Hey folks, the American Society of Addiction Medicine has come out with a policy statement defining "addiction".
Some
high points (pardon the pun), like them or not:
(BTW, these are not my thoughts, but from the newsletter "The Fix" / By Jennifer Matesa and Jed Bickman)
The definition, a result of a four-year process involving more than 80 leading experts in addiction and neurology, emphasizes that addiction is a primary illness—in other words, it’s not caused by mental health issues such as mood or personality disorders, putting to rest the popular notion that addictive behaviors are a form of "self-medication" to, say, ease the pain of depression or anxiety.
Addiction, the statement declares, is a “bio-psycho-socio-spiritual” illness characterized by (a) damaged decision-making (affecting learning, perception, and judgment) and by (b) persistent risk and/or recurrence of relapse; the unambiguous implications are that (a) addicts have no control over their addictive behaviors and (b) total abstinence is, for some addicts, an unrealistic goal of effective treatment.
The bad behaviors themselves are all symptoms of addiction, not the disease itself. "The state of addiction is not the same as the state of intoxication," the ASAM takes pains to point out.
The new definition leaves no doubt that all addictions—whether to alcohol, heroin or sex, say—are fundamentally the same.
Interestingly, the DSM disagrees: The new definition comes as the American Psychiatric Association (APA) is undertaking a highly publicized, decade-in-the-making revision of its own definition of addiction in its Diagnostic and Statistical Manual of Mental Disorders—the bible of the mental health profession. The APA’s DSM will have a larger effect on public health policies that guide addiction treatment, largely because insurance companies are mandated by law to use the DSM diagnostic categories and criteria to decide which treatments they will pay for.
Does this statement push the 12 steps, the mainstay of many treatment centers, programs and clinicians, toward obsolescence? After all, when a problem is declared to be a “medical” issue, doesn’t that imply that the solution should also be “medical”—as in doctors and drugs? “Both approaches have applicability,” says Dr. Marc Galanter, professor of psychiatry at New York University, founding director of its Division of Alcohol and Substance Abuse as well as director of its Fellowship Training Program in Addiction Psychiatry.
When we use alcohol or drugs, Publicker says, the chemical reward—the "high"—is many times more powerful than the natural circuitry’s reward, and the neurological system adapts to the flood of neurotransmitters. “But
because we didn’t evolve as a species with OxyContin or crack cocaine, that adaptive mechanism overshoots. So it becomes impossible to experience a normal sense of pleasure,” he continues. “Use of the substance then happens at the expense of what otherwise would promote survival. If you think about it from that standpoint, it begins to account for illness and premature death.” An active addict has a very high risk of early death via sickness or suicide.
Is it a problem that the definition is incapable of pointing to a quantifiable diagnostic marker of this illness? “I may be stating the obvious, here,” Publicker says, sighing, “but you don’t need to do brain imaging to identify an active alcoholic.”
You can read the article about the new ASAM definition here:
A Radical New Definition of Addiction Creates a Big Storm | | AlterNet
You can read the ACTUAL ASAM definition here:
The Definition of Addiction (Long Version) Adopted: April 12, 2011 Revised: