Author: Kayla Gill

With 9 years in the rehab space, Kayla has overseen the creation of comprehensive addiction treatment content for online audiences worldwide. Her experience managing content for a luxury destination rehab, and her personal path to healing via residential rehab and various therapeutic modalities, inform her first-hand understanding of recovery. She takes inclusion seriously and is especially interested in how trauma and minority experiences shape readers’ journeys.
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How Does Addiction Work? The Brain Under the Influence

Addiction affects the brain in profound ways. This complex condition isn’t just a matter of willpower; it gets “wired” into our systems over time via a series of changes in the brain as a result of substance use.  

Understanding the science behind addiction is what helps researchers and treatment professionals develop effective strategies for treating and preventing it. It also helps loved ones of those struggling with addiction, and our wider communities, dispel myths that lead to stigma and gain genuine understanding about how this condition works—and what we can do about it.

Understanding How Addiction Works 

The National Institute on Drug Addiction defines addiction1 as “a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.” 

Addiction extends beyond substances and can also apply to behaviors. The American Psychiatric Association explains that addiction is based on a psychological dependence: 

Addiction is a state of psychological and/or physical dependence2 on the use of drugs or other substances, such as alcohol, or on activities or behaviors, such as sex, exercise, and gambling.

Addiction takes hold via a series of changes that happen in the brain, a problem scientists often refer to as “wiring” the brain for addiction. 

The Dopamine Pathway and Addiction

While alcohol and drug use may start by choice, once dependency forms, quitting substance use becomes far more than just a matter of willpower. 

“Drug addiction can start with experimental use3 of a recreational drug in social situations,” say experts at Mayo Clinic. “And, for some people, the drug use becomes more frequent.” Once you start using substances more frequently, you’re setting yourself up for brain changes to take place that put you at higher risk for developing an addiction. 

The Role of Dopamine in Reward and Motivation

Dopamine is a brain chemical that’s responsible for the way we experience pleasure and motivation. When we do something enjoyable, like eating or spending time with friends, our brain releases dopamine, which makes us feel good and want to do it again. This is how our brain reinforces positive behaviors.

Certain substances or behaviors can trigger an unusually large release of dopamine. Over time, the brain adapts to this excess dopamine, making it harder to feel pleasure from anything else. As a result, you may start needing more of the substance to feel the same level of enjoyment, leading to compulsive behavior and reinforcing the cycle of addiction. This process makes it hard to stop the addictive behavior, as your brain becomes dependent on it for pleasure and motivation.

Increased Dopamine Levels and Reinforced Desire

When you use a substance that significantly increases dopamine levels in your brain, it creates a strong sense of pleasure. This surge in dopamine motivates you to use the substance again as your brain begins to associate it with intense satisfaction. Over time, as you continue using the substance, your brain’s reward system becomes more and more focused on seeking that dopamine high. This repeated use leads to a cycle where the brain’s natural ability to produce dopamine decreases, making it difficult to feel pleasure from everyday activities. The National Institute on Drug Abuse (NIDA) explains how these changes wire the brain toward drug use4 and away from the things we need to do to maintain a healthy life:

Just as drugs produce intense euphoria, they also produce much larger surges of dopamine, powerfully reinforcing the connection between consumption of the drug, the resulting pleasure, and all the external cues linked to the experience. Large surges of dopamine “teach” the brain to seek drugs at the expense of other, healthier goals and activities.

As this cycle continues, the cravings become stronger, and it becomes harder to resist the urge to use the substance. Your brain starts to prioritize getting that dopamine rush over other important aspects of life, reinforcing the addiction and making it challenging to break free. NIDA explains how certain cues can lead to cravings that make it very hard to resist using again, even when you don’t want to:

Cues in a person’s daily routine or environment that have become linked with drug use because of changes to the reward circuit can trigger uncontrollable cravings whenever the person is exposed to these cues, even if the drug itself is not available. This learned “reflex” can last a long time.

Learn more about managing cravings here. 

The Role of Glutamate in Addiction

The Importance of Glutamate in Learning and Memory

Glutamate is an important chemical in the brain that helps with learning and memory. It allows your brain to strengthen or weaken connections between brain cells, depending on your experiences. This ability to change and adapt is what helps us form memories and learn new things.

How Changes in Glutamate Function Contribute to Addiction

Glutamate plays a significant role in how addiction is formed.5 If you repeatedly use a substance, the glutamate signaling in your brain changes. This affects how the brain processes rewards and forms habits, making substance use more automatic over time. Your brain starts to “learn” that using the substance is important, embedding it into your memory as a strong habit. 

These changes can weaken the brain’s ability to control impulses and make decisions while also strengthening the memories and triggers associated with substance use. This makes it much harder to resist cravings, even when you know the harmful effects. As glutamate continues to drive the learning and memory related to substance use, it deepens the addiction. Understanding this process helps explain why overcoming addiction is such a challenge.

Changes in Brain Anatomy and Function

To better understand this condition, we need to understand the relationship between addiction and the brain.

The Impact of Addiction on Brain Structure

Chronic substance use can lead to fundamental changes in the brain’s structure. Over time, addiction damages essential areas of the brain6 that control decision-making, memory, and behavior. The brain’s reward system also gets altered as it becomes more focused on the addictive drug or behavior. 

At the same time, the parts of the brain that help control impulses and emotions become weaker, making it harder to resist cravings. This is how the brain becomes wired to prioritize drug use over other important activities and responsibilities. 

Changes in Dopamine Receptors and Transporters

There’s a deep connection between dopamine and addiction. Repeatedly flooding your brain with dopamine eventually changes how your brain responds to substances you use and activities you do. Because of the artificially high levels of dopamine, your brain may start making fewer dopamine receptors,7 or the transporters that recycle dopamine may become less efficient. This means you’ll need more of the substance to feel the same high, increasing your tolerance and causing a stronger pull toward addiction. It also makes it much harder to feel good at all when you’re not using substances, further increasing your motivation to use.

Recognizing the Signs of Addiction

Behavioral Signs of Drug Use or Intoxication

Recognizing the behavioral signs of drug use can help you identify when you or someone you love needs help:

  1. Mood and behavioral changes: Mood swings, irritability, aggression, as well as becoming more secretive or withdrawn can signal substance use. 
  2. Neglect of responsibilities: Ignoring work, school, or family obligations is a red flag. This might include missing deadlines, frequent absences, or a drop in performance.
  3. Unusual social patterns: You might isolate yourself from friends and family or start spending more time with a new social group that uses substances.
  4. Physical signs: Red or glassy eyes, slurred speech, and unsteady movements can indicate intoxication. Changes in sleep patterns, such as oversleeping or being unable to sleep, are also common.
  5. Financial problems: Frequently borrowing money, unexplained financial difficulties, or stealing to fund drug use are all warning signs.

Sometimes it’s hard to see these changes in ourselves as addictive behaviors become normalized over time. If any of your loved ones bring up concerns, it’s a good idea to take them seriously. “If you find yourself shifting your priorities, increasingly isolated or feeling irritable when not engaged in a behavior, it may be time to get help in breaking the pattern of behavior,”8 say experts at the Mayo Foundation. Spotting these changes can empower you to intervene early and get the support you need. 

Physical Signs of Drug Use or Intoxication

Physical signs of drug use or intoxication can vary depending on the substance, but often include noticeable changes in appearance and behavior:

  1. Bloodshot or glazed eyes: Red, glassy, or dilated pupils are common signs of intoxication.
  2. Sudden weight changes: Rapid weight loss or gain can result from changes in appetite caused by drug use.
  3. Poor hygiene and neglect of appearance: The mood, sleep, and schedule instability caused by substance use often causes a decline in personal grooming. Signs might include unkempt hair, dirty clothes, or body odor.
  4. Changes in vital signs: Irregular heartbeat, fluctuations in blood pressure, or sweating can signal drug use.
  5. Tremors or shaking: Involuntary shaking or trembling, especially in the hands, is often associated with intoxication or withdrawal.
  6. Nausea or vomiting: Frequent nausea, vomiting, or other gastrointestinal issues can be related to drug use.

These physical signs can indicate that someone may need medical help or intervention. “Making sure you know the risks and harms associated with alcohol or drug use9 can help you stay safe and reduce harm,” says the Victoria Department of Health. 

Seeking Help and Treatment

The Importance of Early Intervention

Addiction is progressive, meaning its intensity and consequences tend to get worse over time. That’s why early intervention is crucial—catching addiction earlier can prevent problems from getting worse and improve your chances of successful recovery. 

The longer addiction goes untreated, the more deeply it takes hold, leading to more disruptive physical, psychological, and social consequences. Early intervention nips patterns in the bud before they become even more engrained, making treatment more manageable and effective. And the sooner you start your recovery process, the more you reduce your risk of overdose and other life-threatening complications. 

Treatment Options for Addiction

Comprehensive addiction treatment usually involves a combination of talk therapy (both individual and group) and complementary therapies. For some people, it may also include medication.

Therapy

Therapy helps you understand and change your behaviors related to substance use. Which therapy is best for you will depend on your condition and which approach resonates best with your goals and values. Addiction treatment professionals use a range of modalities to treat symptoms of addiction and address its root causes. These might include:

  • Evidence-based therapies like CBT, motivational interviewing, and contingency management
  • Complementary therapies such as energy medicine, experiential therapy (like sports or outdoor activities), massage, and mindfulness meditation 
  • Group therapies like psychoeducational, skill building, interpersonal process, or relapse prevention groups 

Medication

Medication is often used in addiction treatment to help manage withdrawal symptoms and cravings. Medications like methadone or buprenorphine, for example, are often used in opioid addiction treatment. If you have a co-occurring mental health disorder that requires medication, a medication review might also be part of your treatment plan. 

Support Groups

Support groups are communities of peers who share experiences, learn together, and motivate each other through challenges. These might be 12-Step groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), or non-12-Step groups like SMART Recovery. These groups can be a vital part of long-term recovery, offering ongoing accountability and support. 

Addiction is isolating. “Anxiety is heightened. Depression is heightened. Sense of loneliness is heightened, which often leads to unhealthy coping in a lot of different ways,” says Jeff Stuhmer, a Licensed Mental Health Counselor and Substance Use Disorder professional. Support groups—whether in-person or online—provide a much-needed sense of community and shared experience. “It’s about community,” says Stuhmer. “We need each other.”10

The Recovery Process

Recovery happens in stages, along what addiction treatment specialists call a continuum of care: 

  • Detox: If you’re physically addicted to alcohol or opioids, or otherwise need a supervised withdrawal process, you’ll need to complete treatment at a medical detox center before starting rehab.
  • Inpatient rehab: Intensive rehab in a residential setting allows you to dive into your recovery process while focusing entirely on yourself.  
  • Outpatient rehab: Intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) allow you to attend an intensive program while living at home. Some people choose to attend these in lieu of, or as a stepped-down transition from, residential rehab.
  • Sober living: Sober living facilities allow you to put your recovery skills to the test outside of residential rehab, while still living in a substance-free, recovery-focused environment. 
  • Continuing care: Ideally, you’ll start planning for life after rehab in earlier stages of recovery. Your continuing care plan is personal to you and may include ongoing therapy, support groups, and lifestyle changes that support a healthy life in long-term sobriety. 

People may not move through this process in a linear way, or may not complete every stage. But research generally shows that the more time you spend in treatment and actively working toward recovery, the better your outcomes will be.11

The Science Behind Addiction in Prevention and Education

Substance use disorders are highly treatable,12 thanks to plenty of effective behavioral and pharmaceutical therapies that have been developed in recent decades. But there’s a treatment gap. That is, not enough people get the life-changing care they need. According to the American Psychological Association,

More than 40 million people in the United States—16 percent of all Americans over age 12—suffer from nicotine, alcohol or drug addiction. Only about 10 percent of those people receive treatment.

This gap is largely due to the stigma that still surrounds this health condition, which can be addressed by raising awareness and understanding of what it truly entails. 

The Role of Education in Preventing Addiction

Education plays a major in preventing addiction13 by demystifying the factors that cause it and equipping people with the knowledge to make informed choices. Understanding the mechanisms of addiction—how substances alter brain chemistry, reinforce compulsive behaviors, and impact mental health—can increase self-awareness and reduce the risk of developing addiction. 

When people are educated about how addiction works, they’re better prepared to recognize early warning signs, avoid risky behaviors, and ask for help when they need it. This empowers individuals and communities to reduce stigma and build supportive environments where prevention strategies can thrive. When we make addiction science more accessible, we lay the foundation for healthier choices and more resilient people.

How Understanding Addiction Can Inform Prevention Strategies 

“Drugs change the brain14 in ways that make quitting hard, even for those who want to,” says NIDA. “Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.” Understanding how addiction works can help us create more effective approaches to treating and preventing it, instead of shaming people who are struggling. If you’re struggling with addiction, effective treatment is available.

Search for rehabs by location, programming, price, and more to find a program that fits your needs.

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Beyond Willpower: The Disease Model of Addiction

Addiction was once viewed primarily as a moral failing. But today, it’s increasingly recognized by addiction scientists and healthcare professionals as a disease affecting the brain. The disease model offers a framework for destigmatizing addiction by understanding it as a disorder that’s no different from any other physical illness or chronic health condition.

We look at the core concepts of the disease model, how it came to be, and the controversies surrounding this perspective. We’ll explore the chronic nature of addiction and how the brain is affected by substance use, and most importantly, what the disease model means for those treating and recovering from addiction. 

What Is the Disease Model of Addiction? 

The disease model views addiction as a chronic, relapsing brain disease characterized by compulsively seeking and using substances despite harmful consequences. This model focuses on the biological and neurological factors that lead to addiction. It positions addiction as a medical condition that requires professional treatment, rather than just willpower.

Definition and Concept

According to addiction scientists, “the disease model represents a comprehensive explanatory concept that encompasses the social, psychological, spiritual, and biological dimensions of alcohol and drug dependence.”1

This model sees addiction as chronic, meaning it’s long-lasting and persistent. Addiction is a condition with a continuous course that involves periods of relapse and remission. This is similar to other chronic diseases like diabetes or heart disease, which require ongoing management.

“Relapsing” means people with addiction often return to substance use after abstaining for some time. Because addiction is cyclical, people may experience periods of sobriety followed by setbacks. This is why ongoing treatment and support are such crucial aspects of the recovery process.

Understanding Addiction as a Health Condition

Proponents of the disease model firmly believe this framework is necessary to effectively prevent and treat addiction, as well as reduce stigma. According to The Addiction Policy Forum, a nonprofit organization with a mission to eliminate addiction,

Addiction needs to be treated like a disease, and we have to follow a disease model. This has been a real area of frustration…for many of us in this field. We only have about half of the country that really understands this as a health condition.2

How the Disease Model Evolved in Addiction Science

The disease model of addiction has evolved over time.3 While earlier perspectives largely viewed addiction as a moral failing, medical perspectives on addiction became more common in the late 19th and early 20th centuries. This marked a shift toward understanding addiction as a health issue, as opposed to a character flaw. The disease model gained even more momentum in the mid-20th century with the rise of Alcoholics Anonymous (AA) and increased scientific research into the brain’s reward system.

Key Concepts of the Disease Model 

Here’s what the disease model says about the brain science behind addiction:

Brain Changes and Neurobiology

Addiction fundamentally alters brain structure and function.4 Over time, repeated substance use disrupts the brain’s reward system, which leads to compulsive drug seeking and use. Dopamine, the brain chemical responsible for pleasure and motivation, becomes overstimulated, creating an imbalance. Over time, the brain adapts to this excess of dopamine and needs more of the substance to feel the same effects. This process, combined with changes in other brain regions involved in decision-making and impulse control, is why addiction is so persistent. 

The good news is that understanding these brain changes allows healthcare professionals to develop more effective treatment approaches.

The Chronic Nature of Addiction 

Addiction is often compared to chronic conditions, like asthma or arthritis, that require ongoing management. But unlike acute illnesses with a clear beginning and end, addiction often entails periods of relapse and remission. This chronic nature highlights the need for long-term treatment and support. While personal choices might initiate substance use, the changes in brain chemistry that result from addiction can make it hard to quit without professional help. This perspective shifts the focus from moral failure to a medical condition requiring sustained care.

Genetic and Environmental Influences 

A number of genetic and environmental factors can influence the development of addiction. Genetic predisposition can make some people more vulnerable to addiction. But genetics alone don’t determine addiction; environmental factors also play a major role. Factors like early exposure to substances, peer pressure, stress, and trauma can heighten the risk of addiction, especially for someone with a preexisting genetic blueprint. 

The disease model opens up space for discussing not just how to treat addiction, but how to more effectively prevent it,5 says The Addiction Policy Forum: 

We know that most people who have an addiction—about 90% of those who have a substance use disorder—begin in adolescence. But it’s also the only disease space where our treatment system is set up for adults. So it’s the only disease in America where we wait for it to worsen before we start to treat it. We need to follow these same core precepts in how we treat diseases for how we prevent and treat substance use disorders.

Criticisms and Controversies of the Disease Model of Addiction

While the disease model has contributed to a more compassionate understanding of addiction, it’s not without its critics. 

One review of the scientific advances in addiction treatment sums up the questions surrounding the disease model6 that still linger among treatment professionals:

Although the brain disease model of addiction has yielded effective preventive measures, treatment interventions, and public health policies to address substance-use disorders, the underlying concept of substance abuse as a brain disease continues to be questioned, perhaps because the aberrant, impulsive, and compulsive behaviors that are characteristic of addiction have not been clearly tied to neurobiology.

While addiction undoubtedly affects brain function, and this understanding has widespread impacts on the treatment approaches of today, “social environments, developmental stages, and genetics are [also] intimately linked to and influence vulnerability and recovery.”

It’s also worth considering that other approaches can be equally effective for people in recovery, depending on how well they align with their existing belief systems.

Alternative Models 

While the disease model has helped advance addiction research and treatment, it’s not universally accepted in the behavioral health community. Some argue that it overemphasizes biological factors and downplays the role of environmental influences. Alternative models, such as the biopsychosocial model, propose a more holistic view of addiction that looks at the interaction between biological, psychological, and social factors. The choice model,7 on the other hand, believes addictive behaviors are voluntary and that recovery is a matter of willpower and personal responsibility. 

Interestingly, one analysis of the disease vs. choice models of addiction found that there’s room for both views within the addiction treatment space, and that what’s most important is that people in recovery receive clear messages about their path forward: 

On one side, treatment providers with strong beliefs in either model are more likely to send a clear and unambiguous message to clients about what addiction is and what it is not. Defining the problem and giving clients clear direction as to what they should do and expect in the short and long term should enhance clients’ perceived self-efficacy and optimism for change.

The same study also notes that “a common criticism of the disease–choice debate is that absolute truths about addiction are irrelevant so long as people do ‘recover,’” and that “the success of treatment may therefore depend on the degree of congruence between treatment providers’ and clients’ beliefs about addiction.”

There’s no one formula for recovery. At the end of the day, it’s about finding what works for you—and that includes finding an addiction treatment program that resonates with your personal framework.

Societal and Stigma Issues 

At the time it rose to popularity, the disease model offered a more compassionate view of addiction by framing those in recovery as needing help with a health condition, rather than being to blame for their drug-seeking behavior. 

But some argue that framing addiction solely as a disease can reinforce stigma by suggesting there’s something fundamentally wrong with people who struggle with addiction. Others warn that the disease model might oversimplify the complexity of addiction’s biological, psychological, and social aspects. 

It’s worth noting that personal choice isn’t the only alternative to the disease model. One study on addiction and moralization finds that “nondisease models of addiction do not necessarily involve moralization.8 Hence, a non-stigmatizing approach to recovery can be realized in ways that are consistent with both the disease model and alternative models of addiction.”

Ultimately, the recovery space has room for multiple perspectives. Effectively treating addiction means balancing the medical perspective with other factors that affect health.

Disease Model-Based Treatment Approaches

Medical Treatment Approaches

The addiction disease model has significantly influenced treatment approaches. It paved the way, for example, for the use of medication to treat addiction. “The disease model views addiction as a physiological disease9 with specified symptoms and course,” says psychologist and Professor of Clinical Psychology Arthur W. Blume. “[it’s] a biomedical model that understands addiction as a physiological pathology that requires medical or pharmacological interventions.” Today, medication-assisted treatment is commonly used to address opioid addiction and other substance dependencies.

Medications help countless people in recovery manage withdrawal symptoms, reduce cravings, and prevent relapse. Opioid use disorder, for example, is often treated with medications like methadone or buprenorphine. These treatments—especially when combined with behavioral therapies—can be life-changing for the people who use them to support their recovery. Ongoing research continues to explore new medical treatments that target specific brain mechanisms involved in addiction.10

Behavioral Interventions 

Behavioral therapies often form the basis of professional addiction treatment. 

These interventions, sometimes combined with medication, offer a comprehensive approach to address the challenges of addiction and support patients’ journeys toward lifelong recovery.

Support and Management Strategies 

Viewing addiction as a chronic condition stresses the importance of long-term support and management strategies. Similar to managing other chronic diseases, people in recovery require ongoing care and progress tracking: 

  • Adhering to treatment plans
  • Checking in regularly with treatment providers
  • Participating in support groups
  • Making lifestyle changes that support sustained recovery

For those who have co-occurring mental health disorders, it’s also essential to address these simultaneously, ideally via specialized care. Family involvement and other social support systems also play an important role in creating a positive environment that supports long-term recovery.

Find Support for Addiction

Understanding the true nature of addiction—no matter what conclusions you draw—can paint a clearer picture of your situation that illuminates your path forward. While overcoming addiction is a challenge, recovery is entirely possible, and plenty of resources exist to help you make this rewarding life change. Search for addiction treatment centers and filter by location, specializations, amenities, and more to find the right program for you.

Frequently Asked Questions About the Disease Model of Addiction

Is addiction a disease?

Yes, the disease model views addiction as a chronic brain disease. This perspective sees addiction as a health condition and challenges the stigma surrounding addiction as a moral failing. It supports seeking professional treatment and long-term management strategies.

Does the disease model of addiction remove personal responsibility?

No, the disease model doesn’t negate personal responsibility. It acknowledges the synergy of biological, psychological, and environmental factors that lead to addiction. Treatment focuses on building coping skills and making informed choices, alongside medical intervention.

Can a person recover from addiction without treatment?

While some people manage to overcome addiction without formal treatment, research shows that professional help significantly increases the chances of long-term recovery. Addiction is complex. Addiction treatment addresses underlying causes and offers strategies for managing cravings and preventing relapse.

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“Substance Use” vs. “Abuse:” The Impact of Language

The term “substance abuse” has historically been used to describe problematic substance use. But for some, this term carries a heavy stigma that implies weakness or moral failing. Recognizing this negative connotation, the recovery community is shifting towards more neutral language, favoring terms like “substance use disorder” (or SUD) which acknowledges the serious, diagnosable, and complex nature of addiction.

What Is Stigmatizing Language?

Stigmatizing language refers to words or phrases that promote stereotypes about certain groups of people. In the context of addiction, terms like “addict” or “substance abuser” might be received as shaming and judgmental. This kind of language can discourage people from seeking help or participating in treatment because of their fear of being labeled or judged. It can also lead to discrimination in areas like employment and housing, hindering someone’s chances of a successful recovery.

As addiction researchers point out in a study on the impact of language on stigma around substance use disorders:1 “Language plays a major role in shaping people’s thoughts and beliefs, and scientific communication can sometimes be an inadvertent vector of harmful stereotypes and assumptions.” We can fight these damaging stereotypes by carefully choosing the language we use to talk about addiction and the people affected by it. 

How Does Stigmatizing Language Affect People With Substance Use Disorders?

The language we use shapes how we perceive people with substance use disorders (SUDs).  Stigmatizing terms like “addict,” for example, can paint them as weak-willed or morally questionable. 

Social Impact 

In larger society, this shapes our views of addiction, the people struggling with it, and what kind of care they deserve. One study on stigmatizing language in media coverage of the opioid epidemic,2 for example, found that “The language included in U.S. news media coverage of the opioid epidemic may contribute to and reinforce widespread public stigma toward people with opioid use disorders,” and that “This stigma may be a barrier to implementation of evidence-based interventions to prevent opioid overdose deaths.” 

Quality of Care

This also has implications for the quality of care people with substance use disorders receive. Research from the American Psychological Association (APA) uncovered increased bias toward patients when they were referred to as “drug abusers.”3 This has real implications for their treatment outcomes. According to the National Institute on Drug Abuse, 

  • “Feeling stigmatized can reduce the willingness of individuals with SUD to seek treatment.
  • Stigmatizing views of people with SUD4 are common; this stereotyping can lead others to feel pity, fear, anger, and a desire for social distance from people with an SUD.
  • Stigmatizing language can negatively influence healthcare provider perceptions of people with SUD, which can impact the care they provide.”

Widening the Treatment Gap 

Shaming language around substance use can also affect whether someone receives addiction treatment at all. Addiction has a wider treatment gap5 (the difference between the number of people who have an addiction and those who seek treatment for it) than any other mental health condition—and stigma only works to increase that. For example, only 18% of people with opioid addiction receive medication for opioid use disorder, despite the widespread availability of medication and the devastating impact of the opioid epidemic.

Addiction is a mental health condition. And like any other health concern, it requires attention and care. “We don’t speak this way about other health conditions,” says John Kelly, PhD, founder and director of the Recovery Research Institute, “so we shouldn’t speak this way about addiction.”6

How Can We Address Stigmatizing Language and Labels?

We see how stigmatizing words for addiction can create barriers to recovery by promoting shame, and isolation, and discouraging people from seeking help. Luckily, we get to choose the words we use. And as such, we have the power to dismantle the negative impact of stigmatizing language and labels.

One of the most powerful ways to do this is by using person-first language.7

Promote Person-First Language

Person-first language8 “shows that a person ‘has’ a problem, rather than ‘is’ the problem.” Terms like “addict” and “alcoholic” define people by their condition rather than acknowledging their full humanity. Person-first language can help reduce the “punitive attitudes and individual blame” caused by using terms like “addict.”  

In their guide on how to talk about addiction,9 the APA recommends naming the person first, and the condition second:

Person-first language prioritizes the individual and avoids defining them solely by their addiction. Terms like ‘person with a substance use disorder’ or ‘someone in recovery’ acknowledge the person’s identity beyond their struggle. This approach fosters respect and dignity, promoting a more inclusive environment where individuals feel comfortable seeking help.

Educate Yourself and Others

The first step toward positive change is exactly what you’re doing now: educating yourself about the harmful effects of stigma.10 These labels fail to capture the complexity of SUDs and instead reduce people’s identity to their addiction. Learn the difference between substance use vs. abuse, addiction, and dependence. Share this knowledge with those around you and be a part of open and honest conversations about addiction.

Lead by Example and Challenge Stigma When You Hear It

Be mindful of your own word choices when discussing substance use, and don’t shy away from challenging stigma when you encounter it. You can do so respectfully and offer a more compassionate alternative. For example, if someone says, “He’s such a drunk,” you could gently suggest, “He’s struggling with alcohol use disorder right now.” Actions as simple as gently correcting terminology can work to raise awareness and promote a more understanding dialogue around addiction.

Focus on Recovery Efforts

When discussing addiction, highlight the positive aspects of recovery. Uplift stories of people who are overcoming their struggles and are living fulfilling lives. This focus on hope in recovery can inspire others to seek help and debunk the myth of addiction as a dead-end situation.

Advocate for Change

Support organizations and initiatives working to reduce stigma surrounding addiction. This could involve volunteering, raising awareness on social media, or even contacting your local representatives to advocate for policies that support recovery efforts.

By taking these steps, we can break down the walls built by stigmatizing language and create a more inclusive environment where people with SUDs feel empowered to seek help and improve their lives.

Non-Stigmatizing Language to Use Instead

Here are some terms to guide you toward more inclusive terminology (based on the APA’s inclusive language guide):11

Instead ofTry
Substance abuseSubstance use, person with a substance use disorder
Addict, drug user, drug abuserPerson who uses drugs
Alcoholic, alcohol abuserPerson with alcohol use disorder, person in recovery from alcohol use disorder
“Clean” or “dirty” drug screensPositive or negative
Fell off the wagonRelapsed
Hit rock bottomReached a crisis point

Simple tips to keep in mind:

  • Focus on the person, not the addiction. 
  • Be respectful and avoid judgmental language.
  • Use neutral terms to describe substance use and recovery efforts.
  • Focus on hope and success. 

Words matter. Stigmatizing language can feed into misconceptions around addiction and can significantly impact those seeking help. Thankfully, we also have the power to change that. By being mindful of the terms we use and continuing to learn as language evolves, we can create a supportive environment where people feel empowered to get the addiction help they need.

Frequently Asked Questions About “Substance Use” vs. “Abuse”

What is the difference between substance use & substance abuse?

Substance use is simply using a substance, such as alcohol or drugs. Substance abuse is when a person uses a substance in a way that causes problems in their life, such as issues with their health, relationships, or work. However, behavioral health professionals now recommend using terms like “substance use” or “person with a substance use disorder” instead of “substance abuse.”

What’s the best way to talk about substance use?

Use person-first language, such as “person with a substance use disorder” instead of “addict.” Focus on the person, not the addiction, and avoid blaming or judgmental language.

How can I help reduce the stigma surrounding addiction?

Educate yourself and others about the dangers of using stigmatizing terms. Promote person-first language and challenge stigma when you hear it. Share stories of empowerment through addiction recovery to inspire hope.

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What Is Medication Management and Why It Matters

Medication management is the ongoing process of collaborating with a healthcare professional to ensure you get the most benefit from your mental health medications. It involves making informed decisions about medications, dosages, and potential side effects to best support your health and well-being.

Why Is Medication Management Important?

If you’re taking medication to help with your mental health or addiction recovery, it’s essential to work closely with a healthcare professional who can regularly review your medication plan and adjust it as needed. This is important both to make sure your treatment is effective and to ensure your safety. 

A qualified psychiatrist, primary care doctor, or mental health-specialized nurse practitioner can help you maximize the effectiveness of your medications while minimizing the risk of potential side effects and drug interactions. 

Components of Medication Management

So what is medication management, exactly? This multifaceted process involves more than just taking a pill—it’s based on a professionally designed treatment plan that’s created for your specific needs. It’s a collaborative effort between you and your prescriber to ensure safe, effective, and optimal medication use. Medication management typically involves these key components:

Medication Review

A thorough medication review1 forms the foundation of effective medication management. In this in-depth assessment, a healthcare professional will assess the appropriateness, effectiveness, and safety of your current medications.

  • Appropriateness: This step ensures the medications prescribed are truly necessary for your conditions. Your prescriber will consider factors like potential duplication of therapies and interactions with other medications or supplements you’re taking. They might also recommend behavioral therapies to address underlying causes of symptoms instead of just managing them. 
  • Effectiveness: The review determines whether your current medications are adequately controlling your condition. This might include symptom control, improvement in certain health markers, or exploring alternative medications if the current ones aren’t working.
  • Medication safety: A critical part of the review involves identifying potential side effects and drug interactions. Your provider will assess your risk factors for adverse reactions and ensure your medications are safe for you to take in combination with each other.

Regular medication reviews are important, especially for people with chronic conditions who may be on multiple medications long-term. These reviews let you know if you need to make any changes to your medication management strategy as your mental health status evolves, or if side effects emerge.

Patient Education

Ideally, your provider should not just send you away with a prescription, but help you understand your treatment plan. Knowledge is power when it comes to making choices about your medication. At your appointment, your doctor might explain the following:

  • Dosage and administration: The prescribed dosage and how to take the medication (with food, on an empty stomach, at specific times of day, etc.)
  • Side effects: Potential side effects, their severity, and what to do if they arise
  • Medication interactions: Potential interactions with other medications, supplements, or even certain foods
  • Proper disposal of expired medication: How to safely dispose of expired medications to prevent accidental misuse

Understanding your medications empowers you to become an active participant in your own mental health journey and catch any issues early on. Patients who understand their medications also tend to adhere better to their treatment plans.2

Monitoring and Follow-Up

Medication management is an ongoing process that requires regular monitoring and follow-up appointments. This allows your healthcare provider to check how you’re responding to your medication, track your progress toward your treatment goals, and make any necessary adjustments.

During follow-up appointments, your doctor may

  • Ask about any side effects you’ve experienced
  • Monitor vital signs and other health markers to gauge the medication’s effectiveness
  • Order lab tests to assess the medication’s impact on your body
  • Adjust the medication dosage or type if needed

The frequency of follow-up appointments will vary depending on your specific condition and medications. Appointments are usually more frequent after starting or switching to a new medication. 

Challenges in Medication Management

While medication management has clear benefits, it can also present some challenges. One of the most significant hurdles is medication adherence,3 or taking medications as prescribed. Factors like complex medication regimens, forgetfulness, or side effects can all contribute to non-adherence.

Another challenge stems from patients managing multiple medications.4 Keeping track of numerous prescriptions, dosages, and administration schedules can be overwhelming, causing you to miss doses.

Communication barriers between healthcare providers5 can also create problems for patients. If doctors, specialists, and pharmacists don’t coordinate with each other, they can potentially duplicate medications and overlook drug interactions, increasing patient safety risks as a result.

Benefits of Effective Medication Management

Effective management has important benefits for people who use medication to manage their mental health:

  • Better outcomes: Taking the right medications at the correct dosages maximizes the effectiveness of treatment, meaning better symptom control and improvement of your overall mental health.
  • Reduced risk of complications: Regularly monitoring and adjusting your medication minimizes the risk of side effects and drug interactions, preventing potential complications and protecting your safety.
  • Enhanced quality of life: Reducing the intensity of mental health symptoms allows you to experience a better quality of life, with fewer limitations and improved daily functioning.

This approach doesn’t have to replace therapy—in fact, research shows that medication works best in conjunction with behavioral therapies6 for treating addiction, personality disorders, and other mental health conditions. For many people, getting their symptoms under control allows them to make the best use of their other mental wellness tools.

A Collaborative Approach to Medication Management

Safe and effective medication management requires a collaborative effort between you and your treatment team. Ideally, any doctors, pharmacists, or nurses involved in your medication plan should work together to prescribe the right medications, monitor your progress, and address your questions and concerns at any point in the process. However, this doesn’t always happen, and many people find it helpful to work with a primary prescriber who oversees their medication plan and coordinates their care. 

Find Help For Prescription Drug Misuse

Medication is a powerful tool for managing mental health conditions. But it’s also important to address any underlying issues that might lead to prescription drug misuse. If you or someone you know is struggling with dependence or addiction to prescription drugs, professional help is available.

Many rehabs specialize in treating prescription drug addiction. Their admissions specialists can provide a brief assessment over the phone, help you determine if you need treatment, and explain your treatment options. Prescription drug addiction treatment programs can provide medical detox, evidence-based therapies, and relapse prevention strategies to help you achieve long-term recovery. Some rehabs have in-house medical professionals who provide medication management services.

Search for a rehab specializing in prescription drug addiction treatment and reclaim control of your well-being.

Frequently Asked Questions About Medication Management

What does medication management involve?

Medication management includes medication review (to evaluate appropriateness, effectiveness, and safety), patient education (to advise on dosage, side effects, and interactions), and follow-up monitoring (to assess your response to medication and adjust if needed).

What are the benefits of effective medication management?

Effective medication management offers better treatment outcomes, reduces risks of side effects, and enhances quality of life by improving mental health symptoms.

How often should medication reviews be conducted?

Regular medication reviews are important, especially for chronic conditions. Your check-ins will likely be more frequent when you start or switch to a new medication, and less frequent as you get used to managing your medication on your own. The frequency of your reviews should be determined by your prescribing healthcare professional.

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Does a Relapse Erase Progress in Recovery?

Does a relapse erase all your recovery progress? Definitely not. 

While setbacks can be discouraging, they’re a totally normal part of recovery. In fact, they can be a hugely helpful opportunity to identify triggers, take advantage of professional help, and build an even stronger support network. Relapse is a chance to learn, grow, and keep taking steps toward the best version of yourself.

What Does Relapse Mean in Drug Use or Alcohol?

Relapse, in the context of addiction recovery, is a return to drug or alcohol use after getting sober. The American Psychological Association defines relapse1 as the “recurrence of substance abuse after a period of abstinence.” 

After all the work you put into your recovery, you might wonder what happens if you relapse. The recovery journey isn’t linear, and feeling like you’re taking a step backward can be discouraging—but it doesn’t erase the progress you’ve made. Instead, it’s a chance to identify underlying triggers, strengthen your coping mechanisms, and recommit to staying sober. It’s a common hurdle on the road to recovery.

Why Did I Relapse?

Understanding why you relapsed can help you prevent problems down the road. Common triggers can be internal or external. 

  • Internal triggers usually have to do with emotional distress like anxiety, depression, or boredom. These can lead to overwhelming urges to use substances to cope.
  • External triggers can include social situations where drugs or alcohol are present, people from your past who enabled your addiction, or places you associate with your past substance use. 

Identifying your specific triggers is a hugely helpful step toward preventing relapse. By recognizing triggers and developing skills for coping with them, you’ll empower yourself to stay focused on your life in recovery.

What’s the Difference Between a Slip and a Relapse?

While a slip-up might involve one instance of unplanned substance use, a relapse is a more serious return to old behavioral patterns. 

A slip is an unplanned, isolated incident of substance use after being sober for some time. It might be fueled by a strong craving or an unexpected situation. A slip doesn’t necessarily signify a return to full-blown addiction. But it does serve as a warning sign that you may need to adjust your recovery plan.

A relapse, on the other hand, indicates a more serious setback. It involves a return to regular or problematic substance use, and is usually accompanied by old behavioral patterns. A relapse might involve using for a longer period or neglecting other areas of life, and may require you to restart formal treatment.

While both slips and relapses can be discouraging, they can also be valuable learning experiences. By acknowledging what happened and getting help to correct its cause, you can return to your path with renewed determination and perspective.

What Counts as a Relapse?

The line between a slip and a relapse can be blurry. So what, exactly, counts as a relapse?

  • Frequency and quantity of use: A relapse might entail daily or near-daily use, exceeding the amount you previously used before recovery, or using for an extended period.
  • Impact on daily life: A relapse disrupts your daily functioning. You might neglect responsibilities like work, school, or relationships as substance use takes priority.
  • Loss of control: Cravings are overwhelming and you struggle to control your substance use, even when you genuinely want to stop. 
  • Return to pre-recovery behaviors: You re-engage in activities or social circles that are heavily associated with your past addiction. This could involve using with old friends or in familiar settings.

A single slip doesn’t define you. But experiencing these behaviors might signal a relapse and the need to recommit to your recovery plan with additional support.

Relapse as an Opportunity for Growth

Kara of Sober Girls Houston says relapse was a huge part of her recovery journey.2 The numerous relapses, time in jail, and stays in rehab were all opportunities for reflection that eventually led her to break through the beliefs that kept her stuck in unwanted patterns. She cites one particular relapse as a breakthrough moment: 

That relapse provided an opportunity for me to get honest with myself, be desperate enough for change, but most importantly drop the ego. I needed that I needed that relapse.

All those struggles helped her get clearer on her relationship with herself, and with recovery. Today, she’s more proactive about making relapse prevention a part of her daily life.

I have to do things on a daily basis that take care of me, and it’s a very clear program now that I work for myself. That has been absolutely life-changing for me.

For Many, Relapse Is Part of Recovery

Hufsa Ahmad, who struggled with intense episodes of psychosis and suicidality after being severely bullied in school, says her mental health relapses3 taught her important lessons about long-term recovery:  

“Those 4 relapses were the lowest points in my life. Yes, I suffered greatly, but I gained something from every relapse: 

  1. Empathy: I learned what it’s like to live with mental illness. 
  2. I saw how much my friends cared about me: something I was so delusional I couldn’t see on my own. 
  3. I witnessed what the illness took away from me, but I also saw what I could gain from it.
  4. That relapse is part of recovery: that I will fall over and over again, but the important thing is to be proactive about relapse not reactive to it; to stay vigilant and take care of myself because my relapses—my struggles—have made me the person I am today.”

Proactively Preventing Relapse

Thankfully, the causes of relapse aren’t a mystery. Research shows that these factors make relapse more likely: 

Causes of relapse among women5 include difficulty severing ties with their substance-based social networks, how their self-worth is affected by relationships with men, and interpersonal conflicts that increase negative thoughts.

Conversely, these factors protect against relapse: 

Rebuilding After a Relapse

If a relapse does happen, it doesn’t have to derail your entire recovery journey. Plenty of resources are available to help you get back on track.

Professional Help

Reconnect with your rehab center. If you attended inpatient treatment, your rehab likely has resources available for alumni. These might include refresher courses, retreats, or connections to groups in your local community.

Look for a short-term or outpatient rehab program. A short-term stay at a rehab of your choice, or an outpatient program at a treatment center near you, can give you the time and space you need to stabilize yourself and adjust your recovery plan.

Find the best alcohol treatment or prescription drug treatment centers near you using our treatment finder tool.

Reach out to your therapist. Let your therapist know what you’re going through. Consider increasing your session frequency for a while to give yourself additional support during this vulnerable time. Together, you can explore the triggers that led to the relapse and develop ways to address them. 

Social Support

Surround yourself with positive people who support your recovery. When you feel safe to do so, let your trusted loved ones know about your relapse and lean on them for strength and accountability. Beyond friends and family, your support network might also include your AA sponsor, recovery peers, or other people from your sober community. 

You Can’t Change the Past, But You Can Rewrite the Future

No one wants to relapse, but the clarity you gain from tough moments can be transformative. Kara reflects on how her perseverance empowered her to build a better relationship with her daughter: 

The legacy that I am able to leave behind is one of a woman who really messed up in a big way, but never gave up. And now I’m affecting my life and her life and our family’s life as a whole. I can’t change the past, but we are rewriting the future. And it’s the most amazing experience.”

You, too, can rewrite your future. Find a treatment center that helps with chronic relapse, and regain control of your life. 

Frequently Asked Questions About Relapse in Recovery

Does one drink break sobriety?

Whether or not one drink breaks sobriety depends on what recovery philosophy you adhere to. For people who practice complete abstinence, having one drink can be a significant event. Even for those who don’t, it could signal a change that’s worth paying attention to. What’s important to remember, however, is that while a single drink might be a setback, it doesn’t erase all the progress you made. Use slip-ups as opportunities to assess what went wrong and adjust your recovery plan accordingly, and focus on progress, not perfection.

Is relapse a part of recovery?

Yes, relapse is a common occurrence in addiction recovery. In fact, many people who struggle with addiction will relapse at some point.

Relapse can be a valuable learning experience. It can help you identify your triggers and build your coping strategies to better manage them in the future. It’s important to seek help from your therapist or an addiction treatment specialist after a relapse to get back on track with your recovery plan.

How can I help someone who has relapsed? 

There are a few steps you can take to help someone who has relapsed:

  • Act with compassion: Listen without judgment and offer emotional support.
  • Set boundaries: Avoid enabling behaviors while still encouraging their recovery efforts.

Support them in getting professional help: Encourage them to seek help from addiction treatment specialists via inpatient rehab or an outpatient program.

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SMART Recovery vs. AA: What’s the Difference? 

Deciding on the right recovery approach is an important step on the path to sobriety. Two popular options are Alcoholics Anonymous (AA) and SMART Recovery. While both aim to empower people to overcome addiction, they take very different views of recovery goals and processes. Here’s how to decide which one might be a better fit for you.

What Is SMART Recovery?

SMART Recovery (Self-Management and Recovery Training) teaches self-empowerment and skill-building to manage addictive behaviors.

The program centers on a set of 4 guiding recovery goals:1

  1. “Build and maintain motivation
  2. Cope with urges and cravings
  3. Manage thoughts, feelings, and behaviors
  4. Live a balanced life”

History and Background of SMART Recovery

SMART Recovery was founded in the early U.S. in the 1990s by Dr. Joe Gerstein, a physician who had himself been through addiction recovery and recognized the need for a nonreligious, science-based alternative to AA’s 12-Step program. SMART quickly gained traction and has since grown into a global movement with chapters in over 30 countries. They also formed the SMART Recovery Global Research Network2 to ensure their program is informed by independent research and continues to adapt alongside evolving addiction science.

Benefits of SMART Recovery

One of the main benefits of SMART Recovery is its flexibility. Unlike AA, there’s no requirement to believe in a higher power or admit powerlessness over addiction. 

“Recovery is a very individual journey.3 What works for one doesn’t work for another,” says Leigh Proctor of UK SMART Recovery, “so we need to have as many options as we can to help people.” SMART can be combined with other recovery strategies, including 12-Step programs.

Meetings are free and widely available both in-person and online, and are open to anyone struggling with substance abuse or addictive behaviors, regardless of the specific substance or the severity of the addiction. 

Philosophy of SMART Recovery

SMART Recovery principles4 aim to help members gain independence from addiction through “proven tools and techniques drawn from many effective approaches to recovery including cognitive behavioral therapy, rational emotive behavioral therapy, motivational interviewing, mindfulness, and various relaxation techniques.”

SMART doesn’t take a position on whether or not addiction is a disease. Religion and spirituality aren’t a part of the program, but members are welcome to incorporate their spiritual beliefs as they see fit.

SMART Recovery is abstinence-based, and is not a moderation or harm reduction program. But it also acknowledges that slip-ups are a normal part of recovery and does not stigmatize relapse.

What Is AA (Alcoholics Anonymous)?

Alcoholics Anonymous (AA) describes itself as “a fellowship of people who come together to solve their drinking problem.”5 

AA is a global phenomenon, recognized as one of the most successful support groups for people battling alcohol addiction. AA is based on the 12 Steps and 12 Traditions,6 a set of specific actions and principles members follow to stay on a lifelong path to sobriety.

The program has its origins in Christian ideology, but its language has been broadened to refer to “spirituality” and a “higher power” to be more accessible to people of all faiths.

History and Background of Alcoholics Anonymous (AA)

The roots of AA7 trace back to 1935 in Akron, Ohio, where a meeting between Bill Wilson, a stockbroker struggling with alcoholism, and Dr. Bob Smith, a physician facing similar challenges, sparked a movement. 

Wilson experienced a spiritual awakening that led him to sobriety, and he believed sharing his experience with others could be the key to their recovery, too. He reached out to Smith, who was on the brink of relapse. Through their shared experiences and mutual support, they found a path to lasting sobriety—and they started helping others do the same.

In 1939, they published the now-famous “Big Book,”8 outlining AA’s core principles. AA meetings sprang up across the U.S., and by the mid-20th century, the organization had established itself as a cornerstone of addiction recovery.

Benefits of AA

One of the most significant benefits of AA is its widespread accessibility. Meetings are held all over the world,9 free of charge, offering a supportive space for people struggling with alcohol addiction. AA’s anonymity10 allows members to openly share their experiences and challenges without fear of judgment from their wider community. 

AA is a strong community. Members can connect with others who understand their struggles and find support, accountability, and belonging. This camaraderie and shared purpose help members stay committed to long-term sobriety.

Many people also enjoy the program’s structured approach to recovery. By following the program step by step, members develop a framework for self-reflection, personal responsibility, and spiritual growth. Working with an AA sponsor provides a deeper level of personalized support, which can be vital, especially in early recovery.

Philosophy of AA

AA’s core recovery philosophy is based on the concept of a higher power,11 a universal force that offers guidance through the challenges of recovery. This doesn’t necessarily equate to a specific religion—the focus is on finding a source of strength outside oneself.

The 12 Steps guide members through a process of self-examination, admitting powerlessness over alcohol, seeking help from a higher power, making amends for past wrongs, and developing a relationship with their spirituality. The Steps also emphasize the importance of helping others, which reinforces AA’s community and lets members find purpose in supporting peers on their recovery journeys.

What Are the Differences Between SMART Recovery and AA?

While both SMART Recovery and Alcoholics Anonymous (AA) aim to empower individuals to overcome addiction, they differ significantly in their approaches. Here’s a breakdown of the key differences between AA vs. SMART Recovery:

Meeting Format

  • SMART Recovery: Meetings12 are structured discussions focused on skill-building and problem-solving. Participants share experiences and offer support, but there’s no requirement to share personal stories or follow a specific format.
  • AA: Meetings typically involve a speaker sharing their story of addiction and recovery, followed by open sharing from other members. The focus is on personal narratives and testimonials about powerlessness over alcohol and the importance of a higher power.

Foundation

  • SMART Recovery: This program adopts a secular, science-based approach. It emphasizes self-empowerment and developing practical skills to manage urges and maintain sobriety. There’s no requirement to believe in a higher power.
  • AA: The spiritual aspects of AA are central to the program. The 12 Steps emphasize admitting powerlessness over alcohol13 and relying on a higher power for help. While not affiliated with any specific religion, AA encourages members to develop a relationship with a higher power of their understanding.

Length of Membership

  • SMART Recovery: There’s no defined timeframe for participation. People can attend meetings for support as long as needed, whether actively battling addiction or maintaining long-term sobriety.
  • AA: A core tenet of AA is lifelong membership. Even after achieving sobriety, members are encouraged to continue attending meetings to offer support to newcomers and maintain their own connection to the program’s principles.

Labels

  • SMART Recovery: The program avoids labels and encourages members to focus on managing their behaviors and achieving their recovery goals. “We need to change the thinking that there’s only one way to recover and to see people not as addicts, but as people.14 It’s about seeing a person,” says Proctor. 
  • AA: AA embraces the label “alcoholic” as a core part of its identity. Members are encouraged to identify as alcoholics, even in long-term recovery, as a reminder of their past struggles and the importance of continued vigilance.

Exploring Which One Is Right for You

SMART Recovery and AA differ in approach, but they share the goal of empowering people to achieve and maintain sobriety. Recovery is a personal journey, and the most effective program is the one that resonates most with your personal needs and beliefs.

Considering factors like your preferred meeting format, the importance of spirituality in your recovery, and your comfort level with labels can help you decide which program might be a better fit.

If you’re unsure where to start, many rehab centers offer peer support groups for addiction that incorporate elements from both AA and SMART Recovery. These programs can provide a safe, supportive environment to explore different recovery options and connect with others on a similar journey.

Ready to take a step toward changing your life? Search for an addiction treatment center that offers support groups and a variety of treatment options tailored to your specific needs.

Frequently Asked Questions About Smart Recovery vs. AA

What are the key differences between SMART Recovery and AA?

SMART Recovery is a flexible, nonreligious program focused on personal empowerment using evidence-based practices, while AA is a spiritual program based on following 12 specific steps and drawing strength from an external higher power. SMART meetings are discussions around skill-building, while AA meetings involve discussing one of the 12 Steps or sharing personal stories.

What is the success rate of AA? 

Success rates for AA are difficult to measure due to a lack of formal enrollment and varying definitions of “success.” However, studies suggest AA is comparable to other treatment options.

Which program is right for me, SMART Recovery or AA?

The best program depends on your needs! Consider the meeting format, the importance of spirituality in your recovery, and your comfort level with labels like “addict” and “alcoholic.” Many rehab centers offer support groups with elements from both.

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What to Expect in the Rehab Intake Process: A Step-by-Step Guide 

The decision to start rehab is a brave one, and it’s nothing short of life-changing. Your journey to recovery has an official entry point: the intake process.  

When you arrive at rehab, a team of treatment professionals will gather information about you, your background, and your addiction. They’ll then use this in-depth assessment to develop a treatment plan to address your needs. 

This guide will walk you through the steps involved in rehab intake, along with other details you need to know to prepare for this first step toward recovery.

Finding a Rehab: Initial Contact and Pre-Screening

This first point of contact, often with an admissions counselor, sets the wheels of your recovery in motion. Here’s what you can expect:

Reaching Out

Be prepared to share some basic information about yourself and your situation. This might include your contact details, the substances you’ve been using, and the severity of your use. The admissions counselor will likely ask about your motivation for seeking treatment and any previous attempts at recovery. This initial conversation is also a chance for you to ask questions about the rehab’s programs, treatment costs, and what to expect once you get there.

Pre-Screening and Assessment

Following your initial contact with an admissions counselor, you’ll likely undergo a more in-depth pre-screening with a clinical professional. They’ll ask questions about your medical history, mental health, and substance use patterns. This may include details about the frequency and duration of your use, any withdrawal symptoms you’re having, and the impact addiction has had on your life. While these questions might feel personal, it’s important to answer them as honestly as possible. The better your treatment team understands your situation, the more effectively they can help you. 

The information gathered during pre-screening helps rehab staff determine the most appropriate level of care for your individual needs. It also allows them to identify any co-occurring mental health disorders that should be addressed alongside your addiction. And it lets them know if you may be a good fit for specialized treatment, such as targeted therapies for certain conditions or support groups for certain patient populations.

Arriving at Rehab: In-Depth Assessment

Once you arrive at rehab, you’ll receive a comprehensive assessment that digs deeper into understanding you and your addiction. This evaluation, conducted by multiple members of your treatment team, is used to map your road to recovery. It typically involves 3 key areas: medical, psychological, and substance abuse evaluation.  

Medical Evaluation 

A medical evaluation by a healthcare professional ensures your physical safety throughout treatment. They’ll review your medical history and current medications, and may order additional tests if necessary. This allows them to identify any underlying health conditions that are contributing to your addiction or require management during detox.

Psychological Assessment

A psychologist will then assess your emotional and psychological well-being. This is often based on what behavioral health professionals call a biopsychosocial assessment.1 Because “a variety of different things can ‘cause’ or worsen behavioral health symptoms,” says Licensed Professional Counselor and Qualified Clinical Supervisor Dr. Dawn-Elise Snipes, looking at the physical, cognitive, and relational aspects of someone can help you piece together more of their puzzle.

Your psychological evaluation may include standardized testing, as well as discussions about your mental health history, current mood, and any underlying mental health disorders like trauma or anxiety. All of these factors play a role in addiction and need to be addressed as part of your addiction treatment plan.

Substance Use Evaluation

An addiction specialist will conduct a thorough evaluation of your substance use history. They’ll ask detailed questions about the types of substances you use, how much and how often you use them, and the impact addiction has had on your life. This may also include a discussion about your triggers, cravings, and past attempts at recovery. This forms a clearer picture of your addiction so your rehab team can help you tackle your problems. 

While going through multiple rehab assessments might seem redundant, they’re each important. They form the basis of understanding for who you are and what you’re going through, and make your treatment team aware of any biological factors that might affect your response to treatment. Ultimately, it helps them create a treatment plan that will effectively meet your needs. 

Creating a Personalized Treatment Plan

The information gathered in the intake process is used to create your addiction treatment plan. This plan outlines your treatment goals and what you’ll do to work toward them over the course of the program and on a day-to-day basis.

A Collaborative Effort

The different specialists at your rehab—medical doctors, therapists, counselors, holistic wellness practitioners, and support staff—will work together to review your assessment results and discuss the most effective course of action. 

Tailored Interventions

Your treatment team will use certain therapeutic interventions to target your unique challenges.  For example, if you’re struggling with co-occurring depression, your plan might include cognitive behavioral therapy (CBT) to address negative thought patterns. If you have a history of relapses, your plan might emphasize relapse prevention strategies and learning recovery skills.

Adjusting as Needed

As you progress through the treatment process, your clinical team will monitor your response to treatment and adjust your plan accordingly. This ensures the program is optimized to meet your needs as they evolve. As an active participant in your recovery journey, you’ll also have the opportunity to voice your concerns and preferences as they come up.

Financial Arrangements and Insurance

Figuring out how to cover treatment costs can be intimidating, but it shouldn’t hold you back from getting the help you need. Rehab admissions teams are experienced in helping patients navigate insurance processes, and are there to answer your questions and help you along the way. There are several financial avenues you can use to access treatment:

Insurance Coverage

Contact your insurance provider directly to ask about their in-network rehabs and the extent of your coverage for addiction treatment. This will give you a clearer picture of what portion of the treatment costs your insurance covers.

Out-of-Pocket Costs

Even with insurance, there may be out-of-pocket expenses like deductibles, co-pays, or coinsurance. Your rehab’s admissions team can give you a detailed breakdown of estimated costs associated with your treatment plan. Be sure to ask about any additional fees so you know exactly what to plan for. 

Payment Options and Financial Assistance

Many rehabs offer flexible payment plans to help manage the financial burden. They can also connect you with resources to explore financial assistance programs. Government-funded programs like Medicaid may offer coverage for addiction treatment, and some rehabs have scholarship funds for those who can’t afford treatment.

See frequently asked questions about insurance coverage for rehab.

Orientation and Beginning Treatment

The first few days in rehab can feel like information overload, which is why it’s important to get oriented and ease into the process. 

Orientation 

During orientation, you’ll receive an overview of the facility’s policies, daily schedule, and safety protocols. This includes information about meals, group therapy sessions, medication management (if applicable), and expected behavior within the facility. You’ll also finalize your living arrangements, whether it’s a private room or shared accommodations. The rehab staff is there to address any questions or concerns you may have and help you feel comfortable in your new surroundings.

Structure and Support

Rehab is a safe, structured environment with routines that will become the foundation of your life in recovery. The first few days to a week in rehab are about acclimating to this new routine and settling into your daily schedule and activities. This structured environment is one of the main benefits of residential rehab, as it provides an immersive, recovery-focused experience.

Connecting with the Community

Orientation is an opportunity to meet the staff members you’ll interact with throughout your stay, such as nurses, case managers, and therapists. You’ll also have the chance to connect with other patients in your program. You’ll likely spend a lot of time with your program peers as you attend group therapy and other activities together. These people will be an important support system during this stage of your journey. 

Family Involvement and Support

Addiction impacts the entire family, and rehab recognizes the importance of including your loved ones in your healing process. Different programs have different tools for facilitating family support in rehab.

Family Programs

Many rehabs offer specialized family programs designed to educate your loved ones about addiction and empower them to best support you. These programs may include several components:

  • Psychoeducational workshops: These workshops aim to educate families about addiction, its causes, and the recovery process. This helps them understand what you’re going through and how to create a more supportive environment for you when you return home.
  • Family therapy sessions: These sessions provide a safe space for open communication between you and your family. A therapist can guide discussions, address underlying issues, and help your family learn supportive communication skills.
  • Support groups: Family support groups connect loved ones of people in recovery. Sharing experiences and challenges with others who understand can be incredibly validating and provide valuable coping mechanisms for your family.

Involving Family in Your Healing Process

Rehabs often facilitate ongoing communication between you and your family during your treatment stay. This may involve:

  • Family day: Some rehabs have designated dates toward the end of a program where family members visit to attend workshops, therapy sessions, and activities with their loved ones in the program. 
  • Family visits: Rehabs might also allow patients to schedule individual family visits within the facility’s guidelines. These visits allow for face-to-face interaction in a facilitated context to create space for mutual understanding.
  • Communication: Different programs have different policies on using your devices to stay connected with your loved ones while you’re in treatment. If this is important to you, check with your rehab for details on theirs.

Setting Boundaries

While family involvement is encouraged, it’s also important to establish healthy boundaries. Rehab is a great time to break old patterns and practice new ways of handling relationships, while you have the support of your therapists. Your treatment team can help guide you through this process.

Working with the staff, you can create a plan outlining the frequency and duration of visits or phone calls that feel comfortable for you during this vulnerable time. Your therapists can also teach you assertive communication skills, allowing you to clearly and confidently express your needs to your family. The goal of family programming is to help you heal relationships with your family and reinforce an important part of your support system to prepare for your return home. 

A strong support network is an essential aspect of life in long-term recovery. But not everyone’s relationships with family members are healthy or supportive of their healing progress. Your family in this case might include chosen family, extended family, your partner, or close friends who are unconditionally loving and supportive. You’ll be making major life changes and continuing to face challenges after you complete treatment, and your support network will be a key part of your success. 

The First Step Toward Your New Life

The rehab intake process may seem like a lot, but it’s an incredible first step toward changing your life. Think of it as laying the foundation for a healthier, happier you. 

The information gathered during intake allows the rehab staff to create a personalized treatment plan specifically designed to address your needs and maximize your chances of success. As such, it’s important to be honest and transparent with staff throughout the process. The more information you share about your addiction history and challenges, the better equipped your treatment team will be to deliver an effective treatment plan. Don’t be afraid to ask questions and voice any concerns you have. The rehab staff is there to guide and support you every step of the way.

Deciding to change your life is a hugely empowering act. Approach the intake process with courage and a commitment to your healing. With the right support, you’ll be well on your way to a beautiful life in sobriety. 

Search for addiction and mental health treatment centers and contact their admissions staff directly today, and take the first step toward your new life. 

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Patience in Recovery: Keep Calm and Stay on the Path

The road to recovery from addiction is full of ups and downs. While milestones and moments of clarity can bring immense joy, the truth is that progress isn’t always easy. Patience allows us to weather the inevitable storms, understanding that healing takes time. 

Let’s look at why patience is so important to addiction and mental health recovery, and explore practical techniques to help you cultivate this essential skill and build a foundation for lasting success.

Understanding the Role of Patience in Recovery

The Nature of Recovery

Just like progressing in any other area of life, recovery is not a linear process. There will be victories—conquering cravings, having breakthroughs in therapy—but there will also be setbacks. Like any hero’s journey,1 in recovery, you’ll undoubtedly face challenges that test your commitment to the journey. This is where patience comes in. 

Creating change takes time. Developing new life skills is like building muscles: it takes consistent effort. As you rebuild your life after addiction, progress might look like two steps forward and one step back. It’s still progress. With patience and dedication, you’ll eventually find yourself well down the path toward lifelong recovery.

Benefits of Patience

While it may sound passive, patience isn’t just about sitting around, waiting for things to come to you. It can actually be an empowering way to take charge of your recovery process. Embracing patience helps you reduce stress and anxiety, which are common triggers for relapse.2 Maintaining a calmer state of mind makes it easier to manage difficult emotions and put your new coping skills into practice. 

Patience also leads to better decision-making. You’ll be less likely to make impulsive choices fueled by frustration, and more likely to take intentional steps toward your recovery goals. With patience as your guide, you’ll cultivate a calmer, clearer mind: an essential asset as you redesign your life. 

Challenges to Cultivating Patience

Losing patience is part of the nature of addiction3 itself, as addiction specialist Dr. David Fawcett explains: 

When we’re in our active addiction, the part of brain where addiction lives is badly overstimulated with all the intensity going on; with the dopamine and all the signals for more and more intensity. That really teaches the brain to forget about patience, because it always wants that instant gratification. And that is a real problem because over time, not only does the intensity increase, but behaviors become more impulsive.

Developing patience is key to countering this impulsivity. But there are other challenges along the way that tend to complicate things.

Frustration With Ourselves

On the road to recovery, you’re sure to encounter plenty of frustrations. There will be times when you hit plateaus and yearn for faster progress and more immediate rewards.  

When progress feels slow, it’s easy to get discouraged. Usually, our default mode in these times is to be self-critical. But while we may think this leads to improvement, the truth is that it often impedes our progress.

“Being hard on ourselves is familiar to many of us,” says meditation teacher Tara Brach. “We often distance ourselves from emotional pain—our vulnerability, anger, jealousy, fear—by covering it over with self-judgment. Yet, when we push away parts of ourselves, we only dig ourselves deeper into the trance of unworthiness.”

The antidote to this is self-compassion.4 “Whenever we’re trapped in self-judgment…our first and wisest step towards freedom is to develop compassion for ourselves,” says Brach.

Setbacks—even relapses—are a common part of this journey. If you find yourself comparing your progress to others, remember that recovery isn’t a race. It’s a deeply personal journey that looks different for everyone. Acknowledging these challenges and focusing on self-compassion lets you cultivate the patience you need to thrive in recovery.

External Pressures

Patience in recovery can also be tested by pressures from the outside. Societal expectations of immediate results can fuel your frustration. Family members might push for faster progress, lacking an understanding of the internal work involved. For many who return home after rehab, the pressure to return to their “old self” at work and in other aspects of day-to-day life can be overwhelming. But recovery is a journey of self-discovery, not a race to return to who you once were. Communicating your needs—setting boundaries with your family and having honest conversations with your employer—creates an environment that supports your sobriety.

Personal Expectations

Your desire for quick results can also be a major hurdle. You might set unrealistic goals or expect immediate changes. All this pressure is a recipe for disappointment and feeling like you failed. But recovery is a healing journey, not a destination. It takes time to rewire ingrained patterns and let go of long-held narratives. Take note of your small wins each day and stay focused on your long-term vision. By letting go of the need for instant gratification, you grow the patience needed for lasting transformation.

Recovery Strategies for Cultivating Patience

Meditation and Mindfulness in Recovery

In the throes of recovery, patience can feel elusive. Here’s where mindfulness and meditation can help. By focusing on the present moment, you detach from cravings and frustrations that fuel impatience. 

Start with simple exercises: focus on your breath, feel your feet on the ground, and listen to surrounding sounds. Notice these sensations without judgment. With practice, your mind will become calmer, allowing you to observe and breathe through intense emotions. As you become more present, you’ll find the space to accept hard moments and overcome frustrations in recovery.

Setting Realistic Goals

The road to recovery is paved with small victories. Instead of setting all-or-nothing goals, focus on achievable milestones. Break down long-term goals into smaller, manageable steps. Regularly review and adjust your goals as you evolve. This keeps you motivated, gives you a sense of accomplishment, and reminds you of the steady progress you’re making. 

Positive Self-Talk

Recovery can be tough, and negative self-talk can easily sabotage your patience. Instead, cultivate an inner voice5 that’s kind and encouraging. Acknowledge setbacks, but don’t dwell on them—reframe them as learning experiences. Remind yourself that this is only a bump in the road, not the end. Positive self-talk boosts your confidence and grows your patience. It reminds you that you’re capable of overcoming challenges—including building a life free from addiction.

Building a Support System

Leaning on Loved Ones

Loved ones are essential to our happiness, in recovery and in life. Surround yourself with supportive people who understand your struggles and celebrate your success. Share your recovery goals with them and ask for their encouragement. Their belief in you can be a powerful source of motivation.

It can be hard to ask for help, especially when we need it. Your loved ones aren’t there to judge, but to offer a safe space, a listening ear, and unwavering support on your mission to improve your life.

Professional Support

Therapists, counselors, and support groups are invaluable recovery allies. Therapists can help you identify the causes of your addiction and addressing them in a safe, supported way. Support groups provide a safe space to connect with others who understand what you’re going through. Professional support can also help you identify and address underlying reasons for addiction, like unhealed trauma. With professional support, you can develop the emotional resilience you need to navigate the ups and downs of recovery.

Practical Tips for Maintaining Patience

Daily Practices

Not everyone is naturally super patient, and that’s okay! Like any skill, patience can be learned. Try these techniques as a starting point:

  • Journaling gives you an outlet for processing emotions, and can help you identify triggers that make you feel impatient. 
  • Gratitude practices, like listing things you’re thankful for, shift your focus to what you already have instead of what you lack. 
  • Urge surfing helps you manage cravings by riding out feelings without acting on them. 
  • Relaxation techniques like deep breathing and meditation help you manage stress and cravings in the moment.

Results come with consistency over time. Try to make these a regular part of your daily routine. Start small—5 minutes of journaling each morning, or 3 deep breaths to center yourself when you feel frustrated. Over time, you’ll see how practicing these simple techniques helps you approach recovery with more ease. 

Managing Triggers

Patience can be especially thin when you’re confronted with a trigger. 

To address this, identify situations, people, or emotions that spark cravings or frustration (your therapist can help with this). Maybe it’s a certain bar, a high-pressure presentation at work, or an argument with your partner. Once you know your triggers, you can start to develop coping mechanisms. Avoid the bar altogether, use a relaxation technique to center yourself before work meetings, and learn how to better communicate with loved ones to reduce conflict. 

Having a plan in place empowers you to manage triggers effectively, preventing them from derailing your patience—and progress in recovery.

Celebrating Small Wins

The path to recovery is paved with small victories. You don’t have to wait for major milestones—acknowledge your daily wins! Did you resist a craving? Attend a therapy session?  These are triumphs worth celebrating.  

Take a moment to appreciate your progress, no matter how seemingly small. Journal about your accomplishments, reward yourself by doing something you enjoy, or share your win with a supportive friend. Taking stock of your wins reinforces positive behaviors, boosts your confidence, and grows the patience you need to persevere in recovery. Every step forward is a reason to celebrate!

Patience and Long-Term Recovery

Sustaining Motivation

Patience contributes to sustained motivation and long-term success in recovery. Embracing patience means you’re less likely to get discouraged by setbacks and more likely to retain your determination. Focusing on the long game, instead of chasing quick fixes, lets you trust the process. As you build your mental and emotional resilience, you position yourself for long-term success. 

Preventing Relapse

Preventing relapse involves tuning in to your emotions and triggers. This self-awareness helps you recognize early warning signs of relapse, like heightened stress or cravings, before they get out of control. Taking proactive steps like using techniques you learned in rehab, reaching out to your support system, or attending a support group meeting keeps you from veering further away from your goals. Patience empowers you to address these warning signs calmly and effectively, preventing them from escalating into a full-on relapse. 

“I had the patience and the willingness to stay sober.”

One man in recovery, Peter, credits patience with helping him finally stay the course toward recovery after years of being in denial about his addiction. He recalls his decision to commit to recovery6 while he was in the hospital after a car accident that happened under the influence:

I could easily have made a phone call but I wanted to quit. I had really had enough of it, and I had the patience and the willingness. I made the adjustments in my life that I had to, to stay sober.

Keep Trusting the Process

Patience in recovery doesn’t always come easy. But having the perspective to stick out tough times and see the process through is what allows you to reach the place where you can start reaping rewards. Nothing truly rewarding comes without effort. Sometimes all we can do when the road seems unclear is to keep putting one foot in front of the other. 

Find addiction treatment programs to support your path to a life in lasting recovery.

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The Relationship Between Alcohol and Anxiety

Many people who struggle with anxiety turn to alcohol to cope with their stress. But what if that drink makes anxiety worse? We explore the self-perpetuating relationship between alcohol and anxiety, and provide insights and resources to help you manage both.

How Alcohol Affects Anxiety

People use the term “anxiety” so casually, we often forget what it means. One man in recovery, Leon, reminds us how profoundly it can impact your life:   

When I’m feeling extremely anxious I can’t talk to people; I can’t work; I can’t get out of my bedroom; I don’t even want to move; It’s horrible…It’s one of the hardest things that I’ve ever experienced. 

Those who use alcohol to cope with their anxiety often find that it bounces back even stronger when they stop drinking. “When I stopped drinking, I had a lot of experiences of up-and-down anxiety,”1 says Leon.

Short-Term Effects

Alcohol is a depressant, meaning it slows down the central nervous system. Initially, this makes people feel calm and relaxed—which is why so many people who live with anxiety turn to alcohol for symptom relief. In the short term, drinking makes it seem like social inhibitions are lowering and worries are fading away. But this calming effect is short-lived—and misleading—because alcohol makes anxiety worse down the line.

Kevin O’Hara, who is in alcohol recovery, recalls how he used to rely on alcohol to deal with social anxiety:2 

When I was younger and just I wasn’t able to speak to anyone—especially women—alcohol provided that lubricant that I needed at the time.

Long-Term Effects

Unfortunately, alcohol’s initial calming effects don’t last. Long-term alcohol use upsets the harmony of chemicals in your brain, such as GABA and serotonin, that regulate your mood. This worsens anxiety symptoms over time, creating a cycle that leads to dependence. As alcohol wears off and anxiety intensifies, you might start to drink even more. This cycle feeds anxiety and increases alcohol use. Before you know it, this can ramp up into a full-blown alcohol use disorder that further complicates your ability to manage your anxiety.

Leaning on alcohol in awkward moments also keeps us from learning the social skills we need to function without it. “You’re sort of priming yourself now for problems later on,” says O’Hara, “because you’re using an outside substance for a problem which is inside, and that is always going to cause problems.”

Alcohol-Induced Anxiety

Not only does heavy drinking disrupt brain chemistry in the long term, but it can also trigger immediate anxiety spikes. As your blood alcohol concentration (BAC) drops, your body goes into alcohol withdrawal. This results in a cascade of physical symptoms which might include sweating, tremors, and racing heart rate (which can be very anxiety-provoking). Heavy drinking also disrupts your sleep quality, and poor sleep is a major risk factor for anxiety. The physical effects of withdrawal combined with poor sleep quality can make your anxiety feel much worse both during and after heavy drinking episodes.

How Anxiety Influences Alcohol Use

Self-Medication

Anxiety symptoms can make life feel so much harder, and it’s common for people who struggle with this condition to self-medicate with alcohol. And understandably so—the initial calming effects of alcohol can feel like a welcome escape from the overwhelm of anxious spiraling. 

Danay, who founded Sober Girls Houston while in alcohol recovery, recalls how she started drinking to cope with academic pressures3 in high school: 

I went to a private school, and if I didn’t get an A there was a problem. So I always felt like I had the weight of the world on my shoulders. I was pretty hard on myself if I didn’t do everything exactly right every time. Drinking was like a way out of it. I mean, that’s all I saw, right? Everybody just got a drink when they were stressed out or when they had a lot going on. It was just what you did to survive, so I didn’t think anything different.

The relationship between alcohol and anxiety is so normalized that we often don’t even see it.

Cycle of Dependence

At first, you might drink to find temporary anxiety relief. But the problem with using substances to cope is that they ultimately don’t work—and you’re often left with an even bigger problem. Alcohol weakens your body’s natural ability to regulate anxiety. And as it wears off after a night of drinking, anxiety rebounds4 and intensifies. When that happens, it creates a strong urge to drink again to relieve your alcohol-induced anxiety. As tolerance builds over time, you have to drink more to get the same calming effect. This cycle eventually becomes deeply entrenched, making both problems worse.

Co-occurring disorders (also known as dual diagnoses)—mental health conditions that occur alongside substance use disorders—are notoriously complex and require specialized treatment to address both conditions at the same time. The best way to avoid this scenario is to find healthier alternatives to drinking, such as therapy, medication, and lifestyle changes, and talk therapy, as a way of managing anxiety.  

The Biochemical Connection

The connection between alcohol and anxiety goes deeper than the temporary stress relief you feel after a few drinks. 

Neurotransmitter Disruption

Alcohol disrupts the chemical balance in your brain. The neurotransmitter GABA, for example, has calming properties. Alcohol mimics the effects of GABA, which reduces anxiety in the moment. But over time, alcohol causes your brain to produce less GABA—and fewer GABA receptors.5 The same process happens with serotonin, dopamine, and other mood-regulating brain chemicals. This builds long-term anxiety by reducing your natural capacity to manage stress.

Impact on Sleep

While alcohol’s drowsiness-inducing effects might help you fall asleep, it negatively impacts your sleep quality throughout the night. Alcohol reduces the amount of time we spend in deep sleep, which in turn affects our mood and ability to regulate emotions. Poor sleep quality due to alcohol6 makes you feel sleepy throughout the day, affects your productivity, and worsens anxiety symptoms. Chronic sleep disturbances make anxiety far worse and create a feedback loop where poor sleep due to alcohol fuels anxiety, which then further disrupts sleep.

Psychological and Social Factors

Behavioral Patterns

Alcohol-related behaviors can also fuel anxiety. For someone with social anxiety, for example, drinking might seem like a welcome icebreaker. But those relaxed inhibitions can be a double-edged sword, as poor decision-making and awkward interactions only reinforce social anxieties once the fog clears. Depending on alcohol to be social can make you afraid to socialize without it, which limits your scope of connections as your social circle narrows to focus on party friends. 

Social Consequences

We don’t often think our behaviors pose risks to those around us, but problematic drinking will eventually affect our friends. 

The behavioral patterns that stem from heavy drinking are notorious for ruining relationships. Drinking destabilizes our mood, making us more irritable and less likely to show up to our relationships as our best selves. You might be more short-tempered or cynical for days following a heavy drinking session—which, if you drink several times a week, means your mood is affected virtually all the time. The effects of this get worse as alcohol dependence sets in: “Evidence suggests that alcoholics experience increasing dysphoria7 as a consequence of alcohol consumption,” say researchers. 

Drinking causes us to act impulsively, without regard for consequences, or without even realizing what we’re doing, leaving us with an embarrassing emotional hangover as we try to remember our actions the night before. 

All of this strains relationships and makes us feel isolated and more socially anxious. This erodes the very support systems that are so important when we’re changing our drinking behaviors and learning to manage anxiety.

Identifying the Signs of Co-Occurring Alcohol Use and Anxiety Disorders

Behavioral Signs

Spotting a co-occurring problem with alcohol and anxiety can be tricky. Here are some signs to watch for: 

  • You only feel comfortable socializing after drinking. 
  • You avoid social situations where alcohol isn’t available.
  • You drink more during periods of heightened anxiety.
  • You’re becoming more socially isolated.
  • Your sleep patterns are changing. 

If you notice any of these signs, it might be time to reevaluate your relationship with alcohol. 

Physical and Emotional Symptoms

Physical symptoms can also signal co-occurring alcohol use and anxiety disorders. These might include tremors, sweating, or difficulty sleeping, which can be caused by both anxiety and alcohol withdrawal. 

Emotional signs include chronic worry, irritability, and difficulty concentrating. Panic attacks8 (a hallmark of anxiety disorders) might also become more frequent. If these symptoms worsen with alcohol use or persist even when you’re sober, it may be time to seek professional help.

Treatment and Management Strategies

Professional Help

Breaking the cycle of anxiety and alcohol dependence is a complex process and is best taken on with professional support. 

If you require alcohol detox, it’s important to do so in a medically supervised environment. Alcohol withdrawals can be highly dangerous and should not be attempted alone. You can contact a detox center for an over-the-phone assessment to determine your level of need.

In a reputable addiction and mental health treatment program therapists provide a safe space to explore the underlying causes of both conditions, teach coping skills to manage anxiety without the use of alcohol, and help you implement lifestyle changes that sustainably support your well-being. Rehabs offer programs at different levels of intensiveness and use a variety of treatment approaches (which may include medication management, talk therapy, and complementary therapies) according to your needs. Your treatment team can help you determine the most effective path toward getting—and staying—well.

Integrated Treatment Programs

For people who struggle with both alcohol use disorder and anxiety, the most effective treatment is a comprehensive program that specializes in dual diagnosis treatment. These programs address both conditions simultaneously and recognize the synergy between them. Therapists experienced in treating co-occurring disorders can tailor interventions to treat symptoms and address the root causes of anxiety and alcohol addiction. This might include therapies like CBT alongside medication management for anxiety, as well as relapse prevention strategies for staying sober long-term. Integrated programs can be highly effective, healing underlying problems and teaching the skills you need to manage your anxiety and live a fulfilling, alcohol-free life.

Medications

As part of your treatment plan, doctors might prescribe medications to target anxiety symptoms,9 such as selective serotonin reuptake inhibitors (SSRIs). These medications may also reduce cravings for alcohol. 

Your treatment team might also recommend medications like buspirone or hydroxyzine to address anxiety and potentially decrease alcohol use as a coping mechanism. 

Medications should only be prescribed by a qualified prescribing doctor after in-depth psychological testing to determine your specific needs and best course of action. 

Not everyone is open to medication, and that’s okay. But for those who are, it can be effective for managing both alcohol and anxiety. Medication is most effective when combined with psychotherapy,10 which helps you learn coping strategies and make lasting behavioral changes. Medication management can help you get symptoms under control so that talk therapy is more effective. 

Self-Help and Lifestyle Changes

Mindfulness and Stress Reduction

Mindfulness practices and stress reduction techniques can help you manage anxiety without relying on alcohol. Mindfulness meditation helps you cultivate self-awareness as you learn to observe your thoughts and feelings without judgment. This can also help you place some distance between feeling triggered and acting on it, meaning you’ll gain more control over your reactions as you learn to self-regulate your emotions.

Stress reduction techniques can include deep breathing exercises, which slow your heart rate and activate your body’s natural relaxation response. Spending time in nature, taking up a new hobby (or rediscovering an old one), and getting regular, good-quality sleep all support your emotional well-being. By making these practices a regular part of your life, you’ll build resilience and get better at managing your anxiety.

Healthy Habits

Long-term recovery from anxiety requires a strong foundation of healthy habits. These lifestyle changes include getting regular exercise, nourishing your body with a nutrient-dense, anti-inflammatory diet, and improving your sleep hygiene. Doing things that nourish your spirit and allow your mind and body to recharge increases your capacity for handling stress and sets you up for success in daily life. 

Support Systems

No one should fight anxiety or alcohol addiction alone—strong support systems are key to long-term success. As you make these life changes, surround yourself with friends and family who understand your struggles and offer nonjudgmental support. Consider joining a local or online support group specifically focused on anxiety. Sharing your experiences openly and hearing those of others reminds you that you’re not alone. 

Feeling Anxious and Doing It Anyway 

There are times when it’s okay to pull back from situations that make us uncomfortable, and times when it’s helpful to push through to achieve your goals. O’Hara says he finds it helpful to put himself in social situations without alcohol11 even if it feels uncomfortable at times: 

You have to put yourself into situations where, if there was no alcohol around, you might normally feel awkward about it. But every time you do that, you learn something. You gain a more confidence in yourself and your abilities.

Resources for Further Help

These hotlines, websites, and support groups are great starting points to learn more about co-occurring anxiety and alcohol use disorder and find the help you need: 

If you’re struggling with anxiety and alcohol addiction, a treatment center can help you uncover the cause of both conditions and make a plan to address them. Search co-occurring disorder treatment centers and reach out to their admissions teams directly to find the right program for you.

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Is Addiction a Choice? What Experts Say 

Is addiction a choice, or is it a disease? In the addiction treatment community, this seemingly simple question is a source of complex debate. On one hand, some view addiction as a moral failing: a result of poor choices and a lack of willpower. On the other, science reveals a different story: one of altered brain chemistry, overpowering cravings, and a chronic disease that requires professional attention.  

If you struggle with addiction, or love someone who does, learning how it works can only help. People affected by addiction need treatment to escape its grasp and heal its effects on their lives. By better understanding this multifaceted disorder, we can better address the problem—and treat those on this journey with compassion and care.

The Nature of Addiction

Definition of Addiction

Addiction goes far deeper than your garden-variety bad habit. It’s a chronic, relapsing disorder that takes hold by affecting pathways in your brain. Here’s how the American Psychological Association defines addiction:1

Addiction is a state of psychological and/or physical dependence on the use of drugs or other substances, such as alcohol, or on activities or behaviors, such as sex, exercise, and gambling.

Treatment professionals have different perspectives on what the exact nature of addiction is. But most of the behavioral health community agrees that it’s characterized by these 3 traits: 

  1. It’s chronic. 

Addiction is chronic. Repeated substance abuse alters brain chemistry, making it extremely hard to control cravings and resist use, even after periods of abstinence. This underlying brain change is why addiction requires ongoing management and support for long-term recovery.

  1. It involves the risk of relapse. 

Addiction has a high risk of relapse.2 Brain change caused by prolonged substance use can trigger intense cravings, making it hard to resist using again, even if you’ve been sober for awhile. This is why addiction treatment centers often address relapse upfront by building relapse prevention planning into their programs. 

  1. It’s compulsive. 

Addiction isn’t simply a matter of willpower. It’s characterized by compulsive drug use despite its negative consequences to your health, relationships, finances, and other areas of life. This comes from changes in the brain caused by repeated substance use. These changes disrupt the brain’s reward system, causing intense cravings that make it feel virtually impossible not to use, even if you know it will cause harm.

As a disease of the brain, [addiction] requires medical treatment in addition to an emotional commitment to treatment and recovery. Calling addictive disorders a habit denies the medical nature of the condition and implies that resolution of the problem is simply a matter of willpower.3

  • Partnership to End Addiction

Types of Addictions

Addiction isn’t limited to just drugs and alcohol. Both substances and behaviors can hijack the brain’s reward system and lead to compulsive use. 

Substance Use Disorders

  • Alcohol
  • Opioids (prescription pain relievers, heroin)
  • Stimulants (cocaine, methamphetamine)
  • Marijuana
  • Synthetic drugs 

Behavioral Addictions

  • Gambling
  • Internet addiction
  • Gaming addiction
  • Sex addiction
  • Eating disorders 

Scientific Perspectives on Addiction

Addiction and Brain Chemistry

Addiction is rooted in changes to your brain chemistry. A key player in all this is the reward system, a network of brain regions activated by pleasurable experiences, including addictive behaviors and substance use. This system releases neurotransmitters like dopamine, which reinforces those pleasurable experiences and motivates us to repeat them.

With repeated drug or alcohol use, your brain adapts to the presence of that substance. Over time, it takes more and more of the substance to produce the same effect. At the same time, your brain stops producing as much natural dopamine, making it harder to find pleasure outside of your addiction. 

This is why you can’t “just quit” using substances: your brain believes your life depends on them and urges you to act accordingly.

Genetic Factors in Addiction

How much of addiction can be attributed to genetics4 has long been a topic of scientific debate. “Even the most extreme environmentalists along the nature-nurture continuum in psychology now acknowledge that genes often contribute to individual differences in behavior,” says neuroscientist and behavior geneticist Dr. John C. Crabbe. 

Your genes, however, are not your destiny. While they may provide a blueprint that increases your vulnerability to addiction, which genes get expressed depends largely on your environment and lifestyle choices. 

Environmental Influences

Environmental factors play a major role in developing addiction. Childhood trauma due to neglect, abuse, or household dysfunction can impact the experiences we have later in life. In fact, there’s a direct link between how many adverse childhood experiences (ACEs)5 someone has and their likelihood of developing addiction as an adult. 

Addiction and trauma expert Dr. Gabor Mate explains that this “wiring” for addiction6 has to do with people’s ability to regulate their emotions: 

If the parents are not there in an attuned, nonstressed way to regulate them, self-regulation never develops. Then there is no impulse control. If they’re stressed to begin with, then they are going to go for anything to reduce the stress. One thing that addictions all do is they reduce stress momentarily.

Addiction can also result from trauma that happens later in life. Even if you’re not severely traumatized, chronic stress can lead you to self-soothe with substances. And if alcohol or drug use is normalized in your friend group and substances are easily available, social factors can play a part in developing addiction, too.  

Psychological and Behavioral Factors

Mental Health and Co-Occurring Disorders

Addiction is often related to an underlying mental health disorder. These co-occurring conditions can be a vicious cycle. While people who live with mental health issues might use substances to cope with their symptoms, substance use itself can also lead to—or worsen—mental health problems.

If you’re struggling with both addiction and your mental health, it’s important to find a specialized program that can effectively treat both at the same time. 

For more on this, see our article on treatment for co-occurring disorders. 

Decision-Making and Impulse Control

Addiction’s grip extends beyond physical dependence. It significantly disrupts the brain’s decision-making and impulse control centers. The brain’s reward system, designed to motivate healthy behaviors, is rewired to seek the addictive substance or behavior. This leads to intense cravings that override rational thought.

Addiction impairs your frontal cortex,7 the part of the brain responsible for decision-making, planning, and foresight. As a result, it gets harder to resist impulsive urges in favor of long-term goals like sobriety. This is why people struggling with addiction may fully understand the negative consequences of their actions, but still feel powerless against the overwhelming urge to use. 

Societal and Cultural Influences

Stigma and Misconceptions

Recovery requires us to be honest with ourselves and others about what we’re going through, and reach out for help. But for many, stigma is a huge barrier to getting the help they need.8 

There are widely held misconceptions of addiction as a moral failing, a lack of willpower, or a bad habit that’s easily kicked. These views don’t just promote discrimination against those who are struggling, but hinder their steps toward recovery.

Learning the science behind addiction helps us understand why healing requires professional help—and why those in this process deserve as much compassion as anyone else. 

Societal Pressures

Societal pressures and cultural norms influence substance use and shape our views on addiction. 

Certain cultures may normalize heavy drinking9 or social drug use, creating an environment where experimentation seems acceptable. This can be especially risky for teens, who are more susceptible to peer pressure and may underestimate the potential for addiction.

Media portrayals that glamorize substance use blur the lines between harmless recreation and dependence. Societal pressures to succeed create the conditions for burnout that often leads to self-soothing with substance use. Meanwhile, while much of the content we consume normalizes drinking as a way to relax. 

But social influences can also play a positive role. Our growing mental health awareness is reducing stigma around seeking help. And communities that promote healthy lifestyles and provide strong social networks create environments that support healing.

The Argument for Addiction as a Choice

Initial Use vs. Chronic Use

There’s a difference between the initial choice to use a substance and the loss of control that characterizes addiction. While the initial decision to use a substance might be a conscious one, addiction itself is not.  

Someone might try a drug or alcohol for the first time because they’re simply curious, or they’re influenced by peer pressure. But with repeated use, the brain undergoes significant changes. As tolerance builds, cravings intensify, and the ability to control impulses declines, addiction takes hold. 

Understanding how addiction develops shifts the focus from blaming people for their initial choice to supporting them through undoing the changes to their brain chemistry that perpetuate addiction. This paves the way for effective treatment that addresses the underlying causes and empowers people to regain control over their lives.

Addiction and Personal Responsibility

While addiction’s hold on neuropathways means behaviors aren’t always a willing choice, recovery empowers you to reclaim your personal agency. Once you recognize that you have a problem, you have choices: to seek treatment, to stay committed to recovery, and to respond differently to the challenges that arise.

Taking ownership over changing your life means actively participating in treatment, which might include individual therapy, medication, and support groups. It also involves making lifestyle changes that reduce your risk of relapse and support your well-being. This includes avoiding people or places that encouraged your substance use, learning healthy ways to deal with stress, and practicing self-care. As Dr. Gabor Mate says: 

We may not be responsible for the way the world creates our mind, but we can learn to take responsibility for the mind with which we create our world.10

The Argument for Addiction as a Disease

Chronic Illness Model

The disease model of addiction11 views this disorder as a chronic illness, similar to conditions like diabetes or heart disease. Just as these diseases alter biological processes and require ongoing management, addiction disrupts brain chemistry and requires long-term treatment.

Treatment for chronic diseases focuses on managing symptoms, preventing complications, and promoting overall health. Addiction treatment follows a similar arc. Initially, detox (if necessary) treats the physical symptoms of addiction. Intensive treatment approaches like inpatient rehab work on the underlying issues that drive addiction, and continuing care helps you prevent relapse and live a fulfilling sober life in the long term. 

The disease model works against the stigma of addiction, and highlights the need for effective treatment approaches that cater to each person’s needs.

Medical and Therapeutic Interventions

Just like treatment for other illnesses, addiction can be treated effectively with medical and therapeutic interventions: 

  • Medication is often used to manage withdrawal symptoms and reduce the cravings that lead to relapse. 
  • Individual therapy helps you uncover and address the root causes of your addiction, which may include unresolved trauma.  
  • Group therapy gives you a space to process what you’re going through and practice new skills with recovery peers. 
  • Holistic therapies complement clinical treatment by helping you access parts of the brain that talk therapy doesn’t. 
  • Support groups provide access to a sober community that can help you feel less alone as you navigate the ups and downs of recovery.

Many rehabs also offer relapse prevention planning and life skills coaching to help you reintegrate with your community when you return home, and hone the skills you need to stay sober as you work toward your life’s purpose. 

Integrative Perspectives

A comprehensive understanding of addiction goes beyond the disease-versus-choice debate.

The Biopsychosocial Model of Addiction

The biopsychosocial model12 acknowledges the interplay between biological, psychological, and social factors that contribute to addiction:

  • Biological: Genetic predispositions and brain chemistry changes
  • Psychological: Mental health conditions, personality traits, and coping mechanisms
  • Social: Exposure to substances, peer pressure, and a lack of support systems 

This integrative approach recognizes that addiction isn’t solely a brain disease or a personal failing. It’s a complex issue shaped by multiple factors, and addressing each of these areas in treatment is crucial for long-term success. Through biological interventions, psychological therapy, and social support systems, the biopsychosocial model offers a holistic approach to healing and empowers individuals to overcome addiction on multiple levels.

Personalized Treatment Approaches

The biopsychosocial model highlights the importance of personalized treatment plans in addiction recovery. Because everyone’s journey with addiction is unique and shaped by so many factors, treatment needs to address your specific needs. If you’re a woman recovering from PTSD, for example, you might feel safer discussing what you’re going through in a women-only therapy group. If your religion is your preferred path to healing, you might benefit from faith-based addiction treatment. 

A personalized treatment plan empowers you to identify and address what’s driving your addictive behavior, and to create lasting life change. 

Moving Beyond the Debate

Fostering Empathy and Support

Debates over the nature of addiction can often overshadow the most critical aspect of recovery: empathy and support for those who need it. Regardless of someone’s initial choices, addiction’s grip is a complex reality with profound physical and psychological effects. Blaming and shaming only hinder someone’s ability to make the life changes recovery requires.

Instead, our focus should shift toward understanding, compassion, and connecting people with quality care. The less stigma there is around addiction, the easier it is for people to seek help without fear of judgment. 

Humans are wired for criticism, and we often believe this is the best way to make change. But in fact, the opposite is true. Self-love empowers people to choose better for themselves. It’s easier to do the hard work of building a new life if you believe you’re worth it. 

Encouraging Treatment and Recovery

Addiction can feel overwhelming, but it is treatable. 

If you’re struggling with addiction, the first and most important step is to seek help. Talk to a doctor or mental health professional about your options. There’s no shame in voicing your needs—it only signals your strength and commitment to change. 

Recovery involves challenges along the way, but with dedication and support, you can overcome them. 

To find a program that’s a good fit for you, search our list of addiction treatment centers and reach out to one directly today.