Treating and Preventing the Medical Disease of Addiction

Dr. Akikur Mohammad MD

Board Certified Addiction Medicine Specialist
Founder/CEO Malibu Horizon
In the world of medicine there are, as you know, medical specialists. For every treatable disease, there are those who focus their research, care, and careers to helping people afflicted with that particular disease. I am a proud member of American Society of Addiction Medicine.

Addiction Defined by the American Society of Addiction Medical (ASAM)

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, and craving, diminished recognition of significant problems with one's behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. (Copyright 2011. American Society of Addiction Medicine, Inc.)

A Gap Between Doctors and Layman

A common problem faced by medical specialists working in the field of addiction is the gap between what we, as doctors, know for a fact, and what the layman often believes. Many people do not believe that addiction is a physical disease, but that is only because they don't understand the meaning of disease, and the current definition of addiction.

All the Medical Organizations Agree... Addiction is a Disease

People often confuse addiction with physical dependence in the context of medical treatment. Drugs that we often associate with abuse, such as opiates or central nervous system stimulants, are, in the proper context, beneficial medications. Addiction is also not synonymous with recreational or social use of mood altering agents, including alcohol. Once we clear up this misunderstanding, everyone understands why addiction is a true medical illness and why addiction is classified as a disease by every medical organization in the world, including the American Medical Association, The World Health Organization, and the American Psychiatric Association. Obviously, if addiction were not a medical condition meeting the clear definition of disease, our area of specialization wouldn't exist.

Addiction Defined

First of all, let's learn the meaning of disease. According to the World Health Organization, disease is "illness caused by biological, chemical or radio-nuclear sources." Genetics, of course, comes under the biological heading. We all know that exposure to certain chemical substances such as mercury, arsenic, and asbestos can cause a variety of diseases such as cancer, lung ailments, liver disease, brain dysfunction, and many others.

Nicotine, For Example

The smoking of tobacco, commercially marketed as cigarettes, fills the smoker's lungs with all manner of chemicals, in addition to Nicotine, and is known to cause chronic bronchitis, emphysema, gastritis and lung cancer. Not everyone who smokes gets lung cancer, but it is an absolute fact that your risk of lung cancer, or heart disease, increases if you smoke.
Not everyone who drinks alcohol has cirrhosis of the liver, but heavy drinking absolutely assures you of that possibility, along with a marked propensity towards diabetes, heart disease and many other diseases and conditions, none of which are pleasant or enjoyable.

Impact on the Brain

Addiction is a chronic disease characterized by anatomical and/or functional changes in the human brain. The anatomical changes can be clearly seen and studied with brain imaging technology such as a standard MRI and CT scans. The functional abnormalities can be seen, studied and evaluated by a PET scan, or use of the Functional MRI. These changes are in the brain's reward, motivation, memory and related circuitry. Some of these changes are repairable, while others are, so far, are not reversible.
As the brain controls behavior, a disease of the brain is going to have behavioral consequences. Because of these brain changes, people become unable to make conscious decisions in their own best interest. The definition of addiction clearly states that the individual thus afflicted will compulsively pursue a detrimental course of action despite continual negative medical and social consequences.

The Criteria

The difference between someone who simply enjoys drinking or drugging, and someone who has the disease of addiction, is that the person with the disease has suffered actual physical or functional changes to their brain that make it impossible for them to simply stop a behavior once it has started, no matter how much they may honestly want to do so.
As you can imagine, when the brain has the disease of addiction, it is if the brain has a mind of its own. You don't want to do something, but you are incapable of not doing it. Don't confuse this with a lack of will power. Ask yourself this question, how effective is will power when you have diarrhea? After all, if will power is useless against something as simple as diarrhea, imagine how useless it is against a brain disease.

Here's a Good Analogy

Let me give you an analogy. Let's say that you are driving down the highway at 60 mph. Suddenly, you see a block of concrete in the middle of the road. If you do not stop, you will crash into it, and perhaps be killed. What do you do? You put on the brakes. The disease of addiction would compel you to keep your foot on the gas, or even increase your speed, no matter how desperately you want to put on the brakes. It is difficult to imagine a living nightmare worse than addiction, and this is why there are specialists in addiction medicine to treat that certain percentage of our population who, for a variety of reasons, are at risk for this devastating medical illness.
Now, let us suppose that you use cocaine, or other stimulant, and have used it regularly for several years. Stimulants such as cocaine can contribute to, or precipitate, stroke, seizure, heat arrhythmia, heart attacks, and hyperthermia, a potentially fatal elevation of temperature. You go to the doctor for a checkup, and he tells you that because of the cumulative effect of your years of cocaine use, you must stop immediately or you will definitely have a heart attack or stroke. What do you do? Simple, you stop. For most people, stopping this, or other life threatening behavior, is simply a decision they make in their own best interest. For others, because of the years of habit, and their circle of social interaction, it requires significant changes in their life style, routine and friendships. They may, in addition to medical advice, call upon family members, and various emotional support groups, to help them in implementing their decision to change their behavior.

Addicts Cannot Just Stop

Addiction severely impacts your ability to simply stop a behavior, even with emotional support. This is where a specialist in addiction medicine comes in. We diagnose your specific condition, and know what medication, or combination of medications, to give you, along with other therapeutic techniques, that treat the disease and free you from the impending consequences of continued use.
A question I'm often asked is whether or not addiction is a disease of choice. That's like asking if lung cancer or diabetes are something we choose. I said this to the husband of one of my patients, and he suddenly believed that he was innately blessed with more medical knowledge than the AMA , WHO, and the American Society of Addiction Medicine combined.
"No," he forcefully insisted, "you're wrong. You're comparing apples and oranges." Apparently he was also now an accomplished green grocer. He insisted that people choose addiction, but don't choose heart disease. People choose addiction, but not diabetes. "No one chooses lung cancer," he said, "but people choose to be addicts."
I told him exactly what I will tell you: No one chooses to get lung cancer, but you may choose to smoke despite the known risk of getting lung cancer. Speaking for myself, I personally wouldn't choose to have type 2 diabetes. My family has a strong history of type 2 diabetes. I diet, exercise, watch my weight, check my blood work and for the warning symptoms of diabetes. If I didn't care, I would gain 40 pounds in a couple of months, and develop diabetes. It's my educated choice that I am at higher risk of developing diabetes, and so I need to watch it.

A Question of Choice

Many people know they have high cholesterol and high blood pressure, but make no attempt to control them. Finally, they have a heart attack or stroke. That is their choice. Many diabetics are not taking medication, cheat on their diet and are walking around with sky high blood sugar levels. Again, that is their choice. People choose to have unprotected sex, share needles, and possibly contract HIV/AIDS. Would you say that they chose to get HIV? No, but their choices facilitated the disease.
Can a person make a poor choice by drinking heavily knowing they have a strong family history of addiction? Yes, and that choice can lead to alcoholism, which is a form of addictive disease.
The disease of addiction is, in many ways, similar to high blood pressure. People can't control their blood pressure by force of will or decision. People with the disease of addiction can't control their disease by force of thought. Patients with drug and alcohol addiction want to stop, but they need professional medical help, and true understanding from friends and family.

A Word About Genetics

Addiction, like other chronic illnesses, has a biological/genetic factor. Genetic studies have shown that at least 50% of the risk factor of addiction is biological and hereditary. Allow me to share one little example of the biological factor. The enzyme which breaks down alcohol is called aldehyde dehydrogenase (ADH). Antabuse is a medication which prevents the activity of ADH. If someone takes this mediation and drinks, they will have a bad reaction to alcohol, and not want to drink. Five to ten percent of Asians, and up to fifty percent of some Japanese populations, have an ADH deficiency. It is as if nature implanted Antabuse in them at birth. If they drink, they have a bad reaction. These people, simply by matter of biology, will never become alcoholics.

Carrot Addiction - A Case in Point

In Scandinavia, there are studies of addiction related to, of all things, carrots. These people will hoard carrot peelings for fear of not having their drug of choice. In the 1970's, a highly intoxicated patient arrived at a treatment center. He had all the symptoms associated with some type of drug or alcohol toxicity, but no trace of either could be found in his system. His case was, at the time, most unusual. The object of his out of control cravings, and the source of his intoxication, was dry roasted peanuts. Obviously, the percentage of people who have addiction resulting from continued ingestion of dry roasted peanuts, carrots or eggs is very small. But that one person's disease is very real, and requires medical treatment just as heart disease requires treatment whether it is the result of diet, smoking, or some other cause.
A certain percentage of people born and raised near pulp mills have addictive/allergic responses to certain hydrocarbons. There are actually people who will become intoxicated and out of control if they were to sit on plastic lawn furniture. This is not a mental problem, nor a matter of will power. It is a rare condition, but for the person who has it, there is nothing funny about it at all. Those of you who watch the television program, House M.D., at least have some idea of the types of unusual medical problems that require specialized diagnosis. I am a specialist in diagnosing and treating the disease of addiction, regardless of what precipitated the disease.

About the Environmental, Psychological and Social factors

We have discussed the biological factor. Now let's discuss the environmental, psychological and social factors. There are very few diseases which are purely biological in nature. The causes of most diseases are multifaceted. For the onset of a disease, and its progression, biology and environment must interact.
Emotional stress (psychological factor) can trigger the onset of a disease, including the disease of addiction, because stress may activate the genetic, biological factor. Stress may also trigger relapse of a disease in remission. We all know this to be true, and perhaps have witnessed this among members of our own families.

Prevention is Easier than Treatment

So, now you know that addiction is a chronic medical illness, and not simply physical dependence in the context of medical treatment, or recreational social drug/alcohol usage. Millions of people drink and drug and never develop the disease of addiction. There are, however, millions of people who are at great risk of this disease. I would rather prevent it than treat it. People come to specialists in addiction medicine because they either have the disease, are fearful that they may have it, or want to know their risk of having it, and how to avoid it. The health dangers inherent in various behaviors, be it stroke, heart attack, liver disease or mental health problems, are increased significantly if a person also has the disease of addiction.
One last thing. Honesty is imperative. I have had patients come to me for treatment of addiction, and upon thorough examination and diagnosis, I find that they do not have the disease of addiction. They may be drinking heavily, and doing more drugs than you can imagine, but they don't have the disease of addiction, yet. Seeing an addiction specialist is like seeing a heart disease specialist. You smoke, you drink, you eat fatty foods, and don't exercise. Okay, you don't have heart disease, yet. Both types of specialists will encourage you to change your life style and behavior to prevent the onset of disease. Among the diseases you want to avoid is the disease of addiction, and as a specialist in disease medicine, my fellow specialists and I are here to both treat and prevent the disease of addiction.

It is a Universal Problem

Addiction, as with other chronic medical illnesses, doesn't consider your race, religion, or political affiliation. It doesn't matter if someone is Christian, Jew, Muslim, Buddhist, Hindu or Atheist. This disease afflicts people from all walks of life, rich and poor, doctors, successful businessmen, clergy, and elected heads of state. The more people know about the disease of addiction, the less stigma will be attached to the individual who suffers from it, and more people will be willing to get the help they need.
Every physician and medical association world wide recognizes that addiction is a medical illness that is both preventable and treatable. It is to this mission prevention and treatment that I have dedicated my life and medical career.

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