Why the New Definition of Addiction, as ‘Brain Disease,’ Falls Short

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 … Continue reading Why the New Definition of Addiction, as ‘Brain Disease,’ Falls Short