wait, doesn't culture "hijack" the brain's reward system too?

Medpagetoday | Addiction is a chronic brain disorder that should be treated like any other chronic disease, according to a new definition from the American Society of Addiction Medicine.

In a public policy statement, the group emphasized that neurological mechanisms -- disruptions in neurotransmission, interruptions in the reward system, failure of inhibitory control -- are the key drivers of addiction.

"At its core, addiction isn't just a social problem or a moral problem or a criminal problem," ASAM past president Michael Miller, MD, said in a prepared release. "It's a brain problem whose behaviors manifest in all these other areas."

The statement describes addiction as a primary disease and not the result of other emotional or psychiatric problems. Addiction hijacks the brain's reward system, which involves areas of memory and emotion, and stifles areas of executive functioning, such as impulse control, the statement says.

And genetic factors account for half of the likelihood that a patient will develop addiction.

Given the physiology, addiction should be monitored and managed over time to diminish the risk of relapse, sustain remission, and optimize patient functioning, the group statement continues.

"Many chronic diseases require behavioral choices, such as people with heart disease choosing to eat healthier or begin exercising, in addition to medical or surgical interventions," Miller said in the release. "We have to stop moralizing, blaming, controlling, or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment."

Treatment should involve not only pharmacological management, but psychosocial rehabilitation as well, the policy statement said.

Focus on the neurological underpinnings of behavioral disorders has increased in recent years, the result of advances in brain imaging and neuroscience, the society authors wrote.

Earlier this month, for instance, some dietitians suggested emphasizing the neurology of obesity in order to help patients lose weight more effectively, instead of telling them simply to eat less.

The ASAM policy statement was the result of a four-year process involving more than 80 experts and "extensive dialogue" with the National Institute on Drug Abuse.

The new definition marks the first time ASAM has taken an official position that addiction is not solely related to substance use.