ASAM’s definition. Utterly new?

the world is upside down by katelynmarie<3

Addiction Doctor offers a response to criticism of the new ASAM definition of addiction.

First, on the issue of stigma being reinforced by the “brain disease” message:

Ms Szalavitz misses the internal inconsistency in the data that stems from the “old” definition of addiction. Until ASAM’s new definition, every biological explanation of addiction as a whole or divided up into parts as addictions considered the etiology of the illness to be the drug which was used. Only such a definition could lead us to an increased understanding of something as a disease of bad character. What is missing in her critique is an examination of the real difference in the new definition: the word primary.

What ASAM’s definition says, at least by my reading, is that addiction is a primary change in brain function leading to symptoms which leads to the characteristic behavioral manifestations. This is utterly new. Addiction is not caused by using drugs; there is no mistake made by a weak person of bad character which caused the illness. This concept is so new, so different from what the public has been taught to believe that any past examination of beliefs about addiction would hardly be relevant.

Second, on the natural recovery criticisms and the limitations of the DSM diagnostic criteria:

Ms Szalavitz’s second point is that the word “chronic” in the definition is just wrong. As evidence she sites a study by Dawson et al in Addiction in 2005 that examined a natural history of DSM-IV alcohol dependence. Again, what she misses is the essential point. DSM defines alcohol dependence on a set a behaviors rather than as a biological disorder; it assumes no active illness if behavior changes, and does not consider drug switching in the definition. So in DSM, an alcohol dependent person who meets three of the seven criteria in a 12 month period modifies his drinking by increasing his use of pot (or overeating, or cigarettes or any other source of increased midbrain dopamine tone) no longer meets criteria for active alcohol dependence and would have been categorized in Dawson’s study as in non-abstinent recovery. What ASAM says is chronic is not the behavior, but the illness.

One thought on “ASAM’s definition. Utterly new?

  1. I am so thankful that this country funnels billions of dollars into organizations like ASAM each year so they can define, re-define, characterize, classify and label our nation’s #1 preventable health care issue (without supporting those attempting to cure it.)

    This “new definition” continues to omit ALL of the physical and medical aspects that commonly characterize addiction (a seemingly odd omission coming from an organization dedicated to Medicine.) When a family member is concerned for an addicted loved one’s life, they never say “his behavioral control is impaired and his recognition of significant problems with his relationships is diminished.” They DO say “he’s so thin.” “His stomach hurts all the time.” “He constantly craves sugar.” “He has rashes all over.” Almost all say “if you just look at him you can see how sick he is.”

    It seems that the statements made by real patients and their families reflect real, organic problems in the BODY of an addict, not just in his hippocampal circuits or nucleus accumbens. While I have no doubt that these neurological parts are severely malfunctioning, I know through years of medical testing that his body is just as impaired if not more. I also know that he is deficient in most essential nutrients, his liver processes are operating out of balance causing a build-up of toxins that will quickly enter his brain and his gut is not able to absorb. Despite these proven medical issues in addicted patients, ASAM’s definition reads like a prescription drug ad for depression (you know, the ones that list 800 side effects including suicidal ideation, stroke and PHYISCAL DEPENDENCE.)

    The extended form of this definition addresses NOTHING about the physical aspects of this VERY physical disease. I find it sad that our tax dollars are being wasted on organizations that remain short-sighted and stagnated in an archaic worldview that facilitates neglect of those suffering from addiction and infects our treatment industry with an ideological virus that prevents progress and success. Our trying economic times make this lack of sincerity and progress even more upsetting. I propose the American Society for Addiction Medicine be renamed the American Society for Addiction Behavior – since there is no mention of anything medical in their perspective of this dynamic, expensive and deadly disease. Then take their funding and just pay addicts to stay off drugs. We might get better results and save paper.

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