Family & Friends FAQ
1. People keep saying that addiction is a disease. What kind of a disease is it?
Addiction (whether it is to drugs or alcohol) is a brain disease – a chronic, often relapsing, brain disease, and here is why this is true.
Everything in our body – both what we can see and what we cannot see – is made up of cells. Diseases change cells in our body – that’s what makes a disease a disease. A disease might change cells in body organs (like the heart or liver or eyes) or in body organ systems (meaning several organs working together), like metabolism or cardiovascular. For example, the disease of breast cancer attacks cells in the breast, and the disease of diabetes attacks cells in the metabolic system.
The diseases of addiction (drug addiction or alcoholism) change cells in the brain, thereby changing how the brain works. Because neural networks in the brain control everything we think, feel, say and do, these brain changes get in the way of a person’s ability to act normally and make good decisions. It can cause that person to do things like: starting fights with friends, yelling at or hitting family members, missing work, carrying on rambling arguments, accusing family members or friends of doing things they haven’t done, driving while under the influence, being super nice, not getting to work on time, not being able to fully concentrate when at work or school, or continuing to use/drink after promising not to. We call these “things” drinking/drugging behaviors. Additionally, alcoholism and/or drug addiction often change cells in several other body organs as well, such as the liver, heart, and kidney. As is true with other diseases, if left untreated or during a lapse in management of the disease, a person can die from alcoholism or drug addiction, just as people die from other diseases.
2. Is substance abuse the same thing as addiction?
Substance abuse and addiction are two different things, even though BOTH cause chemical and structural changes in the brain and therefore changed behaviors (drinking/drugging behaviors) as described in #1.
For example, alcohol abuse is defined as one or more of the following occurring within a 12-month period:
- Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).
- Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).
- Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct, DUI).
- Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights).
- Recurrent binge drinking, which is defined as 5 or more standard drinks on an occasion for men and 4 or more for women.
3. How does addiction differ from substance abuse?
The disease of addiction (whether it’s to alcohol or illegal or prescription drugs) has four primary characteristics that make it different than substance abuse.
These include: cravings, loss of control, tolerance, and physical dependence. An addiction craving, for example, can be five times stronger than our instinctual, hardwired drive to eat food when hungry because of the neural networks that are compromised. These powerful cravings override all other “thought” and are what cause an alcoholic or drug addict to lie and steal and do whatever it takes to drink or use.
4. What makes one person become an alcoholic or drug addict, while another person does not, even though that person drinks or uses too much?
While both substance abuse and addiction (aka substance dependence) cause chemical and structural changes in the brain and thus changed behaviors, there are five key risk factors that contribute to a person developing the brain disease of addiction. These risk factors include:
Genetics (if it runs in the family, genetic predisposition – not an “addiction” gene, rather genetic differences, such as higher or lower levels of neurotransmitters or receptors or the liver enzymes that break down alcohol, as examples); social environment (where heavy drinking or drug use is viewed as “normal,” causing a person to drink or use heavily, which given their brain/genetic make-up, may lead to substance abuse and/or addiction); childhood trauma (verbal, physical, emotional abuse, which “wires” unhealthy coping skills and brain changes); early use (critical brain development ages 12-early 20s makes the brain especially vulnerable to brain changes caused by substance misuse), and mental illness (e.g., depression, anxiety, ADHD, PTSD, bipolar – which also cause brain changes and often a tendency to “self-medicate” with alcohol or drugs). The more risk factors, the more susceptible a person is to the possibility of “crossing the line” from abuse to addiction.
5. Is treatment for substance abuse different from treatment for addiction?
Yes. With substance abuse, abuse patterns may be modified to fall within “normal” limits. Although for some people, “modification” is to stop all together. With addiction, the substance use must be stopped all together; there is no amount that a person who is addicted can “safely” use or drink, ever, if s/he wants to be able to control/stop their drinking/drugging behaviors.
This is an important distinction to understand because not all substance abusers become drug addicts/alcoholics, but all alcoholics/drug addicts go through a period of substance abuse.
As you will see when browsing through the Chooper's Guide FIND TREATMENT section, there is a wide range of treatment and recovery options from which to choose, and that’s because there is no one way or right way to “do” treatment. You will also find a number of other resources, such as detox centers, interventionists, drug and alcohol rehabs, drug and alcohol counselors, and co-occurring disorders treatment options.
As you are browsing through Chooper's Guide, you will likely come across a number of terms with which you are unfamiliar. Our list of Key Terms can help you get started with these.