Today, I want to talk about what alcohol and drug addiction really is — a chronic medical disease of the brain. I believe if we treat the disease as such, long term success rates will greatly improve, in most cases.

One of the positive trends that is helping increase acceptance of a medical approach to alcohol and drug addiction is the growing awareness that substance dependence is not a moral failure, but rather a chronic medical disease with similarities to other chronic medical diseases such as diabetes, hypertension, and asthma. It was only within the last 20 years that researchers began to realize substance dependence is a brain disease – a medical condition with a neurobiological basis that causes lasting changes in the brain — changes that don’t go away, sometimes for months or years, even after recovering patients stop.  Alcohol and drug use can cause changes in the brain’s structure and functioning.  For example, the brain’s communication system is impacted by drug use, interfering with the way nerve cells send, receive, and process information. Other areas in the brain impacted by drug use include:

• Cortex — the outer area of the brain, which contains the most highly evolved cells, where abstract thinking and higher cognitive processes occur, allowing us to think, learn, and understand.
• Limbic Region — the brain’s reward circuit that links together different brain structures that control and regulate our ability to feel pleasure. The limbic system is activated when we perform activities that help us feel pleasure — and also by drugs of abuse. The limbic system is also responsible for other emotions which explains the mood-altering properties of many drugs.
• Hippocampus — an area adjacent to the limbic region where many long-term memory cells reside, all of which are “plugged in” to the limbic region’s emotional circuits. 

The result is an altered brain that’s learned to do the wrong thing, over and over again.* Unfortunately, brain changes related to drug use and addiction are not a “quick come, quick go” (an acute disease).  Like diabetes, asthma, and other chronic diseases, addiction is a chronic disease. Your diabetes is not cured simply because you’re taking your medicine and watching your diet; it may be managed, but it’s still present. It’s the same with the disease of addiction; it can be managed successfully but it is a chronic disease.

Because addiction is a chronic disease, relapse is not only possible, for the majority (40 to 60 percent) it is very likely to happen. This does not mean treatment has failed, it means, as with other chronic diseases, that treatment needs to be readjusted to understand the physiological and behavioral factors that contributed to the relapse. If we look at the relapse rates for other chronic disease such as diabetes (30 to 50 percent), asthma (50 to 70 percent), and hypertension (50 to 70 percent), we see similar rates of relapse. 

There are no quick fixes for any chronic illness including addiction, which is why patients deserve sympathy and support, even when they relapse. We don’t condemn a diabetic for having a sugary dessert or forgetting to take his or her medicine; we don’t revile the person with hypertension who gains weight instead of losing it. Instead, we sympathize with and try to understand what caused them to to slip up despite having a chronic illness and we encourage them to take their medicines regularly and stick to a health-enhancing eating and exercise plan. We understand, in spite of the health consequences, people with chronic diseases such as diabetes, asthma, and elevated blood pressure often do neglect to follow their doctors’ orders. Less than 50 percent of patients with these diseases take their medicines as prescribed, and less than 30 percent comply with lifestyle changes recommended by their doctors, according to the Institute of Medicine Study of Chronic Diseases.  Why should we treat those with substance abuse addictions differently?

The good news about all of this is that once we understand this extremely important information and treat alcohol or drug addiction like a chronic disease, then patients can start to have long term, successful recovery.

Another key component to addiction treatment is the anti-addiction medications designed to rebalance the brain’s biochemistry.  I will be talking more about these anti-addiction medications in future posts on this blog. These medications help correct imbalances in dopamine and other essential neurotransmitters and accelerate healing of the physical damage in both the limbic region and the cortex. Once this damage has been repaired, a person with addictions will find it much easier to learn, remember, and focus on the cognitive and behavioral changes used in talking therapy and achieve longer-lasting sobriety.

But let me be perfectly clear about one thing: I’m not saying that the new medicines are a magical cure or that we can forget the other treatments. Talking therapies (including the 12-step programs) are still essential to the recovery process, as are mastering new coping skills and making permanent lifestyle modifications. Insulin alone isn’t the solution for a diabetic, who must also learn how to eat a healthful diet, exercise regularly, remain slim, check his feet for cuts and sores that may become infected, and otherwise adhere to a good-health program. Neither are the new medications a simple solution to addiction. Successful addiction treatment requires a comprehensive approach, just like any other chronic medical disease. I will discuss more of this comprehensive approach in my next post. Thanks for reading.

*Some material from this post is excerpted from my book Healing the Addicted Brain.

It’s difficult to imagine the agony will ever end.  From the insidious disease and raging teen hormones to the ancient tradition of the younger generation happily torturing their parents, living with a teenage substance abuser feels like a roller coaster ride without a seat harness.

So some good news. If you haven’t joined the witness protection program, rest assured that aging (no, not your aging) impacts the disease.

Something happens as teen addicts get older; they find a little wisdom. Don’t get carried away, not a lot of wisdom. Just enough to see that perhaps this lifestyle isn’t especially productive. As friends land in jail or on slabs in the morgue, a remarkable process of self-awareness develops.

Maybe this isn’t as much fun as it used to be. Duh.

They also want material things. A job they can be proud of, building their often low self-esteem. College, which requires occasional lucidity. Or a decent mate who doesn’t share their joy of getting high. And they want to grow up. Maybe that originally scared them into seeking sanctuary inside a bottle or a joint.

Encourage this maturation process whenever you can. Having spent years serving as their personal cop suspecting their every move (with good reason), that’s difficult, I know. But if they’re changing, you must, too. If you remain mired in how they once were without showing some flexibility on what they may become, both of you will be trapped in the ugly past.

By giving your kids increased responsibilities, you’re showing faith in their decision- making as young adults. If they succeed, they’re the ones who’ve triumphed, not you.

Now it’s still a disease, not a choice. But within the disease is the choice to get sober. Doesn’t mean it’ll be smooth. Relapses are part of the process. If they can prove to themselves that they can handle the temptations of a more relaxed curfew, the responsibility of a job, perhaps they can handle the responsibility of confronting their addiction and saying Yes, I am getting sober. And staying sober.

When you suspect your child is in trouble, one of the most difficult challenges is figuring out how to approach him or her.  Beyond dealing with their particular substance abuse, the big question is how to get them engaged and encouraged to accept treatment. 

Our first attempt at approaching my stepdaughter Katherine did not go well.  As a young adult, access to private information through the school was denied, while friends and acquaintances were never honest with us.  Our only recourse was to invade her personal space at home. 

We read through papers she left around, checked the trunk of her car and found ourselves investigating our own child.  This is not a pleasant undertaking but much needed. 

To this day, I firmly believe Katherine wanted to be helped as she left, in plain sight, writings regarding her usage as well as the failing school notice.  It was then that we decided to tell her that we were no longer paying for her college tuition. 

With this devastating information she left our home for her mother’s in Hawaii.  Ultimately, life in Hawaii took her further downward. 

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