ASAM’s New Definition Of Addiction

After four years of research and consultations with 80 addiction experts, clinicians and scientists, the American Society of Addiction Medicine’s (ASAM) long-awaited definition of addiction has arrived. But is it a change in the right direction?

The new definition has garnered the support of many experts in the field, as well as its share of criticism. Here are a few ways in which the new definition may help (or potentially hurt) people suffering from addiction and the professionals who treat them.

Access to high-quality addiction treatment

How it could help:

By and large, most experts agree that the new ASAM definition makes the future more hopeful for addicts and their families.

The new ASAM definition confirms what addiction experts have known for decades: Addiction is a chronic brain disease. As more health care providers and drug treatment centers develop a deeper understanding of addiction, it is likely that medical screenings will become more frequent and more accurate. Access to high-quality, evidence-based addiction treatment will also improve. Another likely result is enhanced collaboration between primary care physicians and behavioral health care providers, ensuring more consistent care.

According to ASAM, “Recovery from addiction is best achieved through a combination of self-management, mutual support, and professional care provided by trained and certified professionals.”

Given ASAM’s guidance on the most effective treatments for addiction, supporters predict that more people will recognize the need for professional treatment, thereby reducing the risk of relapse and minimizing the personal and public health costs of untreated or inadequately treated illness.

How it could hurt:

Since addiction is now recognized as a disease of the brain, and diseases are typically treated with medication, many experts are predicting an increase in medication-assisted treatment. While this isn’t necessarily a negative development, there is a concern that medication may be the only treatment that will be met with improved insurance coverage.

ASAM members addressed this point by stating that medication can aid in addiction treatment but is only effective when combined with the psychological, social and spiritual aspects of treatment.

ASAM has also come under scrutiny for citing a breakdown in connection with “the transcendent (referred to as God by many, the Higher Power by 12 steps groups, or higher consciousness by others)” as a contributing factor in addiction. For some, bringing the concept of spirituality into medicine detracts from the legitimacy of ASAM’s statement that addiction is a brain disease. But many who have recovered from addiction staunchly support the importance of a spiritual connection.

Insurance coverage for addiction treatment

How it could help:

The new definition of addiction is in line with findings from the past two decades of scientific research. Having the disease concept of addiction formalized by ASAM, the nation’s largest professional society of physicians dedicated to treating and preventing addiction, creates the potential for broad changes in health care.

Supporters believe the new definition, which recognizes addiction as a primary disease that requires long-term treatment, will lead to improved medical screenings and enhanced insurance coverage for various levels of addiction treatment. Since addiction is biological, not a choice, insurers may identify fewer roadblocks to reimbursement.

How it could hurt:

ASAM’s revised definition comes at a time when the American Psychiatric Association (APA) is preparing its highly anticipated revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which sets forth the standard criteria for mental health disorders. Because insurance companies use the DSM to determine coverage, the criteria in the DSM have significant bearing on patients and the health care system.

ASAM’s definition is, in some key ways, at odds with the DSM. ASAM’s approach is based on the biology of the brain while the APA focuses on noticeable behaviors that are symptomatic of addiction. Whereas ASAM views all addictions the same, whether to drugs, sex, food or gambling, the DSM only recognizes certain addictions and will define each of those separately.

ASAM members describe addiction as a chronic illness similar to heart disease and diabetes, but it is also different. It goes beyond physiology and extends into the social, emotional and spiritual realms. This concept is hard to grasp for those who believe that a medical problem requires a medical answer. The medical field is based on empirical evidence, and improvements in social, psychological and spiritual functioning can be difficult to measure.

All of these differences raise concerns. Without a united voice from the experts in the field, insurance companies may have an “out” to cut reimbursements rather increase coverage. If insurers conclude that a medical disease should be treated with a medical solution (i.e., medication), some fear the result may be less coverage for non-pharmaceutical interventions and fewer treatment options.

The stigma of addiction

How it could help:

It is clear that one of ASAM’s goals is to fight the stigma of addiction. Rather than looking at addiction as a moral weakness or character flaw, ASAM defines addiction as a chronic brain disease similar to heart disease and diabetes. Because a person does not choose to be addicted, there should be less blame and shame surrounding the disease.

Some believe that drawing this comparison to heart disease and diabetes brings addiction within the scope of more widely understood diseases, which may translate into fewer barriers for people seeking help. More people will be encouraged to get treatment, including not only those with drug or alcohol addictions but also those facing food, gambling or sex addiction.

How it could hurt:

A number of commentators have pointed out that calling addiction a brain disease is unlikely to reduce stigma. Research shows that genetics and brain abnormalities are still unfairly perceived as weaknesses by many.

Previous studies of alcoholism have found that dubbing a condition as neurobiological does little to reduce stigma and may even increase it. A University of Nevada researcher found that the word disease has similar connotations as the labels drunk and intoxicated.

If people perceive chronic as permanent and unchangeable, they may conclude that addicts are helpless and out of control. In addition, some argue that addiction is not a chronic illness in all instances, since some people recover without treatment or 12 step support.

The role of relapse

How it could help:

ASAM describes relapse as a “persistent risk.” Although not inevitable, relapse is a “common feature of addiction.” As a result of ASAM’s new definition, relapse is less likely to be seen as a failure and more likely to be acknowledged as part of the disease of addiction. Instead of blame or shame, the hope is that more addicts will be supported and helped back into treatment.

ASAM’s description of relapse creates a realistic perception of the chronic nature of the disease. This may help addiction sufferers and their families, health care providers, and insurance companies understand that long-term treatment and monitoring are required for a successful recovery.

At the same time, ASAM communicates an empowering message of hope. The statement reads, “Addiction professionals and persons in recovery know the hope that is found in recovery. Recovery is available even to persons who may not at first be able to perceive this hope.”

How it could hurt:

By classifying addiction as a chronic illness, some question whether the message of hope will get across, or if those struggling with the disease will give up for lack of a “cure.” For the general public, it can be difficult to accept that a friend, loved one or patient may be fighting relapse for the rest of their lives.

The true impact of ASAM’s new definition of addiction may not be fully understood for months or even years to come. But it opens the door for positive change. The way treatment providers and insurers interpret these new insights into addiction could mean a lot less suffering for those who need help most.

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