Brain on Drugs
This brain chemical is heavily involved motivation, reward, and reinforcement and is strongly affected by many addictive substances
Dopamine
You’re having a bad day and unexpectedly experience a strong craving. Name two things you could do before making any decision about using.
Multiple acceptable answers—call someone, delay the decision, leave the environment, meeting, grounding, eat/rest, play the tape forward, etc.
“I don’t have a drinking problem. Everybody drinks like this.”
Denial
True or false: Genetics can influence someone’s vulnerability to developing a substance use disorder.
True
“If you’re only sober because you’re on probation, trying to save your marriage, or afraid of losing your job, you’re not really in recovery yet.”
IT DEPENDS. External motivation can absolutely start recovery. The deeper question is whether motivation eventually becomes internalized. Great follow-up: Does it matter why someone starts if they eventually choose it for themselves?
Over time, the brain adapts to repeated substance use, meaning a person may need more of the substance to experience the same effect. What is this called?
What is tolerance?
Someone you used with texts: “I’m not using anymore either. Come hang out—we don’t have to do anything.” What would you do?
Discuss risk assessment, boundaries, support, and avoiding high-risk people/places, especially in early recovery.
“Yeah, I got arrested, but the cops were targeting me. They could’ve arrested anybody that night.”
Blaming / externalization
What are the three major components of the biopsychosocial model?
Biological, psychological, and social factors
“Sometimes rebuilding trust means accepting that people may monitor or question you for a while.”
IT DEPENDS. Accountability and transparency can be part of repairing trust, but there is a difference between mutually agreed accountability and controlling behavior.
Discussion: When does accountability become control?
After stopping substances, someone says, “Nothing is fun anymore. Food, movies, hanging out—I don’t care about any of it.” What recovery-related brain phenomenon could help explain this?
Anhedonia / reduced sensitivity to natural rewards during early recovery.
You haven’t wanted to use in months. You’re doing well, working, and rebuilding your life. You start thinking, “Maybe I don’t need meetings/treatment/support anymore.” What would you do?
Evaluate whether this represents genuine growth or complacency before abruptly removing supports
“I know I spent our rent money on drugs, but at least I’ve never stolen from my family like some addicts.”
Minimization (with comparison/rationalization)
According to the DSM-5 framework, substance use disorders fall along what three levels of severity?
Mild, moderate, severe
“Someone can take full responsibility for the harm they caused while also recognizing that addiction affected their behavior.”
Explanation and accountability can coexist.
Discussion: What’s the difference between explaining your behavior and excusing it?
Why can simply seeing a person, place, object, or situation associated with past substance use suddenly create a craving—even when someone wasn’t thinking about using?
The brain can learn associations between environmental cues and substance-related reward, causing conditioned cues to activate craving/reward pathways.
Your partner accuses you of using when you’re actually sober. You’re furious because you’ve worked hard to regain trust. You immediately want to say, “If nobody believes me anyway, I might as well use.” What would you do in the next 30 minutes?
Prioritize regulation and relapse prevention before resolving the relationship conflict—pause, separate temporarily, contact support, identify the emotion, avoid impulsive action, return to the conversation when regulated.
omeone constantly accuses their partner of being dishonest while they are secretly lying about their own substance use.
Projection
A person desperately wants to stop using and genuinely means it each time they promise—but repeatedly returns to substance use despite major consequences. Why doesn’t this automatically mean they’re lying or “don’t want recovery badly enough”?
SUD involves impaired control and persistent use despite consequences. Motivation can be genuine while someone’s ability to consistently translate intention into behavior remains impaired.
“You should forgive people who hurt you if you want to fully recover.”
MYTH / IT DEPENDS on what they mean by forgiveness. Recovery doesn’t require reconciliation or removing consequences. Some people find forgiveness freeing; others heal through acceptance and boundaries without conceptualizing it as forgiveness.
Discussion: Can you let go of resentment without forgiving someone?
Someone says, “If addiction changes the brain, doesn’t that mean I have no control over what I do?” Explain why both brain changes and personal agency can be true.
Addiction can impair reward, motivation, decision-making, and impulse control, making change significantly harder, but it doesn’t eliminate the ability to make choices. Recovery involves strengthening alternative behaviors, supports, coping skills, and healthier neural pathways.
You’ve been sober for a year. You attend a wedding where alcohol is being served. You didn’t realize how uncomfortable you’d feel until you got there. Leaving would disappoint someone you love. Staying feels risky. What factors should determine your decision?
There isn’t one universal answer. Consider craving intensity, recovery stability, available support, escape plan, emotional state, exposure, motivation for staying, and whether staying is worth jeopardizing recovery.
“I wasn’t trying to get high. Work has been insane, my relationship is falling apart, and I hadn’t slept. Anyone dealing with what I’m dealing with would’ve needed something.”
Rationalization
Bonus: Ask: What makes rationalization harder to recognize than outright denial?
Two siblings grow up in the same household with an alcoholic parent. Both experience similar adversity. One develops severe AUD and the other never develops an addiction. Why doesn’t this disprove genetics OR environmental theories of addiction?
Addiction is multifactorial. Genetic vulnerability interacts with individual psychology, development, environment, exposure, protective factors, coping, social context, and other influences.
“Sometimes the healthiest thing a person can do in recovery is disappoint someone else.”
Someone may need to decline an invitation, leave an event early, say no to family, end a relationship, prioritize treatment, refuse to lend money, stop rescuing someone, or set a boundary that another person dislikes.
“How do you tell the difference between protecting your recovery and using ‘my recovery comes first’ to avoid responsibility?”