Do We Know What Causes Addiction? Does It Matter?
by Michael Walsh
There are still a lot of unknowns when it comes to substance use, misuse, addiction, treatment and recovery. [Updated March 2023]
Massive amounts of research has been conducted and more is underway, as the world grapples with the effects of substance use disorders.
But we’ve come a long way. Up until the 1950s excessive alcohol and drug use was considered a moral failing that was met with disdain and judgment by society. In 1956 the American Medical Association officially recognized alcoholism as an illness and addiction was given the same classification in 1987.
This was a critical turning point in how society views and treats chemical dependency.
The shift has led to a medical consensus that substance use disorder is a brain disease conceptualized by a three-stage framework called the neurobiology of addiction.
The reframing of substance misuse from a character flaw to a medical condition has served to chip away at the stigma historically associated with it. But many experts feel that the disease model of addiction misses the mark. And so continues the debate about what causes addiction.
World-renowned Canadian addiction expert, Dr. Gabor Maté is a vocal opponent of the disease model. Maté has worked with patients suffering from severe substance use disorders for several decades. He believes that addiction is not a disease but rather a logical (albeit detrimental) coping mechanism, often in response to unresolved trauma.
Both sides of the debate have merit. It’s helpful to be aware of developments emerging from either side but always keep the individual in mind. Experiences with substance dependency vary and so should treatment approaches.
The Neurobiology of Addiction
So what exactly is the neurobiology of addiction? Neurobiology is the science of the physiology, anatomy, and pathology of the brain and nervous system.
The nervous system in the simplest of terms is the body’s command centre. It’s how the brain signals the body to respond to internal and external stimuli.
The neurobiology of addiction asserts that substance dependency is a brain disease. The American Society of Addiction Medicine (ASAM), states, “addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry.”
The primary framework associated with this disease model is that addiction is essentially a three-stage loop. The first is the intoxication stage in which overconsumption – or binging – occurs, providing pleasure that the brain experiences as a reward. This is followed by stage two which is characterized by negative effects and withdrawal as the substance loses its effect. The third stage is a preoccupation with drinking or using again (cravings), which then leads back to stage one.
Regarding the brain's circuitry, each of these stages corresponds to specific brain functions. The intoxication from addictive substances activates the reward systems in the brain by releasing chemicals like dopamine and serotonin. The negative effects and withdrawal that follow increase the body's stress response which then intensifies cravings.
Over time this cyclical pattern is reinforced and becomes habituated. What could have been considered an impulse to use in someone with substance misuse, becomes a compulsion when a full-fledged substance use disorder evolves.
While impulsivity is easier to manage with behaviour modification tools, compulsions are much more powerful.
The compulsion to drink for someone suffering from alcohol use disorder causes intrusive thoughts that heighten anxiety until action is taken to provide relief.
As time goes on, the pleasurable effects diminish with habitual use. This results in the need for greater amounts of alcohol or drugs to achieve the same level of intoxication. As tolerance increases and positive effects are harder to achieve, drug and alcohol use becomes a way to stave off the negative effects of withdrawal.
Substance use then becomes an ingrained behaviour that follows the three-stage loop that defines the neurobiology of addiction. At this point, the cycle becomes increasingly harder to interrupt as the brain is essentially wired to follow its pattern.
Substance Misuse as a Coping Mechanism
Dr. Gabor Maté is just one of many experts who believe that substance misuse is a way that people cope with trauma, adverse childhood experiences, and pain caused by a variety of life circumstances.
Developmental neuroscientist Dr. Marc Lewis (in recovery from substance dependency himself) also refutes the disease model of addiction. Drawing from his personal experience and his own research, he believes that addiction is a behavioural issue rather than a medical one.
His philosophy draws criticism from those who believe that eliminating disease as the cause of addiction will further perpetuate stigma. Suffering from an illness means that it’s outside of an individual’s control. If addiction isn’t a disease then it may again be viewed as a personal choice.
Neither Lewis nor Maté see it that way. They feel that an individual suffering from substance misuse has the highest chance of recovery if they can see themselves as holding the power to make changes, rather than relying on a doctor to prescribe a path forward.
Both experts recognize an individual's history of trauma and environmental factors as critical considerations. The severity of which plays a key role in why someone is unable to get sober, or experiences recurring relapses.
In an interview conducted by The Guardian, Lewis explains that there certainly is a place for medical intervention in addressing severe substance dependency. When drug and alcohol use has led to physical ailments or if withdrawal needs to be medically managed, then yes a doctor is appropriate.
But when it comes to dealing with the habit of drug and alcohol use, positive outcomes are achieved by focusing on non-medical variables. Those are things like where the habit originates, the developmental stage of the individual, and social factors.
Does it Matter What Causes Addiction?
We are human beings, and as such, we tend to get hung up on the question of, why?
In all of the complexities of the human experience, people relentlessly seek to understand how and why things happen in hopes that they may relieve the tension of not knowing.
That is certainly present in the desire to understand what causes addiction. And the better question might be, does it matter?
In my opinion, the answer is yes and no.
The research, theories, and ideologies that continue to emerge around substance misuse are varied and often fascinating. They may very well lead to better treatment options in the future if the root cause is accurately identified.
But in the meantime they can also lead to confusion. People whose lives are impacted by the effects of alcohol and drug use may hesitate to take action because they don’t know which way to go for help.
I believe in treating the whole human and the unique traits and experiences that have led them to an unhealthy relationship with alcohol and drugs.
Rather than plugging a suffering human being into a medical model and subjecting them to a cookie-cutter treatment strategy, it’s important to look at the unique needs of each individual.
Effective treatment plans take many things into consideration. The spectrum from substance misuse to severe substance use disorder is vast.
If someone opens a bottle of whiskey at 8 am every morning to stave off withdrawal symptoms, they likely need a physician’s assistance and/or medical detox. On the other hand, someone who has a few drinks every night and maybe uses cocaine on the weekends when partying will need a completely different treatment strategy.
It doesn’t matter for either of these individuals what brought them to that place or caused the addiction. What matters is that each are supported in taking the next step toward reclaiming their health and their lives.
A one-size fits all approach isn’t effective and much of the science says "treatment needs to be tailored to each individual" – there are many ways to quit drinking or using drugs, and they should all focus directly on the needs of the individual.
Get Help Creating Your Personal Roadmap
It can be really scary to arrive at the realization that you have a drinking problem, no matter how big or small.
But it’s a lot less scary when you have an experienced guide to help you sort things out.
I’m an accredited Addiction Recovery Coach offering worldwide virtual support, and in-person support across Canada. If you’re interested in exploring 1:1 recovery coaching to help you cut back your drinking or stop drinking entirely, I’m happy to answer your questions.
I offer a no-charge consult call to anyone who has questions about their own substance use, or the substance use of a family member. These calls are completely confidential with no pressure to make a decision before you feel entirely ready.
If you’re ready to explore the potential of working together, I’d love to chat. Michael is based in Victoria British Columbia Canada and as of November 21, 2022 the other Recovery Coaches on the team are based in Nanaimo, Vancouver, Calgary, Edmonton, Toronto, Montreal and Halifax. Because we all work virtually — we can work with anyone no matter what city, province or country around the world. We have clients all across Canada and in Seattle, Los Angeles, Dallas, Miami, New York City, Denver, Nashville, Berlin, Tel Aviv, London, Singapore and Australia. — Michael Walsh
I’d also like to invite you to read more about my personal story here.
Michael Walsh
Phone or Text: 250.896.8494
Email: Coach@MichaelWalsh.com
Chat: Start a WhatsApp chat
About the Author
Michael Walsh
When I say I’ve been there, I mean it. I am a different person now, and I am fired up about helping other people get to the place where they, too, are living better, healthier, and bigger lives.
