Where Addiction Meets Your Brain

The Neurobiology of Addiction

Once a Pickle, Never a Cucumber

All addictive substances are probably off limits.

One of the hardest things to talk about with patients who have addiction is the fact that all addictive substances are probably off limits. You hear stories from people who stop their drug of choice and change to a different substance and seem to be able to “control” its use, but I argue that if someone can use an addictive substance without compulsive use then they are not an addict.

This is a very important point for me when I am trying to work with patients. I get the line all the time that “marijuana is not addictive.” I totally agree unless you are addicted to marijuana, which many people are. There are plenty of people who drink alcohol who are not alcoholics, do cocaine and are not cocaine addicts and take opiates and are not addicted to opiates.

The point that I am trying to make is that addiction is a definite physiological phenomenon, just like diabetes or other chronic illnesses and either you have it or you don’t. It affects about 10 percent of the population and that is that. If you have the genetic predisposition, you can either abstain from addictive substances or not. If, however, your brain has the dopamine dysregulation of an addicted individual, then addictive substances are not something that you should try to use recreationally. In my experience of working with addicts, trying other addictive substances turns out badly and leads people back to their drug of choice.

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Why am I writing this? I only am writing this selfishly so that when I get confronted next week by someone who wants to argue whether a substance that they are using is addictive, I can hand them a copy of this blog entry and save a half hour of argument and attempts to educate the person. It is always strange to me that people pay for my advice and want to argue with me when I give it to them. I did not ask for their advice on this subject, so while I am happy to hear their thoughts, I do not want to spend time with them trying to convince me of their position and beliefs.

Addiction by any other name causes the same problems. If someone wants to use a substance and is convinced that they are not abusing it, then I am not going to get them off their position. The fact that they have their third DUI or have no job or have a failed set of relationships seems to not fit into the argument. Reflecting back to them what they are saying is all that I can do. If they are able to hear themselves, then progress is being made.

Please don’t argue with me about it, however.

Joseph Troncale, M.D. FASAM, has been working in addiction medicine for 20 years. He is the Medical Director of the Retreat.
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