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LESSON 5.7 WORKBOOK
Is addiction a chronic disease?
DEFINITIONS OF TERMS
Addiction is a disease – idea
that states drug addiction is
no different from other chronic
diseases, like diabetes and heart
disease, and thus needs to be
treated as a distinct medical
disorder.
For a complete list of defined
terms, see the Glossary.
In this last lesson, we will explore the idea of addiction as a
chronic disease.
Drug Addiction as a disease
Throughout much of the last century, scientists studying drug abuse labored in the shadows of powerful
myths and misconceptions about the nature of addiction. When scientists began studying addiction in the
1930s, people addicted to drugs were thought to be morally flawed and lacking in willpower. Those views
shaped society’s responses to drug abuse, treating it as a moral failing rather than a health problem, which
led to an emphasis of punitive rather than preventative and therapeutic actions. Today, thanks to science,
our views and responses to drug abuse have changed dramatically. Groundbreaking discoveries about
the brain have revolutionized our understanding of drug addiction, enabling use to develop more effective
responses to the problem.
As a result of scientific research, we know that addiction is a disease that affects both the brain
and behavior (Figure 25). We have identified
many of the biological and environmental factors, and are beginning to search for the genetic
variations that contribute to the development and
progression of the disease. Using this knowledge,
scientists are developing more effective prevention and treatment options that reduce the toll drug
addiction takes on individuals, families and communities.
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Lesson 5.7
Figure 25: Addiction is a disease. PET scans
comparing decreased metabolism in diseased
brain and diseased heart. Just as a heart attack
causes decreased metabolism in the heart,
addiction causes decreased metabolism in the
brain.
Why would the myths and misconceptions
about drug addiction in the 1930s hinder research on and treatment of drug addiction?
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Why is drug addiction considered a disease?
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LESSON READING
Can addiction be treated?
Yes. Addiction is a treatable disease. Discoveries in the science of addiction have led to advances in drug
abuse treatment that help people stop abusing drugs and resume their productive lives. Like other chronic
diseases, addiction can be managed successfully. Treatment enables people to counteract addiction’s
powerful disruptive effects on the brain and behavior and regain control of their lives.
Figure 26: Comparison of relapse rates.
Relapse rates for drug-addicted patients
compared with those suffering from diabetes,
hypertension and asthma. Relapse is a common and similar across these illness (as is
adherence to medication). Thus, drug addiction should be treated like any other chronic
illness, with relapse serving as a trigger for
reinstated or adjusted treatment.
Relapse does not mean treatment has failed. The
chronic nature of addiction means that relapsing back
to drug abuse is not only possible, but likely. Relapse
rates for drug addiction are similar to those for other
well-characterized chronic medical illnesses, such as
diabetes, hypertension, and asthma, which also have
physiological and behavioral components (Figure
26). Treatment of chronic diseases involves changing
deeply embedded behaviors, and relapse does not
mean treatment failed. For the addicted patient, lapses
back to drug abuse indicate that treatment needs to
be reinstated or adjusted, or that alternative treatment
is needed – and again, not that treatment has failed.
Research shows that combining treatment medication, where available, with behavioral therapy is the
best way to ensure success for most patients. Treatment approaches must be tailored to address each
patient’s drug abuse patterns and drug-related medical, psychiatric and social problems.
How can medications help treat drug addiction?
Different types of medications may be useful at different stages of treatment to help a patient stop abusing
drugs, stay in treatment, and avoid relapse (Figure
27).
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Lesson 5.7
Figure 27: Medications used to treat drug addiction. With scientific research, we’ve been
able to develop a variety of medications to
aid in the treatment of addiction.
When patients first stop abusing drugs, they can experience a variety of physical and emotional symptoms, including depression, anxiety, and other mood
disorders, restlessness, and sleeplessness. Certain
treatment medications are designed to reduce these
symptoms, which makes it easier to stop abuse.
How can drug addiction be treated?
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How can medications be used to help treat
drug addiction?
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LESSON READING
Some treatment medications are used to help the brain gradually adapt to the absence of the abused
drug – for example nicotine patches or gum in the case of cigarette smokers, or methadone in the case
of heroin addicts. These medications act slowly to stave off drug cravings, and have a calming effect on
body systems. They can help patients focus on counseling and other psychotherapies related to their drug
treatment.
Science has taught us that stress, cues linked to drug experience (for example – people, places, things,
moods), and exposure to drugs are the most common triggers for relapse. Medications are being developed to interfere with these triggers to help patients sustain recovery.
How do behavioral treatments help drug addiction?
Behavioral treatments help engage people in drug abuse treatment (Figure 28). Behavioral treatments
aim to modify attitudes and behaviors related to drug abuse. They also focus on increasing life skills to
handle stressful circumstances and combat environmental cues that may trigger intense drug cravings
and prompt another cycle of compulsive abuse. Moreover, behavioral therapies can enhance the effectiveness of medications and help people remain in treatment longer.
How do the best treatment programs help patients recover?
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Lesson 5.7
Getting an addicted person to stop abusing drugs is just one part of a long and complex recovery process.
When people enter treatment, addiction has often taken over their lives. The compulsion to get drugs, take
drugs, and experience the effects of drugs has dominated their every waking moment, and drug abuse has
taken the place of all the things they used to enjoy doing. It has disrupted how they function in their family
lives, at work and in the community, and has made them more likely to suffer from other serious illnesses.
Because addiction can affect
so many aspects of a person’s
life, treatment must address the
needs of the whole person to be
successful. This is why the best
programs incorporate a variety
of rehabilitation services into
their comprehensive treatment
regimens. Treatment counselors
select from a “menu” of services
for meeting the individual medical, psychological, social, vocational, and legal needs of their
patients to foster their recovery
from addiction.
Figure 28: Variety of behavioral therapies. A variety of behavioral therapies aim to help drug addicted patients beat their
addictions.
How do behavioral treatments help to treat
drug addiction?
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LESSON READING
Summary
Research has shown that addiction is a disease that affects brain structure and impacts behavior. Many of
the biological and environmental factors that contribute to addiction have been identified, and the search
has begun to identify the underlying genetic variations that predispose and contribute to its development
and progression.
Addiction occurs when the activity of the reward pathway is disturbed. The reward pathway is composed
of the connections between the ventral tegmental area (VTA) and the nucleus accumbens (NAc). Drugs of
abuse act on this pathway in various ways to increase dopamine neurotransmission across this synapse.
Dopamine neurotransmission can lead to transient effects on the postsynaptic cell membrane, but also effects gene transcription. Effects on gene transcription result in longer acting effects on neuronal structure,
including building more synapses on the post-synaptic cell. Finally, addiction is considered a chronic disease because it causes long term changes in the brain, it is characterized by the compulsive, non-voluntary
use of drugs, and people are never completely cured of their addictions.
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STUDENT RESPONSES
Pretend you are an advisor to a government agency that needs to decide whether or not insurance companies should be
required to cover treatment for addiction. Write an opinion piece to help the agency make the right choice.
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Remember to identify your
sources
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