Addiction Doctor offers a response to criticism of the new ASAM definition of addiction.
First, on the issue of stigma being reinforced by the “brain disease” message:
Ms Szalavitz misses the internal inconsistency in the data that stems from the “old” definition of addiction. Until ASAM’s new definition, every biological explanation of addiction as a whole or divided up into parts as addictions considered the etiology of the illness to be the drug which was used. Only such a definition could lead us to an increased understanding of something as a disease of bad character. What is missing in her critique is an examination of the real difference in the new definition: the word primary.
What ASAM’s definition says, at least by my reading, is that addiction is a primary change in brain function leading to symptoms which leads to the characteristic behavioral manifestations. This is utterly new. Addiction is not caused by using drugs; there is no mistake made by a weak person of bad character which caused the illness. This concept is so new, so different from what the public has been taught to believe that any past examination of beliefs about addiction would hardly be relevant.
Second, on the natural recovery criticisms and the limitations of the DSM diagnostic criteria:
Ms Szalavitz’s second point is that the word “chronic” in the definition is just wrong. As evidence she sites a study by Dawson et al in Addiction in 2005 that examined a natural history of DSM-IV alcohol dependence. Again, what she misses is the essential point. DSM defines alcohol dependence on a set a behaviors rather than as a biological disorder; it assumes no active illness if behavior changes, and does not consider drug switching in the definition. So in DSM, an alcohol dependent person who meets three of the seven criteria in a 12 month period modifies his drinking by increasing his use of pot (or overeating, or cigarettes or any other source of increased midbrain dopamine tone) no longer meets criteria for active alcohol dependence and would have been categorized in Dawson’s study as in non-abstinent recovery. What ASAM says is chronic is not the behavior, but the illness.