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It was not until much later, after I had completed my medical training in psychiatry, and had already been working for a long time using neuroimaging to study the addicted brain, that I learned the real reason for his death. This came as a shock. She had heard me speak of addiction as a disease of the brain. So I wondered how I had miscommunicated—how I had not made her realize that it was okay to speak about addiction, that there should be no shame in it.

What explains it is the further understanding that the cells in the pancreas can no longer produce insulin, and we need insulin in order to be able to use glucose as an energy source—so without it, the cells in our body are energy-deprived. That explains why your child is so sick. To explain the devastating changes in behavior of a person who is addicted, such that even the most severe threat of punishment is insufficient to keep them from taking drugs—where they are willing to give up everything they care for in order to take a drug—it is not enough to say that addiction is a chronic brain disease.

All drugs of abuse, whether legal or illegal, cause large surges of dopamine in brain areas crucial for motivating our behavior—both the reward regions such as the nucleus accumbens as well as prefrontal regions that control our higher functions like judgment, decision making, and self-control over our actions. These brain circuits adapt to these surges by becoming much less sensitive to dopamine, a process called receptor downregulation.

The result is that ordinary healthy things in our lives—all the pleasurable social and physical behaviors necessary for our survival which are rewarded by small bursts of dopamine throughout the day —no longer are enough to motivate a person; the person needs the big surge of dopamine from the drug just to feel temporarily okay … and they must continually repeat this, in an endless vicious cycle. I go back a lot to that conversation with my mother.

I realize that her shame was not just because her father had been an alcoholic, follow my andropenis treatment blog with constant updates on because he had committed suicide, out of hopelessness and helplessness at his inability to control the strong urges to follow my andropenis treatment blog with constant updates on. He would try to quit, but then he would relapse, and this cycle would repeat again and again and again … until there was one last moment of self-hatred.

Drugs disrupt these circuits. Once people understand the underlying pathology of addiction, people with the disease will not have to go through obstacles to obtain evidence-based treatments such as buprenorphine or methadone for opioid addiction but will simply, nonjudgmentally, receive the help they need, like a child with diabetes or a person with heart disease or cancer.

I know that there are still many detractors of the "addiction as disease" position. The explanation of the loss of free will, and your own personal and tragic experience with your grandfather, are certainly points that should be taken into consideration in this debate. Thanks for the clarification. And if they it is a disease and not a behavior how do you account for the large number of people who experience spontaneous remission?


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