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ASAM Wants New Definition of Addiction to Inspire More Effective Responses

October 28, 2019

Saying that an incomplete understanding of addiction has contributed to “an inadequate and unimaginative national response” to the overdose crisis, two leading officers in the American Society of Addiction Medicine (ASAM) have outlined the reasoning behind the medical organization's new and more comprehensive definition of addiction.

ASAM president Paul Earley, MD, and vice president Yngvild Olsen, MD, co-authored a commentary published last week in Medium, stating that policy and industry discussions that fail to grasp addiction's complexity have marred efforts toward comprehensive action plans and have often led to harmful punitive approaches to people with the disease.

ASAM's new definition of addiction, encompassing the biological, psychological and environmental conditions that contribute to the disease, reads:

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.

Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.

The commentary from Earley and Olsen indicates that ASAM's prior definition, formulated in 2011, focused on brain circuitry at a time when the public still had limited acceptance of the notion of addiction as a brain disease. While strides have been made since then, the authors stated that much of the nuance of addiction has remained beyond the grasp of policy-makers and even members of the medical community.

The authors stated that the new definition helps to clarify the difference between a substance use disorder, which can be characterized as mild, moderate or severe, and addiction, which reflects changes in brain function that manifest as symptoms of a moderate to severe disorder.

The definition's emphasis on continuation of behaviors despite harmful consequences is intended to highlight the misguided nature of punitive approaches to the drug crisis, according to the authors. “Blanket punitive policies—including incarceration without access to evidence-based addiction treatment medications—ignore science,” Earley and Olsen wrote.

Earley is based in Atlanta and has practiced as an addiction medicine specialist for 30 years. Olsen serves as medical director at the Institutes for Behavior Resources Inc./REACH Health Services in Baltimore.

The authors hope that an updated definition of addiction will lead to bolder policy initiatives that encompass areas such as higher standards for treatment programs, enhancement of the treatment workforce and meaningful funding for addiction and mental health treatment.

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