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Despite education and the prevalence of news about drug and alcohol abuse, many continue to lack a true understanding of drug addiction. Once thought to be a moral affliction, drug addiction is now considered to be a disease by various medical organizations, such as the American Medical Association (AMA), the American Society of Addiction Medicine (ASAM), the American Psychiatric Association (APA), and various counseling and social work organizations, to name a few. However, many individuals still harbor massive misconceptions about the nature of drug addiction and how to best confront this public health crisis.

photo of different types of drugs that can cause addiction

A Shift in Perception

Though there has been a gradual shift in society’s perception of drug addiction and its treatment, more progress must be made to advance the public’s understanding of chemical dependence, its prevention and treatment. Drug addiction does not have cultural, racial, sex, or socioeconomic boundaries; anyone can acquire the affliction.

The shift in the medical community from treating drug addiction (outside of withdrawal) solely through psychiatric treatment, counseling or self-help groups came about through research. Researchers first had to ask themselves: “what is addiction?” When one becomes addicted to a substance, there are reproducible and predictable changes that occur in the brain’s structure and function.

The Chemistry of Drug Addiction

Chemically, drug addiction primarily affects an individual’s reward system by impacting the regulation of the neurotransmitter dopamine: the neurotransmitter responsible for pleasure. However, multiple other neurotransmitters like serotonin, GABA, norepinephrine, endogenous opioids (endorphin), glutamate, cannabinoids, and acetylcholine are also involved. Likewise, areas of the brain that regulate emotions, decision-making, impulse control and judgment are impacted. Essentially, when an individual falls into the trap of drug addiction, their brain is being controlled by drugs, and they are unable to stop exposing themselves to mood-altering substances without a drastic impact on their physical and mental well-being.

The Neurophysiology of Drug Addiction

For scientists in the field, drug addiction is defined as a chronic relapsing disorder. This means that it is similar in nature to conditions such as diabetes that individuals must try and manage throughout their lifetimes, often with a combination of medical interventions and behavioral changes. These sorts of diseases often feature relapses that must be addressed in an acute fashion and long-term management strategies that need to be followed consistently and supported by evolving education about the disease. With drug addiction, different drugs each have their own distinct patterns of addiction (that also depend on dose and length of use), but all share a similar three stage pattern in which each stage feeds into the other in a self-reinforcing feedback loop that becomes more intense over time. In simple terms, drug addiction is a feedback loop with three distinct stages: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation.

infographic circle representing the cycle of drug addiction using cloud images with people in each of them


All known addictive drugs activate reward regions in the brain by causing sharp increases in the release of dopamine. When this occurs, the brain elicits a reward signal that also triggers learning or conditioning. And, much like in the experiments with Pavlov’s dogs, when this process is repeated enough times (such as through chronic use of a drug), dopamine cells actually fire off in anticipation of the reward as well. In this way, any stimulus that is repeatedly connected with drug use — such as environments in which a drug has been taken, people with whom it has been taken, and the mental state of a person before it was taken — may elicit conditioned, fast surges of dopamine release that trigger craving for the drug, motivate drug-seeking behaviors and lead to binge usage of the drug in question.

In addition, the greater the reward (in this case the level of intoxication of the drug), the greater the lengths to which people will go to obtain it. And, unfortunately, while dopamine cells usually stop firing after the consumption of a natural reward such as food or sex, the same dynamic does not hold true for addictive drugs. These drugs do not have a similar “off-switch” such as the feeling of fullness after eating a large meal, enabling those suffering from drug addiction to continue tapping into the dopamine high they receive from these substances with much greater frequency. [2]

Withdrawal/Negative Affect

As drug addiction progresses, non-drug-related rewards lose the power to motivate the drug addict and become replaced almost entirely by the pursuit of the drug of their addiction. But, this is not the only way in which drug addiction warps behavior. In addition to the “carrot” of intoxication, drug addiction also has the “stick” of withdrawal. In fact, as the level of drug addiction progresses over time, this desire to avoid the pain of withdrawal becomes the primary reason for drug abusers to continue their use. The science of drug addiction backs this up; multiple clinical and preclinical studies have shown that drug consumption triggers much smaller increases in dopamine levels in the presence of addiction than in its absence. As a result, individuals with drug addiction no longer experience the same degree of euphoria from a drug as they did when they first started using it. This process also causes addicts to become less motivated by other non-drug stimuli such as relationships and activities they used to enjoy. And, over time, these changes become deeply ingrained and cannot be immediately reversed through simply stopping use of the drug in question through medically-monitored or “cold-turkey” detox.

In addition to resetting the brain’s reward system, repeated exposure to the dopamine-enhancing effects of most drugs increases the person’s negative reactions to stress and generates a variety of negative emotions. This process is fueled by the brain’s own stress-response neurotransmitters that cause a drug addict to feel intense physical and emotional distress when the effects of their drug of addiction wear off. Thus, in addition to the direct and conditioned “pull” toward the “rewards” of drug use, there is also an intense motivational “push” to escape the discomfort associated with the aftereffects of use. As a result of these changes, the person with addiction transitions from taking drugs simply to feel pleasure, or to “get high,” to taking them to get relief from the pain of withdrawal, creating a vicious cycle. [2]


During drug addiction, the changes that occur in the reward and emotional circuits of the brain are accompanied by changes in the parts of the brain involved in executive brain function as well. Many brain processes are disrupted by this effect, including:

  • the capacity for self-regulation
  • decision making skills
  • flexibility in the selection and initiation of action
  • assignment of relative value
  • error monitoring

In addition to these changes to executive brain function, individuals suffering from drug addiction have impaired ability in the part of their brain that weakens their ability to resist strong urges or to follow through on decisions (such as the decision to stop taking the drug). These effects explain why persons with addiction can be sincere in their desire and intention to stop using a drug and yet simultaneously impulsive and unable to follow through on their resolve, even in the face of potentially disastrous consequences. [2]

One can be addicted to mood-altering substances such as caffeine, nicotine, or marijuana (depending on the jurisdiction), or can be addicted to highly toxic substances like methamphetamine or opiates (heroin, prescription pain pills). In any case, the diagnostic criteria are nearly identical.

Addiction: The continued use of a substance, despite negative consequences and the inability to terminate use even when one is desperate for sobriety.

Seeking Treatment for Drug Addiction

By the time most addicted persons enter a drug rehab, they have already wholeheartedly attempted to terminate their use multiple times, without success, or with short periods of success. The lack of favorable outcomes is not due to a deficit of morality or willpower, but rather to a neurologic condition that requires expert drug treatment to heal.

Since addiction is a chronic disease, much like diabetes and hypertension, its treatment requires ongoing recovery efforts. Many of those addicted to drugs fear that they will be in treatment for the remainder of their lives. This is far from the truth. Post-treatment recovery activities can include weekly or monthly counseling, regular physician visits and taking medication when necessary, self-help groups, healthy recreation activities and spiritual pursuits.

Unfortunately, relapse is a part of any chronic disease, and drug addiction is no exception. Although many drug addicts who have received appropriate treatment and are in a committed recovery program do not have a “slip” and do not relapse; sadly, others do. A relapse, however, does not necessarily mean that the recovering person did not follow-through or was not committed to his/her sobriety, nor does it mean that the person is a failure. Relapses occur; the most important thing is that the person in relapse seek drug treatment and the assistance of a strong self-help group as soon as possible.

Cost of Drug Addiction in the US per year

Although many medical options have become available for drug addiction treatment, new and more potent drugs are being illegally manufactured and distributed worldwide, ever-battling with the U.S. Drug Enforcement Agency (DEA). Many of these substances, such as fentanyl, carfentanil, U-47700 (Pink), and many other synthetic drugs have led to numerous deaths by overdose or suicide. Prevention is always the best answer for addiction. But, when one has become addicted, there are many drug treatment options available to treat each unique individual and restore health. In order to benefit from treatment, the patient must have a deep comprehension of what drug addiction is and a desire to break its hold upon them once and for all.

Help is at your Fingertips

If you or a loved one has fallen into the vicious cycle of drug addiction, don’t wait until it is too late to get the professional help you need. Call BWR at 800-683-4457 to start your journey to wellness today!



[1] Frontiers in Integrative Neuroscience,
[2] The New England Journal of Medicine,
[3] National Institute on Drug Abuse,


Behavioral Wellness & Recovery is a Joint Commission accredited program. The Joint Commission recognizes excellence in health care organizations and programs.


Behavioral Wellness & Recovery is a Joint Commission accredited program. The Joint Commission recognizes excellence in health care organizations and programs.

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