Michael Baron, MD, MPH, FASAM, a triple board certified psychiatrist and specialist in chronic pain…
Addiction: Behavioral Health Issue, Mental Health Disorder or Something Else?
Decades of scientific research have made clear that addiction is not a moral failing, a character flaw or a sign of weakness, but rather a chronic brain disease. Still, it typically falls under the umbrella of behavioral health. Some suggest that this classification is contributing to the stigma surrounding addiction. Is “behavioral health” a stigmatizing term?
The Advantages of the Behavioral Health Classification
Viewing behavioral health as a stigmatizing term presupposes an overly narrow interpretation of the term. Behavioral health is a broad term that includes illnesses that can be addressed in whole or in part with changes in behavior. For example, a change in diet and exercise regimen may improve or eliminate health conditions such as diabetes, high blood pressure and heart disease. Quitting smoking cigarettes can lessen the associated physical health consequences such as lung disease.
Behavioral health is often used interchangeably with mental health, though the terms are in many ways different. With mental health, the outcome of the diagnosis can’t change by making changes in behavior (for example, bipolar disorder). Behavioral health, by contrast, is a term that brings hope to addicts and their families. Addiction is a brain disease, but there’s much addicts can do to improve the biological hand they’ve been dealt. Addiction is not a choice, but people suffering with addiction can choose to get help and take steps to manage their illness.
Since the 1970s, behavioral health has become almost a philosophy of health that empowers people to make changes that improve their mental, emotional and physical well-being. This can include treatments designed to affect neurobiology, such as medication, but medication alone does not fully address addiction.
Behavioral interventions, such as cognitive-behavioral therapy, motivational interviewing and relapse prevention, are a critical part of treatment and long-term recovery. Addicts must learn how to cope with cravings and triggers to use and develop healthier coping skills and communication strategies to improve their relationships with people in their social support network. They learn the importance of self-care and stress management. Even though addiction is a brain disease, many of the most effective treatment approaches are behavioral.
Addiction affects all aspects of life – social, emotional, physical, financial and spiritual. Nothing about our health occurs in a vacuum. Biology and environment interact. Mental health impacts physical health, and vice versa. Behavioral health care addresses all of these complex issues in an integrated way.
It isn’t a simple question of brain or behavior. It is both. Addiction is a primary brain disease that drives behaviors, such as cravings and drug-seeking. Judgment, decision-making and learning are affected by changes in the brain circuitry caused by prolonged drug use. These behaviors don’t cause addiction but are manifestations of the disease. Regardless of which came first, there are both biological and behavioral components that must be addressed in treating addiction.
A Broad Term for a Complex Disease
Saying addiction is one thing – a chronic brain disease – does not exclude the other – a behavioral issue. That’s the beauty of the term behavioral health. It’s broad enough to include both and paints a realistic portrait of the struggles facing people in active addiction and those on the road to recovery.
Unfortunately, the stigma attached to addiction seems to persist regardless of whether the disease is classified as a behavioral health problem, a mental health disorder or something else. While the appropriate labels can be debated, one fact is clear: Addiction is a chronic brain disease that impacts every area of a person’s life and requires comprehensive, long-term treatment that addresses both brains and behaviors.