One of the largest differences between the behavioral and physical health fields is the degree to which many people are willing to accept and understand the needs of those with behavioral versus physical health problems. Much of this difference can be attributed to the large number of misconceptions surrounding those with behavioral health problems, especially addiction. For many years, addiction was seen as a moral failure, and although this view has relented over the past decade, many misconceptions and falsities regarding behavioral health are still widely circulated. The seemingly most enduring of these misconceptions is the notion that addiction is a choice. While it is true that the first instance of substance use does have an autonomous element to it – although it is important to acknowledge many individuals who develop opioid addictions originally start taking the drug under the advisement and supervision of a medical professional – for individuals with substance use disorders (SUDs) this element of choice disintegrates, often very rapidly.
At a neuro-biological level, addiction is much more than the choice to use a substance. It is a disease of hijacked decision making, defined by the compulsive need for a substance regardless of, and despite, any negative physical, social, or legal consequences. It targets, and ultimately dysregulates, the brain’s ‘reward system‘: a pathway in the brain primarily comprised of the cerebral cortex, nucleus accumbens, and ventral tegmental area. This dysregulation eventually forces an addicted individual’s baseline levels of dopamine (one of the neurotransmitters, or chemicals, in the brain that is responsible for positive feelings) to be significantly lower than that of a non-addicted individual’s. Consequently, when an addicted individual does not have a substance in their body, their system is under stress.
For many non-addicted individuals, this concept is difficult to relate to; however, these are the same brain structures that are responsible for other positively/negatively reinforced human behaviors, such as eating, drinking, and temperature regulation. People often ask why a person cannot simply make the choice to stop abusing a substance. However, by considering the intense juxtaposition of feelings when starving vs. sated, parched vs. quenched, or freezing vs. comfortable temperatures, non-addicted individuals can begin to understand how those with SUDs feel when they have or do not have a substance in their bodies.
Many of the other misconceptions about addiction involve faulting and typecasting those with various SUDs for their addiction(s). It is often assumed that people with SUDs are at fault for their addiction. However, roughly half of a person’s susceptibility to addiction can be attributed to genetics. This is in large part why some people will use drugs frequently and for long periods of time and never become addicted and others will use drugs only a few times and develop an addiction. Commonly perpetrated stereotypes of individuals with SUDs include being of low socioeconomic status, being members of minority groups, being male, and being complacent with their situation. In addition to creating assumptions that all individuals who fall into these categories are addicts, these stereotypes ignore that people with SUDs can come from any demographic background, and the underling social reasons as to why some of these stereotypes hold true.
Neighborhood disadvantage exists exclusively in low socioeconomic areas and creates high barriers to treatment. Residents of disadvantaged neighborhoods experience a higher level of collective stress caused by prejudice, discrimination, a lack of community attention and resources, crime, poor infrastructure, a lack of parks, greenery and recreational facilities, poor selection of food services and grocery stores, and an overabundance of over-priced, liquor and convenience stores. They also tend to experience greater exposure to drugs (especially illicit substances) and drug dealers, as well as greater contact with drug users. These factors, in conjunction with the fact that residents of disadvantaged areas lack access to adequate substance abuse counseling and treatment facilities, not only increase the likelihood that an individual will become reliant on various drugs to ease tension, but also decrease the likelihood that they will seek help if they do develop a drug dependency.
Personal attributes are often confounded with biological factors and social barriers as the reason for substance abuse problems. There are many other misconceptions surrounding addiction relapse, recovery and longevity that must be addressed, but mitigating the misconceptions surrounding the reasons that addictions develop will serve as a large step toward accepting those with SUDs and understanding addiction.