Imagine you are driving a car without brakes. Ahead you see a child in the road. You desperately want to stop but you cannot.

This is addiction as described by Dr. Nora Volkow, head of the National Institute on Drug Abuse – NIDA. Dr. Volkow has the unique ability to write and speak the language of science and common sense.

“…reductions in D2 DA receptors in the striatum are associated with reduced activity of the orbitofrontal cortex…” which sounds like English but makes no sense to me.

She brilliantly blows away the stigma surrounding substance use disorders by likening them to obesity – another field she has studied.

 “Can you imagine food being so pleasurable that you are willing to forego 10 years of your life because of the adverse consequences?”

The stigma of substance-use disorders runs deep. Like other kinds of bias, we sometimes aren’t even aware we are doing it. And we addicts and alcoholics often perpetuate stigma ourselves by our own reaction to our disease.

For example, consider how addicts and alcoholics respond to their own relapse. Shame. In the drinking dreams I still have some nights, I don’t actually drink. The dreams are about the aftermath of a relapse: The shame and embarrassment I am going to feel when I stand up in a 12-step meeting and admit to a room of alcoholics that I have relapsed after all these years.

Would someone with cancer be ashamed to say chemotherapy did not work for them?

I am not saying that we do not have a role in our own relapse. We do. We need to ask ourselves, did I put myself among people, places or things that I knew would intensify my cravings? I already know that the portion of my brain that controls self-regulation does not function properly. Am I respecting and accepting that or ignoring it?

For example, I will not allow myself to be alone in my house with alcohol. I don’t have a problem with a group of people drinking in my house, as long as they bring their own and take it with them.

But after 19 years of sobriety, I still don’t trust myself to be alone in my house with a bottle of wine. I did a lot of drinking at home and alone. So, I am not going to put myself in that situation.

People who aren’t addicts and alcoholics have a hard time comprehending this. But when you liken substance use disorders to obesity and eating disorders, people get it.

“The dismissal of addiction and obesity as just a problem of self-control ignores the fact that for us to be able to exert self-control requires proper function of areas in our brain that regulate our behaviors,” Volkow said. 

When Volkow makes this analogy, the clouds part and substance-use disorders suddenly make sense. Who among use who is overweight and obese cannot relate to craving?

And this is the brilliance of Dr. Volkow. Subtly revealing the true nature and science of addiction by helping all of us feel it. Be it bag of dope, a glass of chardonnay or a pint of Haagen Daz.

“You know, I never ever met an addicted person who wanted to be an addict,” Volkow said. 

Thank you, Dr. Volkow.