Why Addiction Is Not A Moral Failing And How We Can Encourage Recovery

An image visualizing the mental confusion and struggles that come with addictions.

Not so long ago, the nature of addiction, as observed by scientists studying drugs and drug use, was riddled by stereotypes and misconceptions, some of which continue to remain today. When scientists began to study addictive behaviors in the 1930s, addiction was widely considered to be a moral failure or a lack of traits such as willpower, restraint, and discipline. Therefore, measures to “help” those with addiction were a punishment for a moral failing, rather than treatments grounded in science to address health and mental problems. People with an addiction were often shamed and shunned from society altogether, which usually only encouraged them to continue repeating their harmful habits. Scientific studies show that addiction is a medical disorder that affects the brain and behaviors, and the subsequent discoveries focused on genetic variations, environmental stimuli, and individual circumstances. 

According to the Aquila Recovery Clinic, addiction can be thought of as a three-stage process: binge/intoxication, withdrawal/negative effect, and preoccupation/anticipation. With addiction, natural processes in the brain involved with learning and developing habits are affected. It interferes with nerve pathways of attention and motivation to preferentially notice, desire, and seek the addictive substance over time. Throughout this process, addiction causes a change from what begins as an active choice to an unbreakable habit. This is due to the effect on the brain’s reward center, which delivers the feeling of a high, noticed mainly by the intense and almost instantaneous release of the neurotransmitter dopamine. Dopamine can be considered a chemical that causes motivation, allowing us to focus our attention on specific behaviors, drive the pursuit of certain goals, and potentially fall victim to harmful habits. By attributing the substance to the dopamine high, addiction becomes a repetitive and accustomed disorder. Over time, as addiction becomes increasingly repetitive, activity in the brain’s decision-making center, located in the prefrontal cortex, could weaken, which is why addiction was previously dismissed as an issue of willpower or common sense. 

Throughout our evolution, the sensation derived from dopamine was likely used to encourage the repetition of behaviors that support the survival of both the individual and the species. Examples include eating, social interaction, and finding shelter. Under the influence of dopamine, the brain becomes highly efficient in seeking out the actual source of the dopamine. It then focuses its attention on the source, whether a physical object or the feeling attributed to it, and hides nerve connections that respond to other unrelated inputs. This is why many addicts struggle with moving away from addiction despite adverse consequences or the hope of a more positive future. lt is for this reason that simply dismissing addiction as a moral failing, a willful choice, or a brain disease is wrong. Addiction is a learned repetitive response that causes changes in the brain, but those changes are not a pathological process. Therefore, like many things that are learned, they can be unlearned.

Neuroplasticity is the brain’s ability to change and adapt by forming new connections or strengthening existing ones in response to experiences or learning something. Similar to how addiction is made possible with neuroplasticity, recovery also relies on it. Addiction can be unlearned neurally and behaviorally, as evidenced by the fact that most addicts recover, eventually, with the right help. The three main external factors that affect the speed and effectiveness of recovery are the surrounding environment, the source of addiction, and the design of recovery programs.

Of these three, the surrounding environment is typically the most important one. The surrounding environment can include discrimination or stereotypes against those battling addiction, a culture of substance abuse, and financial barriers, all of which can make recovery harder. Although addiction is often talked about and represented in the media, the underlying stereotypes and preconceptions about addiction from a century ago still exist today. In 2021, over 10% of people who felt they needed substance use treatment but did not receive it said they did not seek treatment because they feared discrimination from others. Secondly, harmful cultures wherein drug abuse is normalized can serve to increase peer pressure and diminish those who try to seek help. From blockbuster movies to lyrics in popular songs, pop culture often presents drug use as exhilarating and incredible, all the while downplaying the harmful effects of addiction. Lastly, rehabilitation can get very expensive, and the high costs of treatment in the surrounding environment can make it demotivating. Cost of rehabilitation treatment varies, with average costs around $12,000 for a 30-day stay and upwards of $25,000 for 60-90 days.

Understanding the neural circuits that drive the compulsive seeking of drugs has led to the development of evidence-based recovery programs that target specific brain mechanisms. Behavioral therapies such as contingency management, cognitive-behavioral therapy, and motivational interviewing are all rooted in studies showing how learning and habit-formation pathways can be reshaped. Additionally, there are medications that relieve cravings and prevent substance addiction. Doctors can prescribe those like methadone, buprenorphine, and naltrexone, which block the high found from addictive substances such as heroin. However, it is important to note that such medications are not guaranteed to work. There is also replacement therapy, which can help prevent withdrawal symptoms. Modern science has created pharmaceutical support that provides many different solutions for people to choose from, and continuing this research is essential to making addiction recovery easier and reducing the stigma felt by those suffering from substance abuse.

The contents of a naloxone kit.

Public health policies around reducing the negative effects of drug use have been reframed by addiction science as well. Needle and syringe exchange programs, supervised consumption sites, and widespread naloxone distribution all draw on evidence that addiction is a chronic brain disorder, not simply a moral failing. Research demonstrating the life-saving impact of take-home naloxone kits has driven many jurisdictions to remove legal barriers to possession. Nearly 27,000 lives have been saved as a result of take-home naloxone kits being given to friends and family to reverse opioid overdoses. At the same time, studies of safer environments have led to the creation of supervised injection facilities. Naloxone and these supervised injection facilities not only reduce overdose deaths and the transmission of infectious disease but also act as low-threshold, zero-judgement entry points into treatment.

Science has dramatically changed how we view addiction, and evidence-based interventions are far better than continuing harmful narratives surrounding substance abuse. While non-substance addictions have less possibility for pharmaceutical research and support, it is still essential to apply neuroscience to create solutions where they are welcomed and necessary. As science helps us discover more about addiction, especially the factors that influence a person’s vulnerability to addiction—like genetics—it is important to apply scientific knowledge to education regarding addiction prevention, potential warning signs, and the other dangers that addictions can pose.