What all addicts find most maddening (and terrifying) about addiction: its staying power, long after the pleasure has worn off, long after the relief has transformed into extended anxiety, long after they've sworn up and down, to themselves and others, that this would not continue. It's that resilience that has made addiction so incomprehensible to addicts, their families and the experts they turn to for help, while feeding a firestorm of clashing explanations as to what it actually is.
One explanation is that addiction is a brain disease. The United States National Institute on Drug Abuse, the American Society of Addiction Medicine, and the American Medical Association ubiquitously define addiction as a 'chronic disease of brain reward, motivation, memory and related circuitry' - a definition echoing through their websites, lectures and literature, and, most recently, 'The Surgeon General's Report on Alcohol, Drugs, and Health' (2016). Such authorities warn us that addiction 'hijacks the brain', replacing the capacity for choice and self-control with an unremitting compulsion to drink or use drugs. In the UK, the medical journal The Lancet has provided a forum for figurehead proponents of the brain-disease model, echoing the government's emphasis on 'withdrawal symptoms, tolerance, detoxification or alcohol-related seizures', which suggests that the royal road to understanding addiction is still medicine.
If addiction changes the brain and drugs cause addiction, the argument went, then perhaps drugs unleash pathological changes, literally damaging neural tissue. The implication that addicts do the things they do because they are ill, not because they are weak, self-indulgent, spineless pariahs (a fairly prevalent view in some quarters) also seemed to benefit addicts and their families. The anger and disgust they often experienced could be mitigated by the presumption of illness; and social stigmatisation - known to compound the misery of those with mental problems - could be relieved, even reversed, by the simple assumption that addicts can't help themselves...read more>>>...