Is Addiction Really a Disease?

We have finally learned enough about the brain, we have finally gotten enough pieces of the puzzle that I can tell you exactly how addiction fits that model, I can tell you the part of the brain, I can tell you the nature of the defect, I can explain everything that addicts do without having to refer back to their bad morals, their bad personality, or their bad parents…and this information I think, is very powerful indeed….I think it has the power to change the world.”

-*Dr. Kevin McCauley

This is an overview of Dr. Kevin McCauley’s lecture, Is Addiction Really a Disease? 

He begins the video with the age old question, is addiction a disease or a choice? Initial observation of the affliction points to it being a matter of choice…Addicts are humans who have free will, they can stop if they really wanted to. If you put a gun to their head, they can stop doing drugs. With this observation comes the weighted idea that says addicts are innately bad people who are selfish and don’t care about themselves or the world around them.


Consequences by Kevin Grass

In the disease argument’s defense, McCauley says, just because we have bad actions, does not mean we can assume bad actors. This alludes to something other than an addict’s bad morals or bad personality as being the main culprit under suspicion. If the actors aren’t innately bad people, there must be another factor at play that causes them to act in such ways.

For addiction to be classified as a disease, it must fit certain criteria. It must fit into the disease model that says there’s an organ that has a physical defect which causes symptoms. Under this model, the addict’s behavior can be examined as the symptoms. His or her bad morals and bad personality can then be viewed as being caused by addiction, rather than being the causes of addiction.

When we put this “badness” under a microscope, we’re led to the frontal cortex of the brain. It seems to make perfect sense that the physical defect would be found here, because this is the part of the brain that asserts emotional meaning onto outside objects. It handles conscious processes such as morality, decision making and spirituality, all of which seem to have plummeted in an active addict’s life. It’s the part of the brain where choice lives. It’s the part of the brain where the self is sitting. It seems to make perfect sense to assume that drugs work in the frontal cortex because the frontal cortex seems to be broken in addicts. It seems to make perfect sense to assume this is where the fiend resides.

It’s a very powerful idea that drugs work in the thinking, decent, law abiding brain. There’s only one problem with that idea…it’s wrong. It’s just flat out wrong. It turns out that drugs exert no primary physiological effect in the frontal cortex….Where is their primary function? Where do they work? They work deeper down, in a much older part of the brain called the midbrain.”*

The midbrain is the survival part of the brain. It’s basic functions are to eat….and fuck (and defend itself). It uses a pleasure-reward system to re-enforce behaviors that ensure survival (or not).“It’s a life or death processing station.”* The midbrain has no morals. It doesn’t romance, it’s not personal, it isn’t conscious. There’s no free-will in the midbrain. It’s sole purpose is to handle matters of immediate survival. Dr. McCauley refers to a set of experiments called the Olds Experiments to shed light on the fact that drugs work here (in the midbrain).


In the 1960’s, Dr. Olds injected cocaine into localized areas of a mouse’s brain to determine where exactly the drug had an effect.

Because drunk mice do nothing but pass out, mice on heroin nod out, and tweaked out mice do nothing but tweak, they weren’t optimal candidates for the study. These drugs still work on the midbrain, as do all the others. For the experiments sake though, cocaine worked most efficiently to produce observable results.

The mouse had been trained to push a lever that re-administered pleasurable stimuli. If he was to be injected with Grade-A cocaine in the part of the brain where cocaine worked, he would have the option to push a lever to dispense more of it. When the cocaine was injected into the frontal areas of the mouse’s brain however, he did not push the lever. It produced no pleasurable effect. The mouse did not get high.

It was only when the cocaine had been injected into the midbrain of the mouse that his behavior changed. It was then that the mouse had begun pushing the lever as if his life had depended on it. While he had the option to simply eat food, he did not. He pushed the lever for cocaine until he starved to death.

When an electric grate was placed in front of the lever that administered the drug, the mouse would fry himself to death while standing on it so he could self-administer more cocaine. He refused to protect himself from harm.

The drug had made its way to the top of the survival hierarchy in the mouse’s midbrain.

A mouse has no personality, a mouse does not care how his mommy mouse raised him, we don’t have a problem with mouse gangs back in Utah, and so, what the Olds studies told us… you didn’t need a frontal-cortex for addiction. You didn’t need a bad one, you didn’t need a good one. The basic machinery of addiction is below the cortex in the midbrain. Something goes wrong long before the processing of the cortex.”*


So, what pushed us over the line? What’s the thing that makes that addict’s brain fundamentally different from the non-addict’s brain? What’s the cause of addiction? It’s not mom. It’s not personality. It’s not even genetics……….genes are a necessary cause for addiction, but they are not a necessary and sufficient cause for addiction. You need something actually acting on the genes to turn them on and produce the addiction. What is that thing? We know what it is. And I gotta be honest with you, I don’t think you’re gonna like the answer. The cause of addiction, at long last, is stress. Addiction is a severe stress response deep deep deep in the midbrain.”*

Dr. McCauley goes on to say that the stress a mother experiences before her baby is born even plays a major role on how the baby’s brain develops. Studies show there’s a strong correlation between women who are battered in their first trimester of pregnancy and their children, who when grown up, have a higher likelihood of developing anger management problems, ADHD, and stimulant addiction. Stress changes the physiology of the midbrain.*

And when these stressors build up, and the stress hormones rise, and the cortex can do nothing to bring them down, it has no tools to decrease that stress…eventually the job falls to the midbrain, and the midbrain does not screw around. The midbrain says ‘Listen you, this stress of yours, we’re starting to pick this up now on the level of life and death. This is starting to affect our ability to make it. You must do something! You must go out in the world and find me something! Anything, that will relieve that stress.!’ When these high levels of stress appear they go to the midbrain, and they break the dopamine system.”*

Dr. McCauley uses an example of broccoli and chocolate cake to illustrate how our brains use our sense of pleasure as a tool for survival. If we are literally starving, our brains can tell the difference between the two foods. It knows that broccoli won’t maintain our survival, yet chocolate cake will. In our hypothetical starvation, when we eat the chocolate cake, our brains will release dopamine which gives us a reward in the form of pleasure. Yummy, it will say, do that again.

The same goes with sex. When we engage with another in horizontal and vertical pleasures, our brains release dopamine and we get a reward. Oh my god, that felt so good, it will say, do that again.

One of these brain perceptual systems [pleasure system]is the brain’s ability to tell the difference between ‘broccoli and chocolate cake,’ and that’s the one that breaks in addiction…

In a sentence, ‘addiction is a stress induced defect in the brain’s ability to properly perceive pleasure.’”*

McCauley explains how the midbrain has something called a Hedonic “Set Point,” which acts as a pleasure threshold. When this threshold is crossed, dopamine is released and pleasure is felt. A healthy midbrain experiences pleasure in normal activities such as riding a bike or having a good conversation, making a good grade on an exam or doing something good for someone. But, just as the body’s temperature set point can be raised in times of infection to cause fever to fight off that infection, so too can the midbrain’s Hedonic Set Point be raised by stress hormones.

When the Hedonic Set Point is raised, the things in life that had once caused pleasure no longer register. The person becomes pleasure deaf. Anhedonia sets in.

Anhedonia- loss of the capacity to experience pleasure. The inability to gain pleasure from normally pleasurable experiences

They (people ‘experiencing’ anhedonia) can sense anything that can break the new pleasure threshold (Things that release massive amounts of dopamine). What does that? Drugs. And so the brain says, ‘You know what…I don’t hear normal pleasures, I don’t hear a walk on the beach, I don’t hear Disneyland, but that meth, that I heard! I don’t know what that was, but that’s important… I don’t know what that was, but that lowered that stress. I don’t know what that was, but it is now the central organizing principle of your entire life.”*



Fuck riding a bike at this point. It does nothing for me, unless of course, I’m riding to the dope man’s house. Exam? I better get high to take it…Better yet, fuck the exam, I’ll just get high. Conversation? Um, yeah, you got any drugs dude? Doing something good for someone? Eh…what’s in it for me?

Once the allergic reaction occurs, the mental obsession comes alive. The fiend begins to snicker. Craving kicks in. Gimme Gimme Gimme! More! More! More! Fuck you get out of my way!

He puts his head into the gears and turns and twists. He cannot see. Away he slips into the pits. He has developed a new god of worship. A personal savior, he finally discovers what it is. Reason and logic fall through his grip. Down, down, down he’ll go until the bitter end, unless he can form a new connection.

despair 2.jpg

Despair by Tarbox-Art

When the stress hormones rise and the craving kicks in, the frontal cortex actually shuts down. Because…the midbrain thinks this is about life and death, and it must secure survival at all costs. And so, the person’s values, their morals, their emotional connections to the world, as far as the midbrain is concerned, those things are now liabilities. And so we have all evolved this mechanism (craving) in our brain, that comes on in craving addicts particularly, if we really think we are threatened and our life is at stake. We actually see the frontal cortex shut off, and this is something that we can see on a functional MRI machine…. You can see it as it’s happening…show a movie of people using drugs, get them into craving state, and what happens? Their midbrain lights up like a Christmas tree. Their frontal cortex goes dark. The part of the brain that says I don’t wanna do this, the part of their brain that says, ‘Remember what happened last time? I don’t wanna go back to jail, I don’t wanna hurt mom.’ That part of the brain is off.”* -Dr. Kevin McCauley


Dr. McCauley sums up the lecture by defining addiction as a dysregulation of the midbrain dopamine (pleasure) system due to unmanaged stress resulting in symptoms of decreased functioning, specifically:

  1. Loss of control

  2. Craving

  3. Persistent drug use despite negative consequences


Freedom Sculpture by Zenos Frudakis

Dr. McCauley’s video gave me a new understanding on something I had been turning my shoulder to for over ten years. I’m deeply grateful for his work. I would like to encourage anyone who is going through similar struggles to hold their head up and KNOW that there is a way out of the darkness.

I recommend watching Dr. McCauley’s video, which I’ve posted here. Please feel free to leave a comment if you want to share some of your thoughts. I hope you’re all having a great day today. Thanks for reading.


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I don’t think it has anything to do with free will either, especially when the part of the brain that acts “unconsciously” is running the show. I think that once things balance out, the choice is there to not go back…but like you said, the difficult part is “finding the way out.” Thanks for commenting.


I cannot read the whole article now (don’t have time) but I don’t agree with those theories. Even Freud said that we have only like 15% of free will, everything happens on the level of subcounsciousness. For me someone who is addicted does it because he/she cannot find the way out. It has nothing to do with a free will!

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