It’s Time for a Revolution in Addiction Treatment

A recent article in the New York Times, entitled Rethinking Addiction as a Brain Disease, revealed a destructive truth. For all that addiction experts and policy makers think they know about substance use disorder and recovery, there’s a fundamental misconception that continues to undermine the advancement of treatment in this country: The illusion of choice – choice to use or choice to stop. For centuries, clinging to this illusion – that the struggling person has choice or control over a complicated, chronic and progressive disease that impacts multiple bodily systems including, but most importantly, the brain itself – undermines all the progress we’ve made in treating this disease and ending the stigma that keeps the more than 1 in 3 American families struggling in what can feel like a hopeless cycle.

From first use, legal and illicit substances alike imprint and begin to rewire our brains and bodies – driving our desires, compulsions, behaviors – impacting our decision-making. For some, that means the use of alcohol or a drug can be occasional and even enjoyable, but for the more than 48 million Americans who struggle with a substance use disorder, there is no choice because the brain isn’t allowing it – choice has been replaced by an overwhelming physical, emotional and mental need driven by multiple factors and systems that are feeding bad information to the part of the brain responsible for choice.

The recognition and subsequent adoption of the chronic disease model for addiction treatment was a watershed moment for addiction treatment. It provided a description and treatment model for what we experienced – addiction is a disease of relapse and remission that, when diagnosed properly, can be treated and managed to reduce the risk of relapse and a worsening of the disease – much like diabetes, heart disease and autoimmune diseases. This understanding gave struggling individuals and families not just an understanding of how the disease worked, but it also gave a framework for better interventions and hope. It allowed the treatment of this disease to move from the shadows to mainstream medicine, meaning new research, better medications for cravings and co-occurring disorders, and insurance coverage for treatment.

The research cited in this New York Times article not only seems to try to undermine this alignment, but it also completely negates the significant advancements from decades of research on Alzheimer’s and traumatic brain injury that have improved our understanding of how the brain works – the impact neurochemicals and neurocircuitry on how we process, behave and survive. We’re on the cusp of the next revolution in Addiction Medicine, where we can finally move beyond treating symptoms and manifestations of substance use disorder to actually treating the root cause of the disease: The brain itself.

Today, using brain imaging and neurocognitive testing, we can identify areas of an individual’s brain impacted by substance use disorder, anxiety, depression and trauma – leading to better, more targeted treatments that result in better, sustained outcomes.

What we need now is not retrenchment into old, biased, stigmatized thinking centered on the illusion of choice. We need investment in this new frontier of Addiction Medicine that marries everything we know about treatment and recovery with brain science. We need a paradigm shift where we move beyond the chronic disease model to a neurorestorative model, where we are no longer focused on the illusion of choice but rather on restoring the ability to choose.