ADDICTION 101: Substance Use Disorder

I believe every challenge can become an opportunity for learning and for gaining a new perspective.

I was recently challenged by an acquaintance of mine (my dog trainer in Telluride) about an addiction-related petition I signed.  She was clearly mired in the negative stigma associated with addiction and insisted it was not a disease, but a weakness mostly stemming from bad parenting.  Even in the face of being told my son died from this disease, she did not back off her conviction. She boldly asked me if I raised my son as a divorced parent, trying to find a reason to place blame on me.

While I certainly was not a perfect parent and made many mistakes with Cody, I didn’t cause my son’s addiction.

I am surrounded by those who understand addiction, who have lived with it, and have educated themselves about it.  Most of my past writing assumed those who read it had a basic understanding of the disease, but perhaps that is not true.  Perhaps there are many readers who don’t believe it is a disease at all, but a bad choice based on weak moral character.  If I am to sincerely promote addiction awareness through my blog and nonprofit work,  I believe I need to start with Addiction 101.  Education is the only way to end the stigma.

Here is my attempt, in the most basic terms possible, to define addiction.

Addiction is not about willpower, it’s about brain chemistry.

It is scientifically defined as a chronic, relapsing brain disease that is characterized by compulsive drug use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive behaviors.

In 2013, the American Psychiatric Association updated the Diagnostic and Statistic Manual (DSM-which is the definitive resource for diagnostic criteria for all mental disorders), replacing the categories of substance abuse and substance dependence with a single category: substance use disorder.

Most people in the field have dropped the word “addiction” and now use the more accurate term “substance use disorder”.  I am going to continue with the word addiction in this blog in order to keep it as familiar as possible.

Is addiction a mental disorder? Yes, because it changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and substituting new priorities connected with obtaining and using the drug. The resulting compulsive behaviors that override the ability to control impulses despite the consequences are similar to hallmarks of other mental illnesses.  In other words, it is a mental obsession.

The science is indisputable.  Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.

Dysfunction in the brain circuitry leads to characteristic biological, psychological, social, and spiritual manifestations. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

The initial decision to take drugs is mostly voluntary. However, when drug abuse takes over, a person’s ability to exert self-control can become seriously impaired. Brain imaging studies from drug-addicted individuals show physical changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.

Drug use compromises the long-term health of the brain and leads to addiction. Unfortunately, a drug’s short-term pleasure comes with long-term consequences.  As drug use increases, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive signals.

This means that eventually dopamine simply doesn’t work as well on the reward circuit of a drug abuser’s brain, and the ability to experience any pleasure is reduced.  A person then takes drugs just to try and bring their dopamine function back up to normal — and larger amounts of the drug are needed to create the dopamine high, an effect known as tolerance.  The compulsion to use drugs is fueled by the need to just feel “normal”.

No one is born with addiction. No child wants to be an addict when he grows up.  No adolescent starts using drugs with the intention of making a career of addiction. It doesn’t work that way.  

Unlike any other major disease, there is a relatively narrow window when addiction develops: it nearly always originates during adolescence. The pre-frontal lobe, the area of the brain where decision- making, judgment and self-control reside, is the last area of the brain to develop, usually in the early 20s. This makes adolescents particularly vulnerable to alcohol and other drugs. Drugs stop the development of the pre-frontal lobe and target the brain’s reward system literally changing brain chemistry. All of this combines to make it nearly impossible for many adolescents to stop use once they start.

Ninety percent of those who are currently addicted began using alcohol and other drugs before the age of 18.

My son’s first use was at age 13, and it progressed from there. I asked him why he started to drink and use drugs in the first place and he said it made him feel more comfortable fitting in with other kids.  It reduced his anxiety and made him feel at ease in social situations.  In other words, it increased his self-confidence around his peers and helped him cope with his life.

Approximately 10% of people who use drugs develop an addiction.  It takes the life of more than 120,000 people annually, making it the third largest cause of death in the United States, after heart disease and cancer.  Drug overdoses are now the first largest cause of accidental deaths in the United States, and have reached epidemic levels in all areas of our country.

All told, at least 100 million Americans suffer directly or indirectly from this disease – nearly one in three people in this country. 

It is my hope this information might give a better understanding about the disease of addiction to all of those who are open to learning the facts and thus ending the stigma surrounding the disease.

In my next blog, I will discuss the causes of addiction; why some people get addicted and others don’t, including the genetic predisposition to addiction.

Mary Cucarola – July 12, 2016


“The Science of Drug Abuse and Addiction: The Basics.” National Institute of Drug Abuse.

“Science of Addiction.”

Barnes, Henrietta. Hijacked Brains: The Experience and Science of Chronic Addiction (Dartmouth: University Press of New England, 2015) 61.

Comments 9

  1. Well said Mary. Addiction is a disease. The medical fraternity uses a disease model to qualify something as a disease. The model has three parts- 1) An organ or part of the body 2) A defect in that organ or part of the body 3) Symptoms resulting from the defect. Diabetes is a disease because 1) The pancreas 2) Not producing insulin 3) Low Blood Sugar, Confusion, Dizziness, nerve issues in limbs, blindness, etc. Addiction fits the model as follows the organ 1) The Brain, defect 2) Defects and deficiency in the parts of the brain where decision and choice, pleasure, reward processes are affected, ans Symptoms 3) Dependence, Addict behaviors of every sort including, Changes in body and personality, Overdose, Death and on and on. This is the disease model that has been used for over 100 years. We have been able to actually “see” with our eyeballs the effects on the brain since the late 90’s in brain scan imaging. Upbringing, personality disorders, abuse, and other environmental factors can aggravate, complicate, and accompany addiction but do not cause it. What did the addict think when he was told that they have invented a pill to cure addiction? He thought, I wonder what 2 of them will do.

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    Thank you, Joseph. This is a very good definition of addiction, easy to understand and accurate. I appreciate you taking the time to post your comment. Your last sentence sounds exactly like something Cody would have said for sure. You know it inside and out, backwards and forwards! Good to hear from you.

  3. I lost my 21-year-old son three years ago to an accidental overdose. This information that you have posted is so accurate and unfortunately so true. I hope you can bring more awareness to others, including the doctors who so Easley handout prescriptions for opiates.

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    I am so sorry about your son, Deb. My son died of an accidental overdose on September 25, 2013. My heart goes out to you and I appreciate your comments. We are trying very hard through our organization to bring awareness to this disease and stop the judgment about addiction. It’s the only way we will ever make real progress in finding solutions. Thank you for reaching out and sharing your story.

  5. Wonderful post and my heart goes out to for your loss. That you have been able turn a tragedy into something that will help others is inspirational.

    From my perspective, I think that in addition to the way drugs alter brain chemistry, there’s also learning component that becomes an ingrained, repetitive maladaptive coping mechanism. Those who are by nature risk takers, have a tendency toward rigidity, have a history of trauma or co-existing mental health or learning disorders are particularly vulnerable too.

    Drugs can both elevate social status (within certain social groups), but also offer (temporary) relief from all the feelings associated with the intensity/demands of every day life for those who experience life like a an onslaught of emotions and sensory input. My son has often said,”I don’t know another way to be…” So in addition to the chemical/brain connection, I have come to believe that re-learning on a very fundamental level, has to take place too.

    And yes, none of this is even remotely connected to bad parenting or poor moral character. If that were true, all children of abusive parents would be drug addicted – and statistics don’t bear that out.

    Thank you for your insight, compassion and work. Best Regard 🙂

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    Thank you for your insightful comments. I think you make some very good points about the learning component. It takes such a big change in lifestyle to stay in recovery; a whole new way of learning how to live. My son would do well for a while, but then relapse because he wouldn’t completely commit to changing his life and friends. My next blog will talk about the causes of addiction, including trauma and co-existing mental illness.

  7. I am a substance abuse counselor at an intensive in-patient treatment facility for teen boys. We have 16 beds and over 60 clients on the wait list. I am in Washington State and the leading cause of death here is now accidental opiate overdose. People always ask me “how do you do it”? The answer is “one day at a time”. I do agree with your statement of addiction being a brain disease. Keep going and I hope that your blog helps you. God bless.

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    Yes, the opiate addiction and overdoses are at epidemic levels all over the country. You are doing very important work in helping adolescents recover while they are still young. I would love to hear your thoughts on how they respond to treatment and what works the best. If you have time to email me, my email is Warmly, Mary

  9. Recovery is never easy , but it is possible . I’ve experienced addiction first hand , and this blog is spot on. I had unplanned surgery a few years back , but I never thought that surgery would be the last thing to truly fear. I never seen myself before as just a label “drug addict”. Mary I’m so sorry for your lose . I randomly came across your blog seeking uplifting words , and I found them . A truly beautiful way to honor your son. I’m in recovery myself , and I believe physicians should have some accountability with the prescription pad. It is one thing to prescribe , it’s another to educate before prescribing .

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