Understanding Addiction: From Ancient Views to Modern Science

To an outsider, addiction can seem baffling. Why would a happy, healthy mother of three secretly drink wine from a juice bottle while her children nap? How could a lawyer risk their career by showing up drunk in court, only to repeat the same mistake after rebuilding their life?

Yet, this struggle is more common than many realize. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), nearly 29.5 million people aged 12 and older had alcohol use disorder (AUD) in 2022. That’s over 1 in 10 people in that age group. Additionally, the National Center for Drug Abuse Statistics reports that up to half of Americans over age 12 have tried illegal drugs at least once, with drug overdose deaths nearing one million in the last two decades.

So why do so many people become addicted to substances that harm their health and can even be fatal? Author William S. Burroughs described addiction as something you don’t choose—it’s something you drift into until one day you wake up dependent. While it may feel like a slow drift, science shows there’s much more going on beneath the surface.

Addiction Through the Ages

Addiction is not a modern problem. Ancient Greek philosophers like Aristotle and Plato debated its nature, with Aristotle calling it a failure of willpower (akrasia) and Plato warning against the dangers of excessive drinking. Ancient Egyptian texts from as early as 4000 BC even mention herbs used to treat opium addiction.

By the 20th century, addiction began to be seen as a disease. However, the causes, risk factors, and potential cures remained unclear for decades.

When 12-Step Programs Entered the Scene

Alcoholics Anonymous (AA), founded in the 1930s by Bill Wilson, helped popularize the idea of addiction as a disease. AA and similar programs focus on group support, shared experiences, and a structured 12-step process to help people recover.

Do 12-Step Programs Work?

While many people find value in 12-step programs, they aren’t for everyone. Here’s a look at the pros and cons:

• Pros: They offer community support and a sense of belonging. The structured steps provide guidance and accountability, which can be motivating.
• Cons: The emphasis on a “Higher Power” can be off-putting for non-religious individuals. The program also doesn’t incorporate much modern neuroscience, and its view of AUD as an “allergy” can promote an all-or-nothing mindset that doesn’t suit everyone.

The Science Behind Addiction

Modern science views addiction as a brain disorder, not a moral or spiritual failing. Terms like “alcoholism” have been replaced with “alcohol use disorder” (AUD) or “substance use disorder” (SUD) to reflect this understanding.

Addiction involves changes in brain function, particularly in the reward system. When we engage in pleasurable activities—including drinking—the brain releases dopamine, reinforcing the behavior. Over time, substance use can alter brain structure, making it harder to quit.

The cycle of addiction often involves three stages:

• Binge/Intoxication: The brain’s reward system is activated, leading to excessive drinking.
• Negative Affect: After the high, dopamine levels drop, causing anxiety, low mood, and stress.
• Preoccupation: Cravings take over, and rational thinking is impaired, setting the stage for the next binge.

Why Do Some People Get Addicted?

Not everyone who drinks becomes addicted. According to research, three main factors influence the risk:

• Biology: Genetics account for about half of a person’s risk for addiction.
• Environment: Social pressures and normalized heavy drinking can increase risk.
• Age: Early exposure to alcohol or drugs, especially during teen years when the brain is still developing, raises the likelihood of addiction.

The Brain in Recovery

The good news is that the brain can heal. Through neuroplasticity—the brain’s ability to adapt—recovery is possible. Key changes include:

• Restoring neurotransmitter balance
• Improving memory and cognitive function
• Increasing prefrontal cortex volume over time

Science-based therapies like cognitive behavioral therapy (CBT) can help Quitemate thoughts about alcohol, making sobriety more manageable.

Science-Based 12-Step Alternatives

For those who prefer evidence-based approaches, several alternatives to 12-step programs are available:

• Medication-Assisted Treatment (MAT): Medications can reduce cravings or block alcohol’s effects.
• Therapy: CBT, dialectical behavior therapy (DBT), and other methods address underlying thoughts and behaviors.
• Contingency Management: Provides incentives for staying sober.
• Mindfulness and Meditation: Help manage stress and cravings.
• Neurofeedback: Trains the brain to self-regulate.
• Exercise and Nutrition: Support brain health and natural dopamine production.

Programs like Quitemate offer science-backed tools, community support, and personalized guidance to help people build healthier relationships with alcohol.

Key Takeaways

• Addiction is a complex brain disorder influenced by genetics, environment, and development.
• Modern science offers many effective, evidence-based treatments beyond traditional 12-step programs.
• Recovery is possible, and the brain can heal with time and the right support.