WEEK 5 Biomedical Model of Addiction

BioMedical Model of
addiction
Dr. Wangui Waithima
Introduction
• The biological component of this model are the anatomical, structural, and molecular substrates of a
disease such as SUDs.
• Process
• Natural reward paths in the brain can be activated by drugs.
• Pharmacological reward potential
• Biological determinism
• History
• Dr. Benjamin Rush suggested alcoholism was a disease.
• Jellinek’s work
• He argued that alcoholism is a disease, like cancer or pneumonia. Proposed four stages:
• Pre-alcoholic stage
• Prodromal stage
• Physical dependence
• Chronic stage
• The model offered a new paradigm for physicians to use when assessing a potential AUD; broke from
“moral deficit” model.
• Genetic inheritance theories
• Importance of environment or life experiences was recognized.
• Heritability for Type II alcoholism was higher than Type I
alcoholism, suggesting vulnerability that was transmitted from
father to the son.
• Epigenetics: Environmental forces can activate genes.
• Neurobehavioral theories: Neurological pathways are established and
strengthened by experiences.
• Decades of research have revealed addiction to be a disease that alters
the brain. Research has also taught us that addiction is a complex
disease, influenced by a multitude of highly entangled factors.
• Its characterized by;
• Compulsive behavior
• Continued abuse of drugs despite negative consequences
• Persistent change in brain structure and function
• Research has revealed that addiction affects the brain circuits involved in
reward, motivation, memory, and inhibitory control. When these circuits are
disrupted, so is a person’s capacity to freely choose not to use drugs, even
when it means losing everything they used to value. In fact, the inability to stop
is the essence of addiction, like riding in a car with no brakes.
• Using imaging technology to measure metabolism (in this case,
glucose uptake) in the brain and heart, one can see that both
addiction and heart disease produce observable changes in
organ function.
• In drug addiction, the frontal cortex, which is a part of the brain
associated with judgment and decision-making, is significantly
affected. Like heart disease, drug addiction can be prevented
and treated successfully. If left untreated, however, its effects
can last a lifetime.
• The biological differences theories
• Attempts to identify biological distinctions between those who were and who
were not alcohol-dependent
• The dopamine D2 hypothesis
• At least 5 different dopamine receptors in the brain
• Neuroimaging studies
• Orbitofrontal cortex and anterior cingulate gyrus
• Digestive system—enteric nervous system
Addiction is recognized as a chronic relapsing brain disease expressed in the form of
compulsive behaviors.
• Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry
• The disease model of addiction describes an addiction as a disease with biological, neurological,
genetic, and environmental sources of origin.
• The disease of chemical dependency can be traced to neural pathways in the brain predating a
diagnosis of addiction
• The biological processes that cause addiction involve the reward pathways in the brain. These circuits
provide rushes of positive feeling and feel-good chemicals to "reward" substance use.
• Addiction, often referred to as a brain disease, is a chronic illness that is often characterized by one or
more relapses. Over time, a person who abuses drugs or alcohol will experience changes to the brain
that make it difficult for them to think clearly and make decisions in the same manner as a person
who is not addicted.
• Addictive substances are initially pleasurable.
•The ‘reward centers’ of the brain are stimulated. (limbic system)
•Flooding of the brain with dopamine is a major effect.
•The reward centers of the brain are normal parts of us that make us
glad, help us enjoy life and respond normally to other people close to
us.
• Besides addiction, drug abuse is linked to a variety of health
problems, including HIV/AIDS, cancer, heart disease, and many
more.
• Often, the chemical structure of drugs is similar to brain chemicals
or neurotransmitters. Similarity in structure allows them to be
recognized by neurons and to alter normal brain messages
• Dopamine is a brain chemical involved in many different
functions including movement, motivation, reward — and
addiction. Nearly all drugs of abuse directly or indirectly increase
dopamine in the pleasure and motivation pathways and in so doing,
alter the normal communication between neurons.
Critic to the theory
• Philosophical
• What is meant by “disease”?
• Where does choice begin and end?
• Methodological: Research drawn from animals
• Reactions to the Jellinek model
• Reactions to the genetic inheritance theories
• Neurogenetic determinism that absolves responsibility for behavior
• Addiction may be polygenic, and genetic heritage may account for as little as
10% of risk for developing a SUD
• Reactions to the epigenetics model
• Reactions against the Dopamine D2 receptor site hypothesis
Critic..
• Reactions to the biological vulnerability studies
• Findings regarding this have been mixed
• May not indicate a predestination to addiction
• Challenges to the neuroplasticity aspects of the disease model
• Challenges to the brain imaging studies
• Challenges to the genetic modification treatment approaches
• Remains theoretical with little practical value
• The medical model and individual responsibility
• Theories about “craving” “urges” and such are based on reports from those
who were unsuccessful at resisting.
• Research has failed to show those with an SUD truly lose the power of self-
control.
• Often substance use requires several active decision points in order to
proceed.
• Spontaneous recovery
• Estimates that as many as 75–95% of those with SUD will eventually recover
on their own.

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