Willpower is not enough to combat addiction

Addicts can not overcome their dependence with the will alone

14/10/2011

To date, there is widespread belief that successful addiction treatment is primarily a matter of will. But this view does not do justice to the fact that most addictions are a chronic disease of the brain, say Michael Miller and colleagues from the American Society of Addiction Medicine (ASAM)..

The addictions usually require extensive treatment in order to successfully combat them. Although the willpower of the affected play a significant role, but other factors must also be taken into account, explained the US doctors. Michael Miller emphasized that successful addiction treatment is about much more than bad habits.

The American Society of Addiction Medicine therefore advocates the development of more effective treatments that also consider addiction as a chronic disease. In addition, the US doctors for a changed perception of addictions in public strong. Society needs to understand that addictions are a serious medical problem, the solution of which requires a great deal of patience - even with those affected. The addictions should be tackled with the same seriousness as diabetes or cardiovascular disease, Miller and colleagues said. The US physicians refer not only to dependencies on alcohol and drugs, but also on compulsive eating habits and gambling. Any addiction treatment should be long-term as a treatment and always be prepared for possible relapses, the ASAM experts explained.

23 million Americans need an addiction treatment
The National American Institute for Drug Abuse. „National Institute on Drug Abuse“ / NIDA) welcomes the dedication of ASAM and, for its part, is always keen to make more physicians aware of routinely looking for signs of addiction in their patients' daily medical routines. The NIDA expert Nora Volkow emphasized that the addictions as „Behavioral Disorders Result of a malfunction in the brain“ are. The therapy must consider this aspect accordingly. According to the US Institute for Drug Abuse, around 23 million people in the US currently require treatment for abuse of various addictive substances. However, only about two million patients actually receive professional support in combating their addiction. In addition, participation in a therapy does not automatically control the addiction. According to the NIDA, a particularly high risk for the success of the treatment are possible relapses. These are not only misunderstood, but are also particularly frustrating for the addicts, said Nora Volkow. As a typical statement of family members Volkow called the sentence: „You were at a withdrawal clinic, and now you're taking drugs again.“ This often has a fatal effect on the motivation of those affected.

Addiction as a chronic brain disorder
The lack of understanding of addicts' difficulties does not do justice to the status of addictions as a chronic condition, the NIDA expert said. The addicts' environment is often lacking the awareness that possible relapses in the treatment of a chronic illness simply belong to it, so the statement of Nora Volkow. The predisposition in the brain often remains years after the patients have successfully combated their addiction, explained Volkow. Among the processes that take place in the addict's brain, the expert explained that addictions are a complex interplay between emotional, cognitive, and behavioral factors. In addition, the genetic predisposition play an essential role. So some people are basically more susceptible to the development of addiction than others. Therefore, experimenting with teenage drugs or administering strong pain killers after an injury has very different individual effects.

In addition, age can also have a significant influence on the development of an addiction, since the neural structures in the area of ​​the so-called frontal lobe are consolidated relatively late. The frontal lobe mediates between the more rational and the more emotional sides of the brain, and this also plays a crucial role in turning off unhealthy behavior, the NIDA expert said. Since the frontal lobes are not fully developed in younger people, this has greater difficulty to ward off external influences and to turn off the unhealthy behavior, Volkow continued. However, there is a heightened search risk not only among younger people and people at higher risk, but also when people try to compensate for emotional stress such as alcohol stress or grief, the NIDA expert explained.

Understanding of the neurological processes required
The chronic brain disease that underlies most addictions is described by the US physicians as disorders of the brain reward system. Due to the increased distribution of the so-called „happiness hormone“ Dopamine, which, as a neurotransmitter, triggers a satisfied feeling after satisfying their addiction, takes place in the brain, with the result that routines and rituals that are perceived as pleasurable solidify, explained Volkow. Whether it's smoking, drinking alcohol, overeating or gambling, the expert continues. For the addicts, the distorted reward system means that they continue their behavior even if the brain is already used to the satisfaction of addiction and the original pleasant effects no longer occur, so Volkow on. According to Michael Miller, in order to overcome the addictive disorder, not only the willpower of the patients, but also a therapeutic accompaniment with a deeper understanding of the underlying causative neurological processes are required. It also had to „the shame associated with the topic“ be reduced. Many addicts would already be helped, according to Miller, if the stigma, which is still common, is not met.

Natural healing against addictions
In the interests of those affected, it can be worthwhile to follow new paths in addiction treatment. For example, since 2009, around 500 addicts have been treated at the Salzburg Double Clinic in Austria with the help of natural healing and relaxation methods. This novel approach greatly reduced the use of medicines, reported project manager and psychiatrist Stefan Brunnuber at the end of last year. In addition, the treatment methods such as acupuncture, liver wrap for detoxifying the body or breathing exercises for anxiety and panic attacks were very well received by the patients. While the treatment of patients was based on daily medication and psychotherapy, they were able to learn to take their lives into their own hands again after the introduction of naturopathic treatments, emphasized Brunnuber. The fact that those affected now have to take more responsibility for themselves, they also have their passive inner attitude towards the therapy, says the expert. (Fp)

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Image: Paul-Georg Meister