Addiction begins with the mood-changing effects of substances. At first, people often experience positive effects by using drugs to change the way they feel. Through using they feel “good” or “better.” Many drugs of abuse produce distinct feelings of pleasure, some of which are especially striking and powerful. Using helps people temporarily avoid or lessen mental, emotional, and physical distress. Drugs provide a way to turn down the volume of uncomfortable, painful sensations such as anxiety, fear, depression, physical pain, anger, boredom, loneliness, and stress. However, when this way of temporarily easing, numbing, or blocking out discomfort turns into an ongoing way to cope with life’s challenges and becomes a primary coping strategy, using is no longer voluntary. The word addiction originated in ancient Rome. In Roman law, addiction was a formal award of a person or thing to another person—effectively a surrender to a master. Slaves given to Roman soldiers to reward them for performance in battle were known as addicts. Over time this definition was generalized so that a person who was viewed as a slave to anything became known as an addict. Initially, the decision to use is a conscious choice, but as addiction progressively takes over a person’s life, he or she loses more and more of the ability to exercise control over his or her thoughts, feelings, impulses, and actions. The ability to make conscious choices fades as the unconscious influences of the reward system located deep within the primitive survival-focused midbrain overrides the sophisticated decision-making abilities of the more highly evolved prefrontal cortex. At a certain point in the progression of active addiction, beneath the surface of conscious awareness, drug taking becomes equated with survival. The need to use assumes highest priority, becoming so strong that it suffocates all other needs. What originated as an experience that provides temporary freedom from the stresses and hassles of everyday life has evolved into a prison. Addiction is a brain disease. It is considered a disorder of the brain because addiction actually changes the brain’s structure and functioning. The National Institute on Drug Abuse (NIDA) of the US Department of Health and Human Services defines addiction as a “chronic, relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences.” In 2011, the American Society of Addiction Medicine (ASAM) revised its definition of addiction, classifying it as a primary chronic disease of the brain’s circuitry related to reward, motivation, and memory, rather than simply a problem based in behavior. This brain dysfunction is reflected in impaired behavioral control, craving for the object(s) of addiction, and the inability to abstain consistently, as well as diminished recognition of significant problems with one’s behaviors and interpersonal relationships. The use of drugs and mood-altering behaviors directly affects the brain by changing how it sends and receives information. The brain uses a communication system that sends and receives messages through certain naturally occurring chemicals known as neurotransmitters. When the “reward system,” located deep within a part of the brain called the limbic system, is activated through messages sent by particular neurotransmitters, people experience pleasure. It is this stimulation of the brain’s reward system that produces the mood-changing effects sought by people through drugs and behaviors. Research has been very clear that drug use effectively carjacks the brain’s reward system by changing the levels of specific neurotransmitters—think of the reward system on steroids. Brain imaging studies provide empirical evidence that addicts experience physical changes in the areas of their brains that involve judgment, decision-making, learning and memory, and behavior control. These changes affect how the brain works in extremely important ways. They help to explain the cycle of obsessive thinking, compulsive actions, and self-centered inability to delay gratification (including the decreased capacity to consider the consequences of one’s actions) in which addiction traps those who struggle with it. Opioid pain medications belong to the same class of substances as heroin (developed by the Bayer Company in Germany during the late 1890s as both a cough remedy and painkiller—comically, it was initially touted as a nonaddictive alternative to morphine). Like all drugs derived naturally or synthetically from the chemistry of the opium poppy, the two most prominent effects of these medications are pain relief and enhanced mood. The analgesic effects of opioids are due to decreased perception of pain, reduced reaction to pain, and increased pain tolerance. Opioids work by binding to the brain’s opiate receptors, which just happen to be highly concentrated in the areas that regulate pain and emotions. The activation of opiate receptors increases the level of dopamine in the brain, producing a state of euphoria and relaxation, along with the experience of pain diminution. Dopamine is a neurotransmitter that plays a central role in the brain’s reward system, affecting the processes related to the experience of pleasure and pain, the regulation of emotions, and physical movement. The use of opioids is complicated by this unusual coupling of relief and reward: relief from physical pain combined with the reward of euphoria and mood enhancement—both of which help to relieve emotional pain. This blog post is an excerpt from Some Assembly Required – A Balanced Approach to Recovery from Addiction and Chronic Pain by By Dan Mager, MSW; Published by Central Recovery Press (CRP).