We generally have a lot of time for ASAM and their sometimes long winded definitions of addiction.
Their new definition of Addiction is as “a chronic brain disorder and not simply a behavior problem…and also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems… Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.”
This is an issue for us as it does not appear to fully understand the role of emotions in some of the mechanisms which they include in their definition such as impulsivity, judgement and even reward dysregulation.
This is a poor understanding of brain mechanisms.
Emotions are involved in most basic brain processes from simple motor processes, to other cognitive processes such as judgement and decision making. In fact, impaired emotion processing directly prompts poor decision making via impulsivity by recruiting more motoric parts of the brain rather than cortical prefrontal areas of the brain.
Thus emotion cannot be discounted as secondary to a primary disease it is in fact a primary factor in many brain processes including cognitive processes.
Poor emotion processing means one cannot identify, label, describe and thus “send” the words for these emotions to the pre frontal cortex part of the brain so this, the pre frontal and cognitive part of the brain, cannot use this emotion information to make goal-directed adaptive decisions.
We make decisions based on emotion information regardless of whether we are aware of it or not. If we removed the role of emotion on decisions we would simple make the same mistakes over and over again as we do have not an internal “gauge” of these decisions not being optimal, so can not correct them.
Instead undifferentiated emotions which “read” as distress-like recruit more limbic and motoric parts of the brain. In other words, these undifferentiated emotions prompt a “fight or flight” type response to cope with these distress states. Thus decisions are based on alleviating this unpleasant feeling state and the pre frontal cortex is not recruited properly in decision making. It is a reactionary decision making profile.
This is seen in many studies which use delay discounting paradigms. Addicted individuals usually choose immediate short term gains over waiting a little longer for greater gains. We believe this distressed based impulsivity in decision making is evident in most addicted individuals and is based on relieving unpleasant feeling states as they are aware of the greater gains but still choose immediate rewards.
To say that emotions are not part of a primary disease also ignores the overwhelming research evidence that emotion regulation an processing regions of the brain in addicts and alcoholics are impaired, neuro-anatomically smaller, have network connectivity and functionality deficits and so on.
This means that the impaired emotion regulation networks are primary dysfunctions which represent a pre-morbid vulnerability to later addiction, as these are all seen in children of alcoholics, so emotion can not be discounted as a secondary influence.
Also this emotion regulation deficit can not only be genetically inherited but also greatly impacted on via adverse environmental influences such as child maltreatment often in families where emotion regulation and stress coping strategies are lacking.
Finally emotion dysregulation also potentiates (heightens) reward in those vulnerable to later addiction (so they like stuff more). Negative emotion becomes “regulated” by external means which make them “feel better”.
Stress and emotion dysregulation also continue to become pathologically impaired in the addiction cycle and reward dysfunction is increasingly the consequence of this too.
Addicts have a primary emotion disease and emotions and brain structure can not be disassociated in the manner ASAM attempt to do.
Emotion is the fuel that drives brain processes, the sooner we all grasp this the better for everyone, particularly people who need recovery.
Addiction is a neuro-endocrinological (stress based) disease state, with high genetic and environmental input but which also blends with issues such as insecure attachment and resultant negative self schema.
Not feeling good enough drives addiction as well as any altered neurobiology. In fact it is an altered neurobiology which contributes to brain allostasis as much as so-called primary factors.