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The National Council on Alcoholism and Drug Dependence fights the stigma and the disease of alcoholism and other drug addictions.
Ask Dr. Bob
QUESTION
Many visitors, including a sixteen-year-old girl in Maine and and an eighteen-year-old college student in New York, have posed the same question since this forum was added to the NCADD website.
Many of you wonder about the "disease concept" of alcoholism and drug addiction; i.e., is it a disease or illness? If it is a medical condition, why then do people not want to talk about it? What is the evidence that alcoholism is a disease?
ANSWER
Let's start with a reference to one of the best articles on alcoholism and drug dependence as a "chronic medical illness." I refer any of you seeking science-based evidence to read Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation, and even though it is published for physicians, most of you will get something out of it. The chief author of the article is A. Thomas McLellan, and it appears in the in the Journal of the American Medical Association [2000;284(13):1689-1695].
We professionals lend to the confusion in the general public by often interchangeably using the terms drug and alcohol "abuse" and "dependence," usually knowing ourselves that by "dependence" we mean the addictive illness and by "abuse" we refer to the problematic use of a substance which however remains under the conscious control of the user.
It is less difficult in the 21st century to explain this disease than it was prior to recent neurobiological discoveries. We now can point to a biological pathway common to many of the addictive drugs. Prior to this knowledge, many addiction specialists agreed with Alcoholics Anonymous: we were dealing with a powerful and deceptive "disease;" yet it was difficult to prove this or convincingly describe the idea to doubters without scientific, biological proof.
My usual approach, with both my patients and with fellow physicians and medical students, is to emphasize the "primary" nature of addiction (now we are equating addiction=dependence=alcoholism).
Once established, addiction must be approached as a condition (disease or syndrome) which exists on its own, and not as a symptom of an underlying condition.
As an example, let's say that I begin to drink as a teenager, in part, because I've discovered that alcohol relieves some of my social anxiety (fears of relating to or talking with others) and my life-long feelings of inferiority. In other words, alcohol appeared to relieve my neurotic symptoms and made me feel more normal.
Now follow me some 20 years later, when I've become a solid alcoholic, by any definition. In an effort to help me deal with my problem, you have set up several appointments with an excellent psychiatrist, and, low and behold, she enables me to overcome the social anxiety and feelings inferiority (Note: this is not a simple task and usually takes months or years).
So, now that I no longer have the symptoms which started my drinking (social anxiety and feelings inferiority), I should be able to control my drinking much better, or not even want to drink any longer. In other words, I should no longer be alcoholic if the condition were caused by the psychiatric symptoms which have now been eliminated, right? Well, we all know the answer is NO.
For, as I try to change, I continue to drink in the same "alcoholic pattern." Why? Because the drinking, after beginning symptomatically, has now somehow changed to a primary condition, a disease, which exists independently of the original symptom; a symptom which has become a disease!
Now back to the new neurbiology. In recent years thru research from several groups and under the egis of National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse (both Institutes are branches of the National Institutes of Health), both the anatomical location of addiction activity in the brain and the neurotransmitters (chemicals) which conduct this (addiction) activity have been discovered. The details are increasingly being revealed through ongoing sophisticated studies.
Let me describe some of the details, even though they may not be easily understood. The key brain location seems to be the nucleus accumbens, along with the ventral tegmental area, and others. As it was learned in the 1950s, animals would press a lever to activate this particular area until exhausted. It seemed to be the "pleasure center" and now the "addiction center". Many neurotransmitters seem to activate this system: dopamine, serotonin, endorphin and GABA, but dopamine seems the key chemical whether the addicting drug is alcohol, cocaine, opiates, marijuana or nicotine. Thus, we see a common anatomy and chemistry for the addictions. Certainly relatively sound evidence for an addictive disease.
We now have both a solid biological basis to go with our known clinical syndrome for alcoholism which is as much as is known for most other "diseases"!
Previous Questions
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Disclaimer
Dr. Bob does not provide specific medical advice or a medical diagnosis for any particular condition described, nor verify the authenticity of any information described in the questions presented. Patients should always consult their physician to discuss any specific symptoms, conditions, or modes of therapy for any particular mental or physical difficulties, diseases or conditions.
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National Council on Alcoholism and Drug Dependence, Inc. |
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