One of the most difficult concepts for many primary care physicians to accept is that addiction is a disease. This thought naturally dispels the idea that people who experience the diagnosed disorder of substance dependence have a choice. Actually, once addiction is manifest in an individual, willpower is no longer a viable hypothesis. At this point, “saying no” does not work (although people diagnosed with substance abuse might still have the ability to choose). Basically, there comes a time when the psychosocial, genetic, biophysiologic and the individual’s coping mechanisms have set the stage for a switch to be turned on that starts the disease process, a process that cannot be cured but that can definitely be arrested and brought into remission.


Ventral Tegmental Area Psychoactive Substance Substance Dependence Alcoholic Parent Reward Pathway 


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  1. 1.
    Bechara A. Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective. Nat Neurosci 2005;8(11): 1458–1463.PubMedCrossRefGoogle Scholar
  2. 2.
    Howlett AC. Pharmacology of cannabinoid receptors. Annu Rev Pharmacol Toxicol 1995;35: 607–634.PubMedCrossRefGoogle Scholar
  3. 3.
    Le Foll B, Frances H, Diaz J, Schwartz JC, Sokoloff P. Role of the dopamine D3 receptor in reactivity to cocaine-associated cues in mice. Eur J Neurosci 2002;15(12): 2016–2026.CrossRefGoogle Scholar
  4. 4.
    Brandt JF, Brandt JM, Pomm RM, Frost-Pineda K, Gold MS. Florida Impaired Physicians: Longitudinal, Urine Testing Confirmed, 5-Year Outcomes Study. First Prize Physician Research Award, Florida Academy of Family Physicians, Destin, FL, November 7–8 2001.Google Scholar
  5. 5.
    Piper A Jr. Addiction to benzodiazepines — how common? Arch Fam Med 1995;4(11): 964–970.PubMedCrossRefGoogle Scholar
  6. 6.
    Schuckit MA, Goodwin DW, Winokur GA. A study of alcoholism in half-siblings. Am J Psychiatry 1972;128: 1132–1136.PubMedGoogle Scholar
  7. 7.
    Kaij L. Studies on the Etiology and Sequelae of Abuse of Alcohol. Lund, Sweden: University of Lund Press; 1960.Google Scholar
  8. 8.
    Prescott CA, Kendler KS. Twin study design. Alcohol Health Res World 1995;19: 200–205.Google Scholar
  9. 9.
    Schuckit MA. Biological vulnerability to alcoholism. J Consult Clin Psychol 1987;55: 1–9.Google Scholar
  10. 10.
    Higuchi S, Matsushita S, Murayama M, Takagi S, Hayashida M. Alcohol and aldehyde dehydrogenase polymorphisms and the risk for alcoholism. Am J Psychiatry 1995; 152(8): 1219–1221.PubMedGoogle Scholar
  11. 11.
    Frezza M, di Padova C, Pozzato G, Terpin M, Baraona E, Lieber CS. High blood alcohol levels in women: the role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. N Engl J Med 1990;322(2): 95–99.PubMedGoogle Scholar
  12. 12.
    Alcohol Alert. National Institute on Alcohol Abuse and Alcoholism. No. 10 PH 290, October 1990.Google Scholar
  13. 13.
    Gelernter J, et al. Genomewide linkage scan for opioid dependence and related traits. Am J Hum Genet 2005;78: 759–769.CrossRefGoogle Scholar
  14. 14.
    Graham AW, Schultz TK. Principles of Addiction Medicine, 2nd ed. Chevy Chase, MD: American Society of Addiction Medicine; 1998.Google Scholar
  15. 15.
    Tsuang MT, Lyons MJ, Eisen SA, Goldberg J, True W, Lin N, Meyer JM, Toomey R, Faraone SV, Eaves L. Genetic influences on DSM-III-R drug abuse and dependence: a study of 3,372 twin pairs. Am J Med Genet 1996;67: 473–477.PubMedCrossRefGoogle Scholar
  16. 16.
    Kendler KS, Karkowski LM, Neale MC, Prescott CA. Illicit psychoactive substance use, heavy use, abuse, and dependence in a US population-based sample of male twins. Arch Gen Psychiatry 2000;57: 261–269.PubMedCrossRefGoogle Scholar
  17. 17.
    Carmelli D, Swan GE, Robinette D, Fabsitz RR. Heritability of substance use in the NAS-NRC Twin Registry. Acta Genet Med Gemellol (Roma) 1990;39: 91–98.Google Scholar
  18. 18.
    Kendler KS, Prescott CA. Cannabis use, abuse, and dependence in a population-based sample of female twins. Am J Psychiatry 1998;155: 1016–1022.PubMedGoogle Scholar
  19. 19.
    Kendler KS, Karkowski L, Prescott CA. Hallucinogen, opiate, sedative and stimulant use and abuse in a population-based sample of female twins. Acta Psychiatr Scand 1999;99: 368–376.PubMedCrossRefGoogle Scholar

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