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The essence of any addiction is compulsive seeking and use, even in the face of negative health and social consequences. These are the characteristics that ultimately matter most to the patient and where treatment efforts should be directed. These elements also are responsible for the massive health and social problems that drug addiction brings in its wake.
Although each drug has some idiosyncratic mechanisms of action, virtually all drugs of abuse have common effects, either directly or indirectly, on a single pathway deep within the brain, the mesolimbic reward system. Activation of the system appears to be a common element in what keeps the drug users taking drugs.
Not only does acute drug use modify brain function in critical ways, but prolong drug use causes pervasive changes in brain function that persist long after individual stops taking the drug. Significant effects of chronic use have been identified from many drugs at all levels: molecular, cellular, structural and functional. The addicted brain is distinctly different from the non addicted brain, as manifested by changes in brain metabolic activity, receptor availability, gene expression, and responsiveness to environmental cues.
Of course, addiction is not that simple. Addiction is not just a brain disease. It is a brain disease for which the social contexts in which it has both developed and is expressed are critically important. Exposure to conditioned environmental cues can be a major factor in causing persistent or recurrent for cravings and drug use relapses even after successful treatment.
Addiction is rarely an acute illness. For most people, it is a chronic, relapsing disorder. Total abstinence for the rest of one's life is relatively rare outcome from a single treatment episode. Relapses are more than norm. Thus, addictions must be approached more like other chronic illnesses than like an acute illness, such as a bacterial infection or a broken bone. This has tremendous implications for how we evaluate treatment effectiveness and treatment outcomes. Viewing addiction as a chronic, relapsing disorder means that a good treatment outcome- and the most reasonable expectation- is a significant decrease in drug use and long periods of abstinence, with only occasional relapses. Thus, a reasonable standard for treatment success is not curing the illness but managing it with professional help.
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johnhenson@clinicalsolutions.org