Is Addiction Really a Disease?

Here’s an overview of Dr. Kevin McCauly’s lecture, “Is Addiction really a Disease?”

His lecture saved my life…

“We’ve finally learned enough about the brain, we’ve finally gotten enough pieces of the puzzle that I can tell you exactly how addiction fits the [disease] 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 


For something to be considered a disease, it must fit into the disease model. There must be an organ (the brain) that has a physical defect (the mystery piece) that causes symptoms (the addict’s bad behavior). To isolate the part of the brain we’d be looking at, he refers to the Olds Experiments of 1960: Dr. Olds injected cocaine (for the experiment’s sake) into localized areas of a mouse's brain to determine where exactly the drug had an effect. The mouse had been trained to push a lever to re-administer the drug if it wanted more—if it got high. 

When the cocaine was injected into the frontal areas of the mouse's brain—it did not push the lever, because the drug produced no pleasurable effect—the mouse did not get high.

Olds Experiment. Is addiction really a disease?

But when the cocaine was injected into the midbrain of the mouse, its behavior changed drastically. It pushed the lever as if its life depended on it. It had the option to simply eat food, but it did not. Instead, the mouse pushed the lever for cocaine until it starved to death. When an electric grate was placed in front of the lever, the mouse fried himself to death while standing on it, so it could self-administer more cocaine. In essence, the mouse committed slow suicide because in its brain, the drug had become an object of survival and the mouse was blind to the things that would actually keep it alive (or kill it).

Midbrain. Olds experiment. Addiction. Recovery.

Okay. Drugs work on the midbrain. So what? What does that tell us?

The midbrain is the oldest part of the brain. Its basic function is to stay alive—eat, reproduce, and defend itself. It uses a pleasure-reward system to reinforce behaviors that ensure survival. “It’s a life-or-death processing station,” says McCauley. “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 because it’s hardwired to operate before the function of conscious thought (in the frontal cortex) becomes an option.” 

Dopamine in the addict. Addiction. Recovery.

Okay…but where is its defect?

He gives the example of broccoli and chocolate cake to illustrate how our brains use our sense of pleasure as a tool for survival. If we’re literally starving, our brains can tell the difference between the two foods. It knows broccoli won't maintain our survival (it lacks the calories and fat necessary to keep us alive), but chocolate cake will. In our hypothetical starvation, when we eat the chocolate cake, our brains release dopamine, giving us a reward in the form of pleasure. Yummy, it’ll 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.

So it’s our sense of pleasure. But how does it break?

“I gotta be honest with you, I don't think you're gonna like the answer,” he says. “The cause of addiction, at long last, is stress. Addiction is a severe stress response deep deep deep in the midbrain.”

Stress. Addiction. Physical malady. Shawn Cross.

Whoa. Whoa. Stress? Really?

Stress changes the physiology of the midbrain,” he says. He elaborates on how not only does stress in our daily life affect the way our brains develop but also how the stress a mother experiences during the first trimester of pregnancy affects the way a child’s brain develops—how stress expressed by our parents and their parents is carried down to us.

But it still doesn’t tell me how the brain’s pleasure-reward system breaks…

If the stressors build up and culminate to a point where the frontal cortex has no conscious tools to bring them back down, it passes the job to the midbrain. “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…

Hedonic set point. Kevin McCauley. Is addiction a disease?

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, 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 the infection, so too can the midbrain's Hedonic Set Point be raised by stress hormones. And when the Hedonic Set Point is raised (by the brain’s inability to properly perceive healthy pleasure, because of stress hormones), the things in life that had once caused pleasure no longer register. The person becomes pleasure-deaf—they experience anhedonia, the loss of the capacity to experience pleasure.

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“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.’”


Brain on Dopamine.jpg

It’s all starting to make sense…

Screw riding a bike. 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, screw the exam, I'll just get high. 

Conversation? Um, yeah, you got any drugs, dude? 

Doing something good for someone? Er...what's in it for me? 

Food? Give me meth instead.

Once the allergic reaction occurs through breaking the new (raised) pleasure threshold, the mental obsession comes alive. The hungry ghost begins to snicker. Craving kicks in. Gimme Gimme Gimme! More! More! More! Fuck you, get out of my way!

The addict puts his head into the gears of dissonance 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 has finally discovered what it is. Reason and logic fall through his grip. Down he’ll go to the bitter end, unless he can reconnect with something greater.

No FAce .jpg

McCauley goes on… “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. 

Niko Gyftakis Self Portrait III.jpg

“And so we’ve all evolved this mechanism (craving) in our brain (that comes on in craving addicts particularly), if we really think we’re 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 a 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 (the frontal cortex) is off.”

If ever there were a proper time for a mic drop, this would be it.

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But this isn’t only about proving addiction is a disease and dropping mics. It’s about freedom. Realizing (why) addiction is a disease can, on a personal level, be liberating to those caught in its grips. On a societal level, it can break stigmas and allow new perceptions and new approaches towards healing to take root. What are your thoughts?

Dr. McCauley’s video can be found here, “Is Addiction Really a Disease?” I recommend watching it. He was right when he said, “This information has the power to change the world.”

Jacob O’Cain The Addict with a Thousand Faces

Jacob O’Cain is a recovering drug addict and teaches ESL to kids in China. He’s the author of The Addict with a Thousand Faces (not yet published) and is actively looking to connect with people in the recovery community. Send him a message on Instagram @jacob_ocain or contact him through