.

Many people have never in their life experienced what appears to be a self-induced problem they could not handle on their own. They cannot accept that they got themselves in to this medical problem that they are unable to get themselves out of without help. One of the first steps to recovery of the affected individual is that of admitting that one does not have the power to control or stop their use of the drug/alcohol. Such surrender is perceived by the alcoholic/ addict as shameful or a sign of personal weakness leading some to delay reaching out for treatment for years while jobs are lost, marriages dissipated and perhaps even incarceration.

The good news is that there is effective treatment for this illness that can return the affected individual to healthy function. Medications are available to improve the patient’s chances of recovery.

This month, be aware that alcohol/drug addiction is an illness and not a moral weakness or a bad habit. It is a real illness that requires real treatment.



Dr. Shaw is a member of the  Association of American Indian Physicians and the Medical Director of Citizen Potawatomi Health Services.