For the past quarter of the century, addiction has been described and subsequently widely accepted to be brain disease (Leshner, 1997).
The US National Institute on Drug Abuse (NIDA) defines addiction as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs
Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable. If left untreated, they can last a lifetime and may lead to death (NIDA, 2020).
For information – link for above https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
A recent article summarising argument for addiction as brain disease: https://www.nature.com/articles/s41386-020-00950-y#ref-CR1
Addiction has been used synonymously with, or considered even a more severe form of, substance dependence. It refers to individuals who exhibit persistent difficulties with self-regulation of drug consumption as a consequence of severe substance use disorder (Heilig et al., 2021).
In Roman law and in the Middle Ages, addiction was the sentence pronounced against an insolvent debtor who was given over to a master to repay his debts with his work. An addictus was a person enslaved because of unpaid debts (Crocq, 2007).
In the 1960s, the WHO recommended the use of dependence instead of addiction for their classification system, which still include harmful use and dependence as pattern of use descriptors. The term dependence was included in the American DSM-III-R (1987), but the latest versions, DSM5 2013 and DSM5-TR, 2022 adopted the concept of Substance Use Disorder with severity gradings (mild, moderate and severe).
WHO – Dependence
The World Health Organization (WHO’s) International Classification of Diseases and Health Related Problems (ICD) 11th edition contains a section on disorders due to substance use or addictive behaviours (WHO, 2022). Withing the “Disorders due to substance use” diagnosis categories have been described for various specific psychoactive substances.
The first three diagnoses listed (Episode of Harmful Psychoactive Substance Use, Harmful Pattern of Psychoactive Substance Use, and Substance Dependence) describe the use pattern of the substance.
Dependence (ICD11) – essential criteria:
- A pattern of recurrent episodic or continuous use [of substance] with evidence of impaired regulation of [substance] use that is manifested by two or more of the following:
- Impaired control over [substance] use (i.e., onset, frequency, intensity, duration, termination, context)
- Increasing precedence of [substance] use over other aspects of life, including maintenance of health, and daily activities and responsibilities, such that [substance] use continues or escalates despite the occurrence of harm or negative consequences (e.g., repeated relationship disruption, occupational or scholastic consequences, negative impact on health);
- Physiological features indicative of neuroadaptation to the substance, including: (1) tolerance to the effects of alcohol or a need to use increasing amounts of alcohol to achieve the same effect; (2) withdrawal symptoms following cessation or reduction in use of alcohol (see [Substance] Withdrawal), or (3) repeated use of [substance] or pharmacologically similar substances to prevent or alleviate withdrawal symptoms.
- The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if use is continuous (daily or almost daily) for at least 3 months.
The remaining ICD11 diagnostic categories reflect the impact of the substance use pattern and are thus considered to be associated with one of the primary use pattern diagnoses (Intoxication, Withdrawal, Delirium, Psychotic Disorder, Mood Disorder, Anxiety Disorder, Obsessive Compulsive Disorder, Impulse Control Disorder)
Fifteen specifically mentioned substance are: alcohol; cannabis; synthetic cannabinoids; opioids; sedatives, hypnotics, or anxiolytics; cocaine; stimulants including amphetamines, methamphetamine or methcathinone; synthetic cathinones; caffeine; hallucinogens; nicotine; volatile inhalants; MDMA or related drugs, including MDA; dissociative drugs including Ketamine and PCP; other specified psychoactive substances, including medications, multiple substances, unknown or unspecified psychoactive substances and non-psychoactive substances.
DSM5 – Substance Use Disorder
Substance Use Disorder, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) combined the previous DSM-IV categories of substance abuse and substance dependence into a single disordered measured on a continuum from mild to severe (Hasin et al., 2013). There has been no changes in the latest text revision DSM5-TR (2022) in this chapter.
Criteria for Substance Use Disorder (two or three – mild, four or five – moderate, six or more severe):
- Hazardous use
- Social/interpersonal problems related to use
- Neglect of major roles to use
- Withdrawal
- Tolerance
- Used larger amounts / longer
- Repeated attempts to quit/control use
- Much time spend using
- Physical/psychological problems related to use
- Activities given up to use
- Craving
The DSM 5 refers to substance-related disorder in relation ten separate classes of drugs (alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics or anxiolytics, stimulants (including amphetamine-type substances, cocaine, and other stimulants) and tobacco. Substance-related disorders encompass Substance Use Disorders and Substance-Induced Disorder, the latter describing mental disorders cause by the effect of substances such as intoxication, withdrawal, psychosis.
Behavioural / Process Addictions
A variety of behavioural or process addictions have been described in the addiction literature and by those who struggle with repetitive and out of control behaviours, such as sex, gambling, shopping, food addiction, exercising, work and use of various electronic media as pornography, television, internet, social media.
The DSM 5 chapter of “Substance-Related and Addictive Disorders” also includes “Addictive Disorders” with currently Gambling Disorder as its sole condition. The authors announced that this new term and its location in the new manual reflect research findings that gambling disorder being similar to substance-related disorders in clinical expression, brain origin, comorbidity, physiology, and treatment (AMA, 2013).
In ICD11(2022), Disorders Due to Addictive Behaviours are recognizable and clinically significant syndromes associated with distress or interference with personal functions that develop as a result of repetitive, rewarding behaviours other than the use of dependence-producing substances or sexual behaviours. It specifies Gambling Disorders (predominantly online and offline) and Gaming Disorders (online/offline).
Compulsive Sexual Behaviour Disorder is a recently included diagnostic category in ICD11’s Impulse Control Disorder Section.
References
AMA. (2013). Substance-Related and Addictive Disorders. American Psychiatric Association. https://www.psychiatry.org/file%20library/psychiatrists/practice/dsm/apa_dsm-5-substance-use-disorder.pdf
Crocq, M.-A. (2007). Historical and cultural aspects of man’s relationship with addictive drugs. Dialogues in Clinical Neuroscience, 9(4), 355–361. https://doi.org/10.31887/DCNS.2007.9.4/macrocq
Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale. American Journal of Psychiatry, 170(8), 834–851. https://doi.org/10.1176/appi.ajp.2013.12060782
Heilig, M., MacKillop, J., Martinez, D., Rehm, J., Leggio, L., & Vanderschuren, L. J. M. J. (2021). Addiction as a brain disease revised: Why it still matters, and the need for consilience. Neuropsychopharmacology, 46(10), 1715–1723. https://doi.org/10.1038/s41386-020-00950-y
Leshner, A. I. (1997). Addiction Is a Brain Disease, and It Matters. Science, 278(5335), 45–47. https://doi.org/10.1126/science.278.5335.45
NIDA. (2020, July 6). Drug Misuse and Addiction | National Institute on Drug Abuse (NIDA). https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
WHO. (2022). International Classification of Diseases and Health Related Problems (ICD). World Health Organization. https://icd.who.int/en