Here's another one about the addiction declaration
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Here's another one about the addiction declaration
In 1956, the American Medical Association declared alcoholism a "disease." More than half a century later, the American Society of Addiction Medicine (ASAM) has proclaimed addiction, including alcoholism and "process" addictions like gambling, to be the same.
According to the ASAM's definition, published on the group's website on Monday, addiction is a "primary, chronic disease of brain reward, motivation, memory and related circuitry." This clarification, which was based on consultations with more than 80 experts, is aimed in part at de-stigmatizing addictive disorders.
That's an admirable goal. The scientific evidence shows that addiction is rooted in distinct brain changes, just like other mental illnesses such as depression (though in both instances, the same changes are not found in all people with the conditions). The research does clearly show that evidence-based treatment is far more effective at resolving drug abuse problems than law enforcement efforts like incarceration. There's no justification for treating people with addiction any differently than other patients.
MORE: Q&A: The Author of Unwasted Talks About Socializing Sober
But if you want to reduce stigma, calling something a brain disease may not be the best way to go. Studies that have looked at this question have found that labeling a disorder as "neurobiological" tends to have either no effect on stigma or actually increases it.
For example, a 2010 study published in the American Journal of Psychiatry examined the levels of stigma associated with alcohol dependence, schizophrenia and major depression. In 1996 and again in 2006, researchers surveyed 630 participants about their views on alcoholism. While the percentage of people who said they believed alcoholism was a brain disorder increased from 38% to 47%, that shift was not linked with a decrease in stigma. In fact, over the same time period, the percentage of people who said they thought alcoholism was linked with "bad character" also increased significantly, from 49% to 65%.
Similarly, psychologist Steven Hayes of the University of Nevada found that people's implicit associations with the word "disease" were as negative as those linked with "drunk" or "intoxicated." The problem may be that people think of "brain diseases" as fixed and unchangeable; they may also view people whose brains are damaged as potentially dangerously out of control. Genetic explanations of mental illness, which are similarly associated with the perception that the condition is permanent, have also been linked with increased stigma.
The inclusion of the word "chronic" in the ASAM definition doesn't help here. Although addiction is indeed chronic in some cases, this is not always the case. Research shows that the majority of people who receive a diagnosis of addiction or alcoholism actually recover without treatment or participation in self-help groups. In a 2005 study involving 4,442 people with alcoholism who were not in treatment, researchers found that one year after their initial interview, a full 75% had improved to the point where they were no longer considered to be actively alcoholic.
MORE: The Pain of Addiction
Eighteen percent had quit drinking entirely, while another 18% had become low-risk drinkers; 12% were drinking at levels that were considered asymptomatic but potentially risky, and another 27% had cut down but not entirely eliminated their drinking problem. Only a quarter of the sample had gotten any type of outside help, including 12-step meetings.
Longer term studies of multiple types of addiction show similar trends: far more people meet the criteria for addiction in their youth and later recover than ever attend self-help groups or get treatment. Many simply "age out" of the problem and never look back.
Another problem with the ASAM definition is its description of the disorder's "characteristic bio-psycho-socio-spiritual manifestations." Addiction clearly involves problems with neurobiology, psychology and social connections, similar to other mental illnesses. But spirituality?
According to ASAM, the "spiritual" manifestations of addiction include "distortions in the connection with ... the transcendent (referred to as God by many, the Higher Power by 12-steps groups, or higher consciousness by others)."
MORE: Defining Recovery in Anorexia — and Addiction
When trying to convince doctors and the general public that a condition is a genuine disease, I would argue that it's probably best to leave God out of it. Definitions of cancer, diabetes, depression and schizophrenia manage just fine without intruding on territory better left to priests, rabbis, imams, ministers and the like.
Like depression, addiction is a real medical disorder that affects the brain. But if we want to reduce the stigma associated with it, emphasizing recovery and resilience is probably more useful than focusing on definitions of brain disease.
To increase the use of effective and non-stigmatizing care, let's stick to the empirical evidence, not the ineffable.
Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.
Read more: Why the New Definition of Addiction, as “Brain Disease,” Falls Short – TIME Healthland
According to the ASAM's definition, published on the group's website on Monday, addiction is a "primary, chronic disease of brain reward, motivation, memory and related circuitry." This clarification, which was based on consultations with more than 80 experts, is aimed in part at de-stigmatizing addictive disorders.
That's an admirable goal. The scientific evidence shows that addiction is rooted in distinct brain changes, just like other mental illnesses such as depression (though in both instances, the same changes are not found in all people with the conditions). The research does clearly show that evidence-based treatment is far more effective at resolving drug abuse problems than law enforcement efforts like incarceration. There's no justification for treating people with addiction any differently than other patients.
MORE: Q&A: The Author of Unwasted Talks About Socializing Sober
But if you want to reduce stigma, calling something a brain disease may not be the best way to go. Studies that have looked at this question have found that labeling a disorder as "neurobiological" tends to have either no effect on stigma or actually increases it.
For example, a 2010 study published in the American Journal of Psychiatry examined the levels of stigma associated with alcohol dependence, schizophrenia and major depression. In 1996 and again in 2006, researchers surveyed 630 participants about their views on alcoholism. While the percentage of people who said they believed alcoholism was a brain disorder increased from 38% to 47%, that shift was not linked with a decrease in stigma. In fact, over the same time period, the percentage of people who said they thought alcoholism was linked with "bad character" also increased significantly, from 49% to 65%.
Similarly, psychologist Steven Hayes of the University of Nevada found that people's implicit associations with the word "disease" were as negative as those linked with "drunk" or "intoxicated." The problem may be that people think of "brain diseases" as fixed and unchangeable; they may also view people whose brains are damaged as potentially dangerously out of control. Genetic explanations of mental illness, which are similarly associated with the perception that the condition is permanent, have also been linked with increased stigma.
The inclusion of the word "chronic" in the ASAM definition doesn't help here. Although addiction is indeed chronic in some cases, this is not always the case. Research shows that the majority of people who receive a diagnosis of addiction or alcoholism actually recover without treatment or participation in self-help groups. In a 2005 study involving 4,442 people with alcoholism who were not in treatment, researchers found that one year after their initial interview, a full 75% had improved to the point where they were no longer considered to be actively alcoholic.
MORE: The Pain of Addiction
Eighteen percent had quit drinking entirely, while another 18% had become low-risk drinkers; 12% were drinking at levels that were considered asymptomatic but potentially risky, and another 27% had cut down but not entirely eliminated their drinking problem. Only a quarter of the sample had gotten any type of outside help, including 12-step meetings.
Longer term studies of multiple types of addiction show similar trends: far more people meet the criteria for addiction in their youth and later recover than ever attend self-help groups or get treatment. Many simply "age out" of the problem and never look back.
Another problem with the ASAM definition is its description of the disorder's "characteristic bio-psycho-socio-spiritual manifestations." Addiction clearly involves problems with neurobiology, psychology and social connections, similar to other mental illnesses. But spirituality?
According to ASAM, the "spiritual" manifestations of addiction include "distortions in the connection with ... the transcendent (referred to as God by many, the Higher Power by 12-steps groups, or higher consciousness by others)."
MORE: Defining Recovery in Anorexia — and Addiction
When trying to convince doctors and the general public that a condition is a genuine disease, I would argue that it's probably best to leave God out of it. Definitions of cancer, diabetes, depression and schizophrenia manage just fine without intruding on territory better left to priests, rabbis, imams, ministers and the like.
Like depression, addiction is a real medical disorder that affects the brain. But if we want to reduce the stigma associated with it, emphasizing recovery and resilience is probably more useful than focusing on definitions of brain disease.
To increase the use of effective and non-stigmatizing care, let's stick to the empirical evidence, not the ineffable.
Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.
Read more: Why the New Definition of Addiction, as “Brain Disease,” Falls Short – TIME Healthland
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Alcoholism is complex. It's important to remember, diagnoses have their place, but we are more than the label. I have lived with labels all my life, seen many doctors who have tried to put me in a box, write me off as a mental health case. I'm grateful now to have a doctor who wanted to listen to me and get to know me as a human being, at our first session she glanced over my referral, then looked me in the eye and wanted to hear my side of it.
The last time I went into treatment, I fully accepted that I had a problem, but wanted to get on with the solution. I didn't really care anymore if my alcoholism was nature/nurture/a bit of both, I didn't care anymore about other people's stereotypes. I just knew it was going to destroy me if I allowed it, everything else seemed a bit semantic. My ultimate focus had to be recovery.
I read up on what I had to so that I could understand what was happening, during my recovery, though I don't enter into this debate much. I needed a sense of hope early in recovery, that is what I try to provide here as well, and to be recovery oriented.
The last time I went into treatment, I fully accepted that I had a problem, but wanted to get on with the solution. I didn't really care anymore if my alcoholism was nature/nurture/a bit of both, I didn't care anymore about other people's stereotypes. I just knew it was going to destroy me if I allowed it, everything else seemed a bit semantic. My ultimate focus had to be recovery.
I read up on what I had to so that I could understand what was happening, during my recovery, though I don't enter into this debate much. I needed a sense of hope early in recovery, that is what I try to provide here as well, and to be recovery oriented.
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Myself, I like to go to the source material...
Definition of Addiction
Adopted by the ASAM Board of Directors on April 12, 2011
ASAM Public Policy Statement: Definition of Addiction (Short Version)
ASAM Public Policy Statement: Definition of Addiction (Long Version)
ASAM Definition of Addiction: Frequently Asked Questions
Definition of Addiction
Adopted by the ASAM Board of Directors on April 12, 2011
ASAM Public Policy Statement: Definition of Addiction (Short Version)
ASAM Public Policy Statement: Definition of Addiction (Long Version)
ASAM Definition of Addiction: Frequently Asked Questions
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Where are their studies? Where is the data? What is their methodology? I'm having a hard time finding something substantial to review. If anyone has any links to some actual studies, please do post. I'm interested in reading up on this.
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Originally Posted by Bamboozle 
I'm having a hard time finding something substantial to review.
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Originally Posted by AVRT
ASAM is still primarily an advocacy and lobbying group.
What I would like to see are all the studies they're going off of so that I can read for myself rather than relying on what they say.
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Many members, I would dare say that most members, of the ASAM are recovered alcoholics/addicts themselves... Every professional at the treatment center I was at was ASAM certified, or was training to be, and every single one of them was "in recovery" (stable, for years)... Members of ASAM are one of us.
Members of ASAM are going to come in contact with those addicts and alcoholics that were either unable to stop drinking/using themselves, or were unable or unwilling to before they came to the attention of legal, professional and/or occupational authorities. So they (ASAM) are not involved with those people who didn't need them in the first place.
Many professionals, those people that are the benificiaries (?) (LOL) of the ASAM, professionals... psychologists, physicians, social workers, teachers, etc... have some type of spiritual lives themselves.. I know that at my church there are many of these people. These ASAM statements did not harp on, nor did they make the spiritual component of their definition any more important than any of the others... biologic, social, psychologic... It was one of several...
Not all of us fit neatly into one category of dysfunction... for me, psychologically speaking, I had no co-morbidity... I didn't drink or take pills because I was depressed, I just liked how they made me feel... but spiritually I felt unfit... That's my experience and I believe that ASAM should not back off from including the spiritual while also discussing the neurologic, biologic, psychologic and social.
Those to whom the ASAM statements are directed can think for themselves. I am sure that people with training and experience can, for the most part, take what they need from the ASAM definition and leave the rest, depending on whom they are working with. No where in that statement does ASAM say one MUST consider the spiritual with every patient.
Whoever wrote the above quoted article does not speak for me. He or she also belied their atheism and bias.... Who is ANYONE to say that spirituality is or isn't an important part of the life of another. Advocating that we leave it completely out of the discussion takes away an important part of this issue for many, maybe not all, of those with addiction.
Addiction is not like other diseases. To make it so, will hobble those who treat addicts and alcoholics.
Members of ASAM are going to come in contact with those addicts and alcoholics that were either unable to stop drinking/using themselves, or were unable or unwilling to before they came to the attention of legal, professional and/or occupational authorities. So they (ASAM) are not involved with those people who didn't need them in the first place.
Many professionals, those people that are the benificiaries (?) (LOL) of the ASAM, professionals... psychologists, physicians, social workers, teachers, etc... have some type of spiritual lives themselves.. I know that at my church there are many of these people. These ASAM statements did not harp on, nor did they make the spiritual component of their definition any more important than any of the others... biologic, social, psychologic... It was one of several...
Not all of us fit neatly into one category of dysfunction... for me, psychologically speaking, I had no co-morbidity... I didn't drink or take pills because I was depressed, I just liked how they made me feel... but spiritually I felt unfit... That's my experience and I believe that ASAM should not back off from including the spiritual while also discussing the neurologic, biologic, psychologic and social.
Those to whom the ASAM statements are directed can think for themselves. I am sure that people with training and experience can, for the most part, take what they need from the ASAM definition and leave the rest, depending on whom they are working with. No where in that statement does ASAM say one MUST consider the spiritual with every patient.
Whoever wrote the above quoted article does not speak for me. He or she also belied their atheism and bias.... Who is ANYONE to say that spirituality is or isn't an important part of the life of another. Advocating that we leave it completely out of the discussion takes away an important part of this issue for many, maybe not all, of those with addiction.
Addiction is not like other diseases. To make it so, will hobble those who treat addicts and alcoholics.
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Michelle, I agree with you. We are who we are.
I'm willing to bet those of us in active and successful recovery admit or acknowledge our problem and move on from there...the media be damned.
I think the "outside" world tries to put a label or diagnoses or whatever on it for the masses who do not seek treatment or do not think they have a problem. I've never met a person in AA or in "recovery" who cared much about what the outside world classified them as. It's such a personal thing when it comes down to us getting ourselves better. And part of that is not caring what other people think or how they classify you. Just my opinion...
I'm willing to bet those of us in active and successful recovery admit or acknowledge our problem and move on from there...the media be damned.
I think the "outside" world tries to put a label or diagnoses or whatever on it for the masses who do not seek treatment or do not think they have a problem. I've never met a person in AA or in "recovery" who cared much about what the outside world classified them as. It's such a personal thing when it comes down to us getting ourselves better. And part of that is not caring what other people think or how they classify you. Just my opinion...
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Originally Posted by Mark75
Who is ANYONE to say that spirituality is or isn't an important part of the life of another. Advocating that we leave it completely out of the discussion takes away an important part of this issue for many, maybe not all, of those with addiction.
Um....you can have your spirituality. No one is saying that you cannot.
What I'm looking for is science based research concerning addiction. There is no reason that addiction should be treated differently than any other medical condition.
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Originally Posted by Bamboozle
I'm looking for verifiable scientific claims. Anyone actually have any?
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One thing I did always find rather curious is that many people who say that they accept the ASAM disease definition of addiction, or even the one from NCADD, which also defines it as a "primary, chronic disease" nevertheless go on to speak about "underlying causes" of addiction. By definition, "primary disease" necessarily implies that addiction is separate from other pathophysiologic states which may be associated with it, and that it is not a symptom of anything else.
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