Substance addiction is a neurological disease. With effective medical and psychological treatment, patients can benefit from a “normalization” of brain activity in the affected regions.
The Nature of Addiction PDF Print E-mail
Rick Christensen, P.A., CAS
Chair,  PA Wellness Committee
ASAPA Board Member

We have a new understanding of addiction based on SPEC and PET Scans.  We can now observe a living working brain and so understand the common denominator in addiction is not the drug or behavior, it is the brain and how it responds to stimuli.
As it turns out the same part of the brain is stimulated when encountering beauty, sex, and winning a jackpot at the gambling table as when using cocaine.  For most people this is not a problem and, if it becomes a problem, 90% of individuals will stop with the first consequence.

I worked in a heroin amnesty program 35 years ago in Viet Nam.  These U.S. servicemen were using 98% pure heroin.  The National Institutes of Drug Abuse did a 25 year outcome evaluation study on these individuals.  They found that 90% of these US servicemen did not come back to the states and continue their addiction to heroin.  We now understand why.  They did not have a genetic predisposition to addiction and their brains returned to normal when they stopped using.  This 90% rule plays out across the board, whether you are talking about pain meds prescribed in the PA's office or illicit drug abuse.

You can give patients pain meds in what ever quantities are necessary to control their pain, and 90% will not develop a problem or take more pain meds than are prescribed.  Upwards of 50% of adults in this country are current consumers of alcohol.  Only 10 % will ever meet the criteria for alcoholism.

We know for the 10% who will develop a problem their brains are fundamentally changed. This is based on brain scan technology, not on the old, "this is your brain on drugs" propaganda with frying pans and eggs.

Addiction is represented as a group of brain diseases that most people will not develop.
It is an inappropriate neuro-chemical imbalance in the brain which may take as long as 35 weeks to 2 yrs to normalize past withdrawal from the drug they are abusing.

This fundamental brain change for most reinforcing stimuli happens in the limbic system.  What tells the individual their brain is changed is craving.  Craving happens in the same part of the brain as hunger and thirst.  When you are thirsty you drink, when you are hungry you eat and when you crave you use what ever it is that you are craving for.
This is not part of the brain which is under your control.

Addiction treatment has become medication based due to this new understanding of the mechanisms involved in the same way that psychiatric treatment became medication based 20 years ago.

There is no conflict between 12 step based treatment and medication assisted treatment.  The two go hand in hand if the provider hopes for the best outcomes for the individual.

Bill Wilson the co-founder of AA stated there will come a time in medicine when affective medications are developed to help in the addiction treatment process.  There is nothing in the 12 step process which states you must be medication free.  The only thing you need is a desire to be clean and sober.

The bottom line in treatment is that all treatment works.  The objective is matching the proper treatment to the right patient.
 
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