The 10 Most Common Misconceptions About Addictions

Over my 50-year career as an addiction researcher, these are the most common misconceptions I've heard about people with alcohol and drug addictions.

Myth 1: Addiction is a bad choice.

Many people believe addiction results from weak willpower or lack of morals. They are wrong. Addiction is a complex condition involving specific drugs, doses, routes of entry (smoking, eating, injection, sniffing), and age of onset, with people who start substance abuse at younger ages having higher risks.

Addiction directly affects and is affected by a person’s brain chemistry, genetics, and environmental factors. Trauma and life experiences are also critical. Yale’s Joel Gelernter has identified specific genetic variants associated with vulnerability to addictions. However, genetic characteristics interact with environmental factors in the development of substance use disorders.

Myth 2: People must hit "rock bottom" to recover from addiction.

Addiction is a chronic, relapsing condition driven by changes in brain circuitry, particularly in areas controlling reward, stress, and decision-making. While some people seek help after experiencing dire consequences, many others can and do get help from an intervention after listening to the advice of family, coworkers, and others. Waiting a longer time, however, increases damage done to the person’s relationships, job, and health and also strengthens the relationship between the drug and the person.

Roadside alcohol testing, for example, has prevented thousands of deaths and helped many with alcohol use disorders (AUD) get help. About 50 percent of those arrested for DUI have an AUD and should not delay getting help.

Myth 3: Addicts could quit anytime they wanted.

Mark Twain said, “Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.” Addiction changes the brain, making quitting difficult. Nora Volkow, head of the National Institute on Drug Abuse, and other experts have argued that free will is lost with addiction because the addict needs drugs like others need food and water. If medication-assisted treatment (MAT) is discontinued, all bets are off unless the person has already done considerable psychological work as well.

People actively involved in AA often complain that their friends ask them why they are not cured yet, since they go to meetings all the time. However, going to treatment is a good sign, a positive step, and an active involvement in disrupting addiction.

Myth 4: Only certain types of people get addicted.

Addiction neuroscience has done a great job of identifying brain systems involved in the processes of addiction, withdrawal, and craving. Not much progress has been made in predicting risk for addiction.

It’s complicated. For example, addiction is more likely to be found in people who used drugs at an early age, suffered from trauma and/or psychiatric illness, and who used drugs of abuse. But addiction does not discriminate by age, ethnicity, gender, or socioeconomic background. Anyone can become addicted, given the right circumstances and risk factors. Addiction happens “only” to people across all demographics, from all walks of life, and no one is immune.

Myth 5: Alcohol is less dangerous than other drugs.

Alcohol is legal but is just as addictive and harmful as other substances. It can lead to physical dependence, mental health problems, and fatal overdoses. Recent surveys indicate that 29.5 million people ages 12 years and older had an alcohol use disorder (AUD) in the past year in the United States in 2022.

Studies also link alcohol consumption to greater risks for cancer, particularly breast, liver, colorectal, esophageal, and oral cancers. Even moderate drinking is associated with increased cancer risks. According to the American Cancer Society, researchers have found that alcohol consumption causes about 5 percent of cancers and 3 percent of cancer deaths. Accumulating evidence on health risks associated with alcohol led the World Health Organization (WHO) to report that there is no "safe" level of alcohol consumption that does not affect health.

Myth 6: Relapse means that treatment failed.

Addiction is a chronic and relapsing condition, and, as with other chronic conditions, patients may need to adjust their treatment plans if setbacks occur. Relapse does not equal failure.

Instead, relapse is so common in addictions that many experts have considered adding relapse to the diagnostic criteria. In many ways, relapse is the consequence of treatments that don’t (or can’t) reverse the brain changes to the pre-use state.

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Relapse has been unreasonably minimized by people with SUDs, their families, and providers. Indeed, data has shown that ending medication-assisted treatment subjects relapsed patients to overdose rates equivalent to those of patients with SUDs not treated.

The use of MAT should be seen as proof of active participation in relapse prevention and SUD remission, The data on MAT use is clear: More and longer is better, and people should be discouraged from thinking "When will I not need those MATs anymore?" .

Myth 7: Dual diagnoses, having both a substance use and psychiatric disorder, are rare.

The reality is that dual diagnoses (polydiagnosis) are the rule, not the exception. High rates of co-occurrence are observed between SUD and generalized anxiety disorder, panic disorder, PTSD, depression, bipolar disorder, attention-deficit hyperactivity disorder (ADHD), psychotic disorders, borderline personality disorder, and antisocial personality disorder. Also, the early initiation of substance use is a significant risk factor for subsequent development of SUD and may also elevate risks of mental health disorders.

More than 60 percent of adolescents in SUD treatment programs meet diagnostic criteria for at least one additional mental illness. Among people who use drugs, polydrug use is also the norm. In one study, up to 90 percent of opioid users reported using benzodiazepines, alcohol, and cocaine. Among those who used fentanyl, around 50 percent reported concurrent use of other drugs, especially stimulants like methamphetamine and cocaine.

Myth 8: Detoxification with medications is not necessary.

Detox alone is unlikely to result in sustained recovery, but it is still necessary in many cases. Alcohol detoxification can be dangerous for the individual and should not be attempted alone. Alcohol withdrawal symptoms include tremors, arrhythmias, anxiety, sweating, high pulse/blood pressure, nausea, and seizures. Additionally, alcohol withdrawal can be complicated by delirium tremens (DTs), a life-threatening condition marked by confusion, hallucinations, and seizures. Alcoholics are often dehydrated and have vitamin, nutritional, and electrolyte imbalances. Intense alcohol cravings can lead to leaving a treatment program against advice or early relapse. Medical supervision is often required during alcohol detox to manage the risks.

For some addictions, such as those to stimulants like methamphetamine and cocaine, patients do not have the dramatic withdrawal seen with benzodiazepines, alcohol, or barbiturates. However, people addicted to stimulants still need rehydration, rest, and refeeding as the drug leaves the body. They usually look very exhausted and depressed.

Myth 9: If addiction is a disease of the brain, why don’t we have a cure?

There are many conditions for which science has yet to find a cure. The field of addiction is new, and research has progressed since the 1970s to today, with new understanding, treatments, and hope. Our work in the 1970s discovered where in the brain heroin acts, what changes are produced, how addiction and withdrawal occurr, and how it could be reversed with medicines. This work made it clear that detoxification was understandable and treatable.

Naloxone (Narcan) was approved by the Food and Drug Administration (FDA) for emergency opioid overdose reversal in 1971. Naloxone, now available in multiple doses and intranasally, has saved hundreds of thousands of lives by reversing respiratory depression induced by opioid overdose and by “kicking” heroin or fentanyl off of opioid receptors.

In 1984, the FDA approved naltrexone, now also in a long-acting injectable form, for OUD and AUD, reinforcing the idea addictions are related. While progress has been slower against cocaine and methamphetamine, clinicians have learned to deemphasize withdrawal distress and focus on dopamine and pathological attraction. The cocaine epidemic allowed psychiatry to understand behavioral addictions such as gambling, supporting diagnostic and treatment development. Progress in addiction neuroscience has been remarkable.

Myth 10: Medication-assisted treatment (MAT) replaces one addiction with another.

Medications like the nicotine patch, invented in 1984 by researchers at UCLA, were the first widely used transdermal medication and have helped many people quit smoking. Safe medical treatments have changed alcohol use disorder (AUD), diminishing alcohol craving and preventing relapse with disulfiram, acamprosate, and naltrexone. The problem is not the lack of innovation and treatments. In AUD, MATs are used in fewer than 8 perent of cases—the real problem.

Today, the nicotine patch and other nicotine-replacement treatments, as well as methadone or buprenorphine, help the addicted person detoxify, manage their withdrawal and cravings, and prevent relapse. About 6.2 million people have an OUD, but only 1.2-1.5 million receive buprenorphine, and 400,000-500,000 receive methadone.

These 10 misconceptions hinder effective treatment and contribute to stigma, deterring seeking help and staying in treatment long enough.