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After 32 days in rehab I accepted I was an alcoholic. But I didn’t accept that addiction was a disease because rehab never adequately explained how the brain was afflicted. It seemed I was supposed to take the disease model on faith and I refused to take anything on faith. I wanted hard facts, not vague assertions, and didn’t see any. (For more, click Doubt Addiction Is A Disease? I Did.)

Furthermore, in my mind the 12-Step solution undercut the disease model. If addiction was truly a disease, why wasn’t there a medical treatment? To me, a spiritual solution was a non-sequitur. (For more click on Doubt a Spiritual Program Works?)

Upon discharge, I struggled mightily to follow AA’s program despite my doubts because rehab convinced me if I didn’t I was a goner. Even if to my mind AA provided a flawed explanation, it offered two things I desperately needed — hope and direction. I did what I was told because they said if I didn’t, I’d succumb to my addict brain with fatal results.

I quickly relapsed and returned for more reprogramming, but I still didn’t believe addiction was a disease.

Despite rehab and AA’s fixation on a spiritual solution, it was science that proved to this Yale-educated former Assistant D.A., a trained skeptic, that addiction is a genuine brain disorder. And it was science that verified what AA claimed and I doubted: a spiritual program is therapeutic. It’s not a non-sequitur after all.

My mind started to change about a year after my second hospitalization when my Dad, a retired metallurgy professor, sent me the latest issue of Science Magazine, a special addiction issue with articles like “Molecular and Cellular Basis for Addiction” and “Psychoactive Drug Use in Evolutionary Perspective.” 

Now, I’m no scientist. I attended law school at night while working as a D.A. Investigator during the day. My last science class was an introductory biology course I took more than 35 years ago as a college freshman nicknamed “Bio for Poets” for its lack of lab requirement (or rigor). But I spent my last decade in the San Francisco D.A.’s office litigating environmental cases. I had to learn to make the complex evidence of hazardous-waste chemistry, where contaminants are measured in parts per million, understandable to judges and jurors. As a result, I had lots of experience translating complex data into understandable English, which came in handy in tackling addiction research.

As I plowed through Science, reading and re-reading passages until I either got an inkling of what they meant or too frustrated to keep puzzling and moved on in ignorance, I developed a feel for the big picture even if I didn’t understand all the details.

In contrast to AA’s portrait of a spiritual battle, scientists frame addiction as a clash between brain systems whose balancing mechanisms go haywire, allowing instinct-like circuits that find drugs rewarding to hijack the brain.

Science laid out the crux of the medical model: “The addicted brain is distinctly different from the non-addicted brain … That addiction is tied to changes in brain structure and function is what makes it, fundamentally, a brain disease. A metaphoric switch in the brain seems to be thrown as a result of prolonged drug use.”

That switch is the point-of-no-return for addiction, but it’s the result of a process. The brain’s corrective systems respond to the over-stimulation of drugs by developing tolerance to them, which can change the brain permanently. As tolerance develops, the brain “switches” from the “old normal” — liking the effect of drugs — to a “new normal” in which drugs are constantly necessary to avoid plunging into withdrawal. After the “new normal” switch is thrown, what was once voluntary turns compulsive because the brain now needs drugs just to feel normal.

Drug-induced molecular rewiring modifies addicts’ brain function, altering their very thought processes and motivations, explaining why they act irrationally. Neuroscientists thus agree with one of AA’s most basic premises: there is a distinct “addict brain.”

Science provided convincing support for the disease model that had been missing at rehab. It also sparked a personal investigation into addiction research, something I’ve been following since 1997. It has given me a profound appreciation for the brain’s design and function, particularly its remarkable ability to identify and understand its own irrationality.

Knowing that addiction has a biological basis helped relieve me of the guilt and shame I felt over having lost control of my drinking. It also helped me gain the emotional acceptance necessary for long-term sobriety.

I originally thought the scientific model of addiction was contradictory to AA’s. But it turns out they’re complementary, like two eyepieces of a microscope which when brought into focus together renders a better-defined picture. 

Addiction lies at the nexus of learning, memory, and motivation. Understanding it requires a primer on how drugs affect the neural systems involved. Yes, it’s complicated, especially when it gets down to the molecular level. It is, after all, neuroscience. But you don’t need that level of detail to fathom the addiction research summarized in this website. Think of it as “Brain Science for Poets.” (For more click on Addiction Science Intro/Menu).