Biological Contributions to Addictions in Adolescents and Adults: Prevention, Treatment and Policy Implications PMC

Close to a quarter of a century ago, then director of the US National Institute on Drug Abuse Alan Leshner famously asserted that “addiction is a brain disease”, articulated a set of implications of this position, and outlined an agenda for realizing its promise [1]. The paper, now cited almost 2000 times, put forward a position that has been highly influential in guiding the efforts of researchers, and resource allocation by funding agencies. A subsequent 2000 paper by McLellan et al. [2] examined whether data justify distinguishing addiction from other conditions for which a disease label is rarely questioned, such as diabetes, hypertension or asthma. It concluded that neither genetic risk, the role of personal choices, nor the influence of environmental factors differentiated addiction in a manner that would warrant viewing it differently; neither did relapse rates, nor compliance with treatment. The authors outlined an agenda closely related to that put forward by Leshner, but with a more clinical focus. Their conclusion was that addiction should be insured, treated, and evaluated like other diseases.

Nowhere in DSM-5 is it articulated that the diagnostic threshold (or any specific number/type of symptoms) should be interpreted as reflecting addiction, which inherently connotes a high degree of severity. Indeed, concerns were raised about setting the diagnostic standard too low because of the issue of potentially conflating a low-severity SUD with addiction [116]. In scientific and clinical usage, addiction typically refers to individuals at a moderate or high severity of SUD.

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Addiction is defined as a disease by most medical associations, including the American Medical Association and the American Society of Addiction Medicine. It contains thousands of paper examples on a wide variety of topics, all donated by helpful students. You can use them for inspiration, an insight into a particular topic, a handy source of reference, or even just as a template of a certain type of paper. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. The realities of opioid use and abuse in Latin America may be deceptive if observations are limited to epidemiological findings. In the United Nations Office on Drugs and Crime report, although South America produced 3% of the world’s morphine and heroin and 0.01% of its opium, the prevalence of use is uneven.

First, they may relate to important differences in co-occurring disorders whereby addictive behaviors like gambling are more closely linked to depression in girls and women as compared to boys and men, respectively [130, 131]. Second, they suggest that differences exist in biological underpinnings of addictions in women and men, particularly with respect to responses to negative (stress/anxiety) and positive (addiction cue) responses. Third, these findings have treatment implications as interventions like mindfulness-based approaches that target stress reduction might be differentially helpful for women and men with addictions [133]. Motivation-focused models have proposed that addiction might be considered a disorder of misdirected motivation in which relatively greater priority is given to drug use and relatively lesser priority is given to other motivated behaviors like familial care, work or school [49-51]. In these processes, decisions to pursue typically smaller, immediate rewards (e.g., a drug-related high) at the expense of typically larger, delayed rewards (e.g., longer term life possibilities emanating from studying for an exam or taking children to school).

The Biology of Addiction

“As with heart disease or diabetes, there’s no one gene that makes you vulnerable,” Koob says. A healthy brain rewards healthy behaviors—like exercising, eating, or bonding with loved ones. It does this by switching on brain circuits that make you feel wonderful, which then motivates you to repeat those behaviors. In contrast, when you’re in danger, a healthy brain pushes your body to react quickly with fear or alarm, so you’ll get out of harm’s way. If you’re tempted by something questionable—like eating ice cream before dinner or buying things you can’t afford—the front regions of your brain can help you decide if the consequences are worth the actions. A sizable body of research evidence addresses four domains of potential biological influence on the development of substance use disorders and addiction.

• Some people think addiction cannot be a disease because it is caused by the individual’s choice to use substances.
• That does not in any way reflect a superordinate assumption that neuroscience will achieve global causality.

According to the biological model, each person’s unique physiology and genetics causes addiction. People differ in the degree to which they like or dislike a particular addictive substance or activity. Some people may enjoy a substance or activity so much that it becomes sober house very tempting and difficult to resist. Another person would not experience this difficulty because they do not experience a similar enjoyment. Likewise, the ability to temper impulsive desires with rational thought is a brain function that varies among different people.

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He suggested that the addiction field needed to follow the rest of medicine in moving away from viewing disease as an “entity”, i.e., something that has “its own independent existence, apart from other things” [11]. To modern medicine, he pointed out, a disease is simply a label that is agreed upon to describe a cluster of substantial, deteriorating changes in the structure or function of the human body, and the accompanying deterioration in biopsychosocial functioning. Thus, he concluded that alcoholism can simply be defined as changes in structure or function of the body due to drinking that cause disability or death.

Expectancy theory proposes that an individual will behave or act in a certain way because they are motivated to select a specific behavior over others due to what they expect the result of that selected behavior will be. In essence, the motivation of the behavior selection is determined by the desirability of the outcome. However, at the core of the theory is the cognitive process of how an individual processes the different motivational elements. As related to addiction, expectancy theory explains how there may be a motivation to experience the “high” of the substance and the euphoric state that the drug brings to the body. Also, this euphoric state may motivate individuals in the future to take the substance again and again, and hence exacerbating the addiction process.

Using information related to individual differences in biologies may help to optimize such policies, and the resulting policies may have substantial impact on reducing the societal burdens of addictions. From a global perspective, having resources and policies that would help increase the currently scarce mental health and addiction efforts in low- and middle-income countries could have a major impact on world health [ ]. Biological knowledge of addictions may help inform advances in policy and prevention [203]. An improved understanding of genetic factors or related endophenotypes might help identify individuals with vulnerability factors that could be targeted preventively for interventions. Similarly, an improved understanding of gene-by-environment interactions, and how specific environmental exposures may influence gene expression (epigenetic phenomena), may also improve prevention strategies. Identification of brain imaging measures that reliably link to addictions could aid in both prevention and treatment strategies.