Adi Jaffe Ph.D.
Is Addiction Really a Biological Disease?
Find out how important your biological makeup is to your addictive behaviors.
Posted Jul 17, 2018
Have you ever noticed just how preoccupied we humans are in trying to understand everyday difficulties? It comes from our curiosity to identify problems and find solutions. Addiction is just another one of those problems we've been trying to understand and "cure" for hundreds of years.
Wrong. We are complex beings, and if there were a simple cure for addiction, we'd no longer have people struggling with it. Instead, we need to look at our complex behaviors through a range of lenses.
In my research, I’ve found four main "camps" that attempt to explain addictive behaviors. These include 1) the spiritualist and religionists (bad, amoral people become addicted), 2) psychotherapists and traumatists (unresolved past trauma causes addiction), 3) environmentalists and social scientists (external factors cause addiction), and 4) neuroscientists and biologists (internal biochemical factors cause addiction). People have been fighting about which of these is the true cause of addiction for decade. In isolation, each of these camps tells us something interesting about human behavior, but together they give us a complete picture of why someone becomes addicted in the first place and how addiction is maintained.
I explored the spirituality camp in a previous article. Today I'd like to examine the biological perspective in more detail because this is one of the most debated questions of all time: Is addiction really a biological disease?
There is absolutely no way to examine this entire question, and I’ve written about this extensively in previous articles (HERE and HERE for example). But drawing on the biological theories of addiction, we'll look at some of the biological impact of drug use and its effects on addiction.
Neuroscientists and the Biological Explanation
In essence, the biological viewpoint of addiction states that we are predisposed to addictive behavior through physiology and chemistry. Not only does our genetic blueprint make us more susceptible to addiction, but the ways our brains are wired make us more vulnerable to substance-abuse problems, as the use of these substances alters the way our brain functions and further cements the foundations for addiction.
According to many in this camp, once the addiction is triggered, there is no way to undo the pathways—the proverbial cucumber turning to a pickle.
It's a reciprocal relationship, whereby your experiences shape your brain function, and your brain function shapes your experiences. But from the biological camp’s perspective, the changes are driven by your biopharmacological processes.
The research suggests that people with a family history of mental illness or addiction are more at risk of developing these conditions themselves compared with someone who has neither of the risk factors. This is the same explanation that drives most biological health problems, such as heart disease, breast cancer, and diabetes. That's why if you have a family member with breast cancer, (which puts you more at greater risk of developing breast cancer), it's recommended you have regular check-ups to ensure the disease has not yet been triggered. Addiction, from a biological perspective, is seen as a disease.
In addiction research, it’s believed that people misuse alcohol and drugs because of the the chemical reactions these produce in the brain. Most substances increase dopamine release in areas that have become known as our biological “reward” pathways (some people still mistakenly call these our “pleasure centers”). Repeated substance use can cause long-term changes in these reward pathways, altering responses and making future substance use more likely.
The disease model of addiction has its advantages and disadvantages. Yes, there’s some power in knowing what may make you at risk of addiction. As a society, we can look at ways to minimize these risk factors, and therefore the possibility of addictive behaviors. However, predeterminism can also promote a sense of helplessness. It may lead you to think, Well, addiction is in my genes. What hope is there?
“A risk factor is not destiny.” – Adi Jaffe, The Abstinence Myth
At the same time, biological research has also led to effective pharmacological treatments (medications) that help people overcome their problems with alcohol and drug use, mental-health issues, and such associated difficulties as cravings and withdrawal. This is primarily achieved by either replacing or blocking the same receptors with which the drugs typically interact. For some, medications have produced incredibly successful outcomes, while for others they have had little to no effect.
Addiction Essential Reads
So...Is Addiction Really a Biological Disease?
Importantly, research has revealed that certain biological risk factors increase the odds of addictive outcomes, but not a single factor has been discovered that predicts addiction with certainty. This means that, while biology is necessary for drug-use problems to develop (if your brain doesn’t react to a drug, you will not become addicted to it), it is not sufficient to explain them.
As far as I’m concerned, this alone means that we cannot rely on biology as the stand-alone explanation for addiction. If someone can be heavily biologically predisposed and yet not develop the condition, then additional factors—environmental influence, life experience, etc.—must be added to the model.
So the question isn’t whether biology matters, but rather to what extent? The problem is that everyone believes the answer, whatever it might be, would be static—the same for everyone at all times.
But we also know that the brain is not static.
Your brain changes constantly with experiences. It can change through exposure to drugs, sure, but it is also rewired constantly with new experiences (and the stoppage of drug taking).
The same exact thing can be said of environmental and psychological influences—they ebb and flow as circumstances change.
It's important to understand the neurological basis of addiction and drug use because it can be helpful in understanding why one person may develop an addiction and another may not. Understanding the causes can help empower you to understand your own circumstances, but let's not let it limit you in your beliefs about making positive changes in your life.
Biology works in conjunction with many other factors to result in addiction, and treatment must encompass all of those factors too. The notion that addiction is one thing for all people can be dangerous and leave many addicts feeling misunderstood, reacting to an imposed rationale for their experience. If we can adopt a more nuanced understanding, I believe we will be able to help more people and help them more comprehensively.
In my new book, The Abstinence Myth, I rely on this nuanced understanding of addiction as the basis to my system for overcoming addiction. This is also the foundation for my IGNTD Recovery Course which aims to generate hope rather than hopelessness. I believe that you can personalize your recovery and see immediate results, regardless of your specific mix of factors and circumstances.