The definition of addiction has been a controversial topic for doctors and other medical practitioners for a very long time now. It is crucial to point out that any addiction model, be it medical, moral, or biopsychological, advocated for by any addictions professional directly impacts the professional's choice of assessment methods and treatment of addiction for a patient. It is for this reason that addiction professionals cannot seem to agree on the conventional mode of assessment because as far as each of them holds different modes of addiction in their explanation and understanding, they are bound to follow the same patterns in developing differing assessment and treatment methods.
Michael Miller, the former president of the American Society of Addiction Medicine (ASAM) for instance holds the medical model of addiction in his assessment and treatment process. This model suggests that all habits are merely an addiction. What this means is that drug addiction is just like food or gambling addiction (Kampman & Jarvis, 2015). This model disputes the traditional behavioral argument that drug addiction is not the same as alcohol abuse or obsessive shopping. Miller stresses that imbalances in the brain's reward system cause the disease of drug addiction, meaning drug addiction does not cause brain differences in as much as they reinforce them. According to this model, addiction is a primary disease and is not caused by other mental disorders like depression which most professionals hold that causes patients to self-medicate before progressing into food and drug addictions. Based on this mode, Miller suggests that since addictive behaviors are symptoms of the underlying disease, which can be chronic and lifelong just like diabetes and arthritis, it should be managed through medication, therapy, and behavior-based treatments which could include losing weight and monitoring the blood sugar. If left untreated, addiction can potentially cause disabilities and premature death since it is a progressive disease that gets worse without treatment. Other treatment methods Miller advocates for include psychological and spiritual approaches in treatment. This is because, at its core, addiction is not just a social problem.
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In support of Miller's argument, Volkow, Koob, & McLellan, (2016) review scientific advances in the prevention and treatment of substance use disorder and related developments in public policy. Research has increasingly supported the opinion that addiction is a disease of the brain. Even though the brain disease model of addiction has yielded effective preventive measures, treatment interventions, and public health policies to address substance use disorders, the underlying concept of drug abuse as a brain disease continues to be questioned, majorly because the aberrant, impulsive, and compulsive behaviors that are characteristic of addiction have not been explicitly tied to neurobiology. The article reviews recent advances in the neurobiology of addiction to clarify the relationship between addiction and brain function and to enlighten the understanding of addiction as a brain disease. The findings build on the desensitization of reward circuits, which dampens the ability to feel pleasure and the motivation to pursue everyday activities. It also relies on the increasing strength of conditioned responses and stress reactivity, which results in increased cravings for drugs and negative emotions when these desires are not sated; and the weakening of the brain regions involved in primary functions such as decision making, inhibitory control, and self-regulation that leads to repeated relapse. In conclusion, the article holds that neuroscience continues to support the brain disease model of addiction. Neuroscience research in this area offers new opportunities for the prevention and treatment of drug addictions and related behavioral addictions such as to food, sex, and gambling while also improving the understanding of the underlying biologic processes involved in voluntary behavioral control.
However, Hall, Carter, & Forlini, (2015) argue that drug addiction manifests as a compulsive drive to take a drug despite severe adverse consequences. This "odd" behavior has traditionally been viewed as bad 'choices' that are made willingly by the addict. However, recent research has shown that repeated drug use leads to long-term changes in the brain that negatively impact voluntary control. Combined with the new knowledge of how environmental, genetic and developmental factors contribute to addiction; this should bring about changes in the approach to the prevention and treatment of addiction. This stand questions Miller's opinion that drug addiction is a medical condition that needs medical condition which should then be coupled with other measures like therapy. However, by pointing out that drug addiction is a condition which results in therapeutic implications implies that the approach to be taken in assessment and treatment should focus on therapeutical and psychological interventions first before concentrating on medical interventions. Hypothetically, this stand argues that one cannot focus on treating the signs and symptoms of a disease, which in this case is long-lasting changes in the brain that undermine voluntary control, resulting in addiction. Instead, it should focus on the underlying factors causing the symptoms which are the repeated drug use. This leads back to the argument on finding the reasons a patient would indulge in repeated drug abuse, basing their argument on such factors as environmental and psychological factors, thereby building on the moral and biopsychosocial models of drug addiction. In this case, the assessment processes taken are not centered on medical interventions as much as they are focused on environmental and psychological approaches.
References
Hall, W., Carter, A., & Forlini, C. (2015). The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises? The Lancet Psychiatry, 2(1), 105- 110.
Kampman, K., & Jarvis, M. (2015). American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. Journal of Addiction Medicine , 9 (5), 358.
Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371.
