Labeling drug addiction a choice is intellectually dishonest

By Dr. Michael Brant-Zawadzki

Categories: Neurosciences
In recent mainstream articles, addiction has been portrayed as a habit or a choice, instead of what it truly is – namely, a chronic, treatable brain disease.

This misconception is both wrong and dangerous, and it flies in the face of neuroscience, which has shown addiction to be rooted in the brain's chemical imbalance and altered circuitry in afflicted individuals. The habit is merely a symptom. Once that is recognized, it leads to the success that we in the medical community see daily in our patients' battle against addiction.

The understanding of drug addiction as a disease of the brain has been well-documented by the medical research community for more than a decade. Just as too much sugar can lead to a breakdown of the pancreas and the development of diabetes, the abuse of drugs is predisposed to by the brain's underlying makeup, and in a vicious cycle, substance abuse fundamentally changes the brain's structure and functioning, leading to the disease of addiction.

Powerful brain-imaging techniques repeatedly show us evidence of structural and metabolic changes in specific areas of the brains of addicts, documenting how drugs profoundly change brain function.

As an example, recent Magnetic Resonance Imaging studies have found that even after a year of abstaining from drugs, women who had been addicted to cocaine, amphetamines or methamphetamines, had significantly lower gray matter activity in widespread brain regions of the brain compared to women who did not abuse drugs.

Compounding the problem is the fact that repeated abuse of drugs and alcohol can affect a person's self-control and ability to make good decisions, all the while sending intense impulses to the brain to take more drugs. This interplay between chemistry and behavior makes it very challenging for a person who is addicted to stop abusing drugs — and it is why medical intervention is so essential.

Similar to other chronic, relapsing diseases, such as diabetes, drug addiction can be successfully managed and overcome with the combination of behavioral therapy and proven medical interventions. At Hoag, we take this approach so seriously that we have aligned our Addiction Treatment Centers, including our new residential "rehab" — SolMar Recovery, with Hoag Neurosciences Institute.

This is why we now have the only hospital-linked residential recovery facility in the region, though we are not alone in our understanding that the medical disease of addiction requires a medical solution.

For decades, studies have found that a comprehensive approach to addiction works. Integrating medical interventions, including medical detox, with longer-term cognitive behavioral medicine, medical therapy to address co-existing mental health conditions (often self-medicated with substance abuse) and family involvement has led to successful recovery and sobriety for thousands of people.

As with other chronic diseases, it is not uncommon for a person to relapse and begin abusing drugs again. Relapse is not an indication of failure in drug addiction any more than a spike in blood sugar is a failure of the diabetic. What it means is that active treatment should be reinstated, adjusted, or augmented to help the individual regain control and recover.

Defining addiction as a habit, bad behavior, or a choice could potentially divert patients from access to the comprehensive medical treatment that they need and deserve. It is intellectually dishonest, may in fact be counter-productive, and it does a disservice to patients and their families, people who are seeking real, evidenced-based treatment to reclaim their lives from the clutches of this very real and very powerful brain disease.

Dr. Michael Brant-Zawadzki is executive medical director Hoag Neurosciences Institute and the Ron and Sandi Simon Endowed chairman.