Addiction = Chemical Dependency: An Ever Evolving Concept

As time goes by, research reveals more scientific evidence about the nature of addiction, and as a result, the concept of addiction continues to change and evolve.

Addiction wasn’t a major public health concern until the late eighteenth century, when thousands of people – including young children - became addicted to morphine and opium prescribed by physicians. Concerns for alcohol and tobacco addiction came later, but still, treatment was rudimentary and the primary criteria for defining addiction was the occurrence of withdrawal symptoms upon stopping.

In the last few decades, studies have revealed that addiction has much to do with actual chemical changes in a certain area of the brain. These changes involve release of dopamine, a brain chemical linked to habit, learning, and pleasure and associated with powerful cravings. This explains why most experts now believe that addiction is a chronic, progressive disease similar to diabetes, high blood pressure and asthma.

Some people may find it difficult to believe that sex or eating – normal activities required for survival of the human race – can be addictive, and the considerable media hype about the subject hasn’t helped. As research becomes more sophisticated, however, it has become apparent that those chemical changes in the brain don’t necessarily require a substance. For example, one study revealed that dopamine is released in the brains of cocaine addicts who simply viewed people using cocaine.

Armed with the burgeoning information that nearly any enjoyable activity can release dopamine, drug and alcohol treatment centers and rehabs began integrating treatment for certain addictive and compulsive behaviors – primarily gambling and compulsive eating. These, and other compulsive or addictive behaviors such as shopping, working, pornography and sex, are often known as process or behavioral addictions. Today, treatment is available for nearly every powerful compulsion and addiction, ranging from Internet gaming to body building and exercise (Bigorexia) or excessive healthy eating (Orthorexia) and more common eating disorders such as anorexia and bulimia.

We are also learning more about substance abuse and addiction, notably that addiction is a complex disorder that involves genetics, the social and physical environment, the physical makeup and family structure and family history. We also know that if addiction is left untreated, people may develop more than one addiction, such as an alcoholic who gambles compulsively, a chronic overeater who is addicted to nicotine, or a heroin addict who also uses other substances such as alcohol and marijuana.

So far, compulsive gambling is the only behavioral addiction included in the latest edition of Diagnostic Statistical Manual of Mental Disorders (DSM-5), the standard reference for psychiatric illnesses. More research is required before other behavioral disorders are included, but it is expected that more will be added in time.

Many people have expressed concern that more everyday activities such as making money, shopping, use of mobile phones or posting on social media will be considered as “addictive,” which could potentially trigger concerns about epidemics, thus costing the health care system (and insurance companies) millions. This may be a viable concern; as more behavioral disorders continue to be recognized as diseases, the higher the chance that insurance providers will be mandated to fund addiction treatment or rehab. However, substances are not a problem for a majority of – especially young – people if they are provided with better choices than drugs, who get the chance to live in a healthier environment which supports their own resources, a promising outlook on life, an education and good self esteem. This is a new perspective on the political “war on drugs”.

Finally, it is important to note that just because substance abuse or a behavior disorder is classified as a chronic disease, this doesn’t equate to helplessness. Like other chronic disorders, addiction is currently not entirely curable, but it is highly treatable. The afflicted person, their family and their job and private environment will profit highly from an empathic, professional and knowledge based treatment program, which, again should be highly individualized.

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