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Written and produced by Clara Liao, PhD student in neuroscience at Yale University.
Addiction is now considered a brain disease. Whether it's alcohol, prescription painkillers, nicotine, gambling, or something else, overcoming an addiction isn't as simple as quitting or exercising better control over impulses. That's because addiction occurs when the pleasure circuits in the brain become overwhelmed, in ways that can become chronic and sometimes even permanent. This is the point at play when you hear about reward "systems" or "pathways" and the role of dopamine in relation to addiction. But what does all this really mean? One of the most primitive parts of the brain, the reward system, evolved as a way to reinforce behaviors we need to survive — like eating. When we eat food, the reward pathways activate a chemical called dopamine, which in turn triggers a jolt of satisfaction. This encourages you to eat again in the future. When a person develops an addiction to a substance, it's because the brain has begun to change. This happens because addictive substances trigger an excessive response when they reach the brain. Instead of a simple, pleasant dopamine rush, many drugs – such as opioids, cocaine, or nicotine – cause dopamine to flood the reward pathway 10 times more than a natural reward. The brain remembers this rush and associates it with the addictive substance. However, with chronic use of the substance, the brain's circuits adapt over time and become less sensitive to dopamine. Achieving that pleasant feeling becomes increasingly important, but at the same time, you develop a tolerance and need more and more of that substance to achieve the desired high. Addiction can also cause problems with concentration, memory, and learning, not to mention decision-making and judgment. Drug-seeking is therefore driven by habits – rather than conscious, rational choices. Unfortunately, there is a widespread belief that people with addictions simply make poor choices. In addition, the use of stigmatizing terms like "junkie" and "addict" and "getting clean" often creates barriers when it comes to getting treatment. There is also stigma attached to treatment methods, creating additional challenges. Although treatment modalities vary depending on medical history and the specific addiction disorder, medication can make all the difference. "Many people think that the goal of treating opioid use disorder, for example, is to not take medication at all," says David A. Fiellin, MD, a Yale Medicine family medicine and addiction medicine specialist. "Research shows that medication-based treatments are the most effective treatment. Opioid use disorder is a disease like depression, diabetes or high blood pressure, and like those diseases, it is most effectively treated with a combination of medication and counseling."
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