How an Addicted Brain Works

Written and produced by Yale Neuroscience PhD student Clara Liao.

Addiction is now understood to be a brain disease. Whether it’s alcohol, prescription pain pills, nicotine, gambling, or something else, overcoming an addiction isn’t as simple as just stopping or exercising greater control over impulses. That’s because addiction develops when the pleasure circuits in the brain get overwhelmed, in a way that can become chronic and sometimes even permanent. This is what’s at play when you hear about reward “systems” or “pathways” and the role of dopamine when it comes to addiction. But what does any of that really mean? One of the most primitive parts of the brain, the reward system, developed as a way to reinforce behaviors we need to survive—such as eating. When we eat foods, the reward pathways activate a chemical called dopamine, which, in turn, releases a jolt of satisfaction. This encourages you to eat again in the future. When a person develops an addiction to a substance, it’s because the brain has started to change. This happens because addictive substances trigger an outsized response when they reach the brain. Instead of a simple, pleasurable surge of dopamine, many drugs of abuse—such as opioids, cocaine, or nicotine—cause dopamine to flood the reward pathway, 10 times more than a natural reward. The brain remembers this surge and associates it with the addictive substance. However, with chronic use of the substance, over time the brain’s circuits adapt and become less sensitive to dopamine. Achieving that pleasurable sensation becomes increasingly important, but at the same time, you build tolerance and need more and more of that substance to generate the level of high you crave. Addiction can also cause problems with focus, memory, and learning, not to mention decision-making and judgement. Seeking drugs, therefore, is driven by habit—and not conscious, rational decisions. Unfortunately, the belief that people with addictions are simply making bad choices pervades. Furthermore, the use of stigmatizing language, such as “junkie” and “addict” and getting “clean,” often creates barriers when it comes to accessing treatment. There’s also stigma that surrounds treatment methods, creating additional challenges. Though treatment modalities differ based on an individual’s history and the particular addiction he or she has developed, medications can make all the difference. “A lot of people think that the goal of treatment for opioid use disorder, for example, is not taking any medication at all,” says David A. Fiellin, MD, a Yale Medicine primary care and addiction medicine specialist. “Research shows that medication-based treatments are the most effective treatment. Opioid use disorder is a medical condition just like depression, diabetes or hypertension, and as with those conditions, it is most effectively treated with a combination of medication and counseling.”

[DominikPavel-fkwb]

I started drinking years ago as a teenage, got addicted to alcohol. Spent my whole life fighting alcohol addiction. I suffered severe depression and mental disorder. Got diagnosed with cptsd. Not until my wife recommended me to psilocybin mushrooms treatment. Psilocybin treatment saved my life honestly. 6 years totally clean. Never thought I would be saying this about mushrooms.

[pineapplepotato]

Finally, a real video about HOW addiction works in the brain.

Understanding the social pressures that cause addiction is important, but YouTube has a distinct lack of neurological and pharmacological explanations of the phenomenon. Great work!

[HALTSMAULALLLER]

And now imagine that physical opiate withdrawal is added to that. Because this is mainly caused by noradrenaline. The lack of dopamine makes you feel incredibly tired and weak, but the adrenaline doesn't let you sleep. Your body is also running at full speed but you have no motivation. Add to that the pain, diarrhea, vomiting, shaking, endlessly sad depression etc etc etc....

It's a real miracle that some people stop using opiates all on their own. I did it because I had no strength left and suicide was the only solution. I can't believe it myself but it's possible

[StoneSoupVideos]

Superbly done and brief enough to use for the "Opiod Response Network's" (ORN) trainings I do nationally.
THANK YOU ALL for the educating and compelling explanation, AND mentioning the impact of stigma on Tx aversion. This is going directly into a slide deck!

[Astrovic]

most successfully recovered Ex-Addicts say that tagging Addiction as an chronic illness hinders people recovering and excuses failing medical treatment (sry for bad englisch, I am from germany)

[LinusE]

This doesn’t mention the stress circuitry’s role which is reverse to the dopamine. While dopamine down-regulates, stress receptors are upregulated which makes an addict more stress in sober situations. Leading to hyper-stress which can only be alleviated with drugs, a vicious cycle.

[thomasbrouwer]

Amazing summary. It is only worth mentioning that behavior addictions such as porn and gamble also activate the same mechanisms.. is one process of addiction with different objects.

[early.]

I love your way of explaining.
Please would you discuss for me the VTA and the prefrontal cortex considering dopamine release and the effects the addictedd brain will encounter

[quietE]

Thank you so much, that was really informative and clear ! I couldnt understand how the reward system worked before, but now i get it !

[tossitin]

i am 17 years old. I was addicted to anime, reels, YouTube, nonstop music and other internet related things like shopping and games. I quit all of these at the same time because I was aiming to score high in my exams. After a few days I experienced sudden stress and anxiety and was confused about what was going on with me. I had gotten anhedonia because of sudden drop of dopamine and was very very scared about my future. It's been 1 month and I'm still having a few symptoms.

I get a lot of mood swings, I don't enjoy anything as much as I used to before, I get scared of many things, I get suicidal thoughts even though I would never do such a thing. These suicidal thoughts make me overthink and give so much distress that I disconnect from the world and just keep thinking about why all this is happening to me.

There have been a few positive changes since the past month. It's very difficult for me to handle this. I'm glad I have such wonderful parents and friends and that is why I get panicked and scared about getting suicidal thoughts. Please tell me what I can do to have a speedy recovery so I can enjoy life again. I really really hope this is temporary.

[inywtyt]

Addiction is unnatural. What's hard about this is that you need to change both environment and your habits to bring about a change. And that is a losing battle. Education and reprogramming the subconscious mind as well as changing the environment is a hardprocess but the only thing you need to know is hope. There is hope. You can change. If this was a totally permanent situation this would be a terrifying situation.

[KindOfSushant]

Don't try to quit the medium instead try to take control of damage brain. Defeating addiction with just willpower that ain't possible. Understand the mechanism of dopamine and brain. Develop a strong mind which resist urges

[sharminrocks]

Ek zabardast vlog. Kya shandaar sajaya riza rehan sara milkar. Just wow. ❤❤❤❤❤❤❤❤

[bernstock]

Hate to say it but I think most of us are addicted to our phones

[paperdoodlevg]

Been struggling with fentanyl addiction, it’s rough I get clean then backslide just to go through the torture of detox, again and again knowing how miserable and the things I would do to just never try a perc mane. To not understand that rewarding feeling when u are going through wd and get your fix, it’s all just such a curse.

[kennedystreetrecovery]

Great explanation, what I’d really be interested in is a video on how active recovery engagement works creating new neurological pathways

[johnalexir]

This is a well delivered, concise explanation of this subject. Thank you.

[tomaszprzegwizdane]

I cant get addict to anything cuz i dont have this funny sponge in the head

Thank you odin 🙏

[cysabela]

This is such a great, easy to understand explanation. Thank you.

[dmtdreamz]

Then I heard a new sound: a living sound, like the richest, most complex, most beautiful piece of music you've ever heard. Growing in volume as a pure white light descended, it obliterated the monotonous mechanical pounding that, seemingly for eons, had been my only company up until then. The light got closer and closer, spinning around and around and generating those filaments of pure white light that I now saw were tinged, here and there, with hints of gold. Then at the very center of the light, something else appeared. There was a wooshing sound, and in a flash I went through the opening and found myself in a completely new world. The strangest, most beautiful world I'd ever seen. Brilliant, vibrant, ecstatic, stunning . . . I was flying, passing over trees and fields, streams and waterfalls, and here and there, people. There were children, too, laughing and playing. The people sang and danced around in circles, and sometimes I'd see a dog, running and jumping among them, as full of joy as the people were. A beautiful, Incredible dream world . . .
Except it wasn't a dream.
The word real expresses something abstract, and it's frustratingly ineffective at conveying what I'm trying to describe. Imagine being a kid and going to a movie on a summer day. Maybe the movie was good, and you were entertained as you sat through it. But then the show ended, and you filed out of the theater and back into the deep, vibrant, welcoming warmth of the summer afternoon. And as the air and the sunlight hit you, you wondered why on earth you'd wasted this gorgeous day sitting in a dark theater. Multiply that feeling a thousand times, and you still won't be anywhere close to what I felt like where I was.