Opioid Addiction: A Brain Disease. So Why Don't You Believe It?
by Zac Talbott, BA, CMA
Director | NAMA Recovery of Tennessee
Since opioid addiction was first documented in the United States following the U.S. Civil War of the 1860's and dubbed "the Army Disease," through the synthesis of heroin a couple decades later and its marketing by the Bayer Company as a "wonder drug" into the early 1900s, its rise among minorities and the poor in the mid-20th century, to its resurgence in the middle class today due largely to the rise of the "pill mill" and Purdue Pharmaceutical's effective marketing of OxyContin during a time the American Medical Association was decrying the "under treatment" of chronic pain, dependence on opioids has long been referred to as a "disease." But an unfortunate reality remains that many, including the 12 step fellowships like Narcotics Anonymous, call it a disease yet don't truly embrace the disease theory due to their rejection of its medical treatment. So why is it that many today, even within the field of substance use and medication assisted treatment, don't fully believe or embrace the disease concept?
It is hard for people to see addiction as a disease because it is expressed by behavior. Behavior starts in the brain and is controlled by hormones and substances in the brain called neurotransmitters. The brain signals behavior and gives the outward appearance that the person is in control and choosing to endanger themselves - and others - with their drug use. The average citizen does not realize that they don't understand addiction because it looks like all you have to do is "just stop using." But there are many other things going on - some of them biological.
Addiction is a chronic brain disease expressed as compulsive behavior within a social context. Besides addiction, drug use is linked to a variety of health problems, including HIV/AIDS, cancer, heart disease and many other illnesses. It is costly to individuals and society, and is linked to homelessness, crime and violence. Like many chronic diseases, we were able to treat opioid addiction before we understood it, but our understanding has improved treatment protocols. Now we know why medications work, and we recognize addiction as a medical condition that is treatable.
Neuroscience has exploded our understanding of how the brain works. The past twenty years have been a revolution and an expansion in understanding human behavior. We can now measure the brain's response to drugs in real time. There are now scans where we can actually see opioid addiction and its effects on the human brain. A study published in the Mount Sinai Journal of Medicine in 2000 measured glucose metabolism in three brains: a control group (never any issues with substance use), opiate-dependent on agonist therapy (methadone maintenance) and opiate dependent in sustained remission (abstinent and went to 90 meetings in 90 days). The brain in sustained remission (the "NA brain") was in a state of extreme stress, a predictor for relapse. The methadone maintained brain showed to be significantly close to the control brain when looked at over a 24 hour period. What does all of this tell us? The brains of patients enrolled and stabilized in medication assisted treatment for opioid dependence are healthier and closer to "normal" than the brains of those who take other approaches to recovery from opioid addiction. These facts from the evidence base are crucial for both practitioners and patients to know and comprehend if our community is to truly understand that addiction is a brain disease.
We are still learning and understanding the mysteries of the brain and how substance use disorders (and their treatment) work and manifest, but there are some things that are no longer up for debate. Some things are a matter of medical and scientific fact. Addiction is a complex medical condition. Methadone and buprenorphine are not "substitute drugs" but medications that normalize a system that has been damaged by drug use. Effective advocacy requires all of us to be able to understand and share these facts that, nearly 50 years later, far too many individuals in the medical community and society at large still cannot comprehend.