If you think addiction is all about booze, drugs, sex, gambling, food and other irresistible vices, think again. And if you believe that a person has a choice whether or not to indulge in an addictive behavior, get over it.
The American Society of Addiction Medicine (ASAM) blew the whistle on these deeply held notions with its official release of a new document defining addiction as a chronic neurological disorder involving many brain functions, most notably a devastating imbalance in the so-called reward circuitry. This fundamental impairment in the experience of pleasure literally compels the addict to chase the chemical highs produced by substances like drugs and alcohol and obsessive behaviors like sex, food and gambling.
Psychological and environmental factors, such as exposure to trauma or overwhelming stress, distorted ideas about life's meaning, a damaged sense of self, and breakdown in connections with others and with "the transcendent (referred to as God by many, the Higher Power by 12-steps groups, or higher consciousness by others)" are also acknowledged as having an influence.
One of ASAM's unstated goals was obviously to fight against the stubborn social stigma against addiction experienced by many addicts. "There's no question they set out to de-stigmatize addiction," Publicker says. "Nobody chooses to be an addict. The concern that I have is placing blame on the patient. It takes a very long time for the brain to normalize. While it's waiting to happen, you're feeling bad, your thinking is impaired, and it's a setup for relapse. Patients are likely to be blamed for relapse, and families see them as unmotivated and weak. But that's the disease of addiction."