Disease Process Overview Handout

The Disease Model of Addiction

Addiction is more than a series of poor choices or a lack of willpower. It is a chronic, relapsing disease that affects the brain’s structure and function. When we view addiction through a medical lens—much like diabetes or asthma—we recognize that biological, psychological, and social factors all play a role. This framework helps reduce shame, encourages treatment, and highlights that recovery is possible.

Biological Changes: How Substance Use Alters the Brain

1. Neurotransmitter Flood
   Many addictive substances trigger an intense release of dopamine, the brain’s “feel-good” messenger. This surge reinforces drug use by making the experience feel rewarding.
2. Reward Circuit Adaptation
   Over time, the brain adjusts to these repeated surges. Neurons reduce the number of dopamine receptors or produce less dopamine naturally. As a result:
   • Tolerance develops: you need more of the substance to achieve the same effect.
   • Withdrawal symptoms emerge when you stop using, driving continued use to avoid discomfort.
3. Brain Region Impact
   • Prefrontal Cortex: Governs decision-making and impulse control. Chronic use can weaken its function, making it harder to resist cravings.
   • Amygdala: Processes stress and negative emotions. Heightened sensitivity can increase anxiety and trigger relapse.

These changes can last long after substance use stops, which is why addiction is considered a lifelong condition requiring ongoing management.

Psychological Components: Thoughts, Emotions, and Behaviors

1. Conditioned Learning
   Environmental cues (people, places, or moods) become linked to substance use. A familiar setting or feeling can spark intense cravings through classical and operant conditioning.
2. Coping and Escape
   Many people use substances to cope with stress, trauma, or mental health challenges like depression and anxiety. Initially, using may feel like relief—but over time, it often worsens underlying issues.
3. Craving and Obsession
   As the brain adapts, wanting the substance can become overpowering. Persistent thoughts about using can dominate daily life and decision-making processes.

Understanding these psychological forces helps you recognize triggers, develop healthier coping strategies, and rebuild your sense of control.

Social and Environmental Influences

1. Family and Relationships
   Family history and peer groups can shape attitudes toward substances. Supportive relationships can be protective; conflict and instability can increase risk.
2. Stress and Life Events
   Unemployment, housing instability, or major losses often accompany substance use. Chronic stress keeps the brain in “survival mode,” making collapse into old patterns more likely.
3. Cultural and Economic Context
   Social norms, availability of substances, and economic hardship all shape how and when people use drugs. Community resources and stigma also influence recovery options.

Building a supportive network and changing your environment—whether through new routines or treatment programs—are critical steps in recovery.

Why Understanding the Disease Process Matters

When you know how addiction changes your brain, thoughts, and environment, you can:

• Reduce Self‐Stigma: Recognize that addiction isn’t a moral failing but a treatable condition.
• Enhance Motivation: Use knowledge of brain changes to see why cravings occur and plan coping strategies.
• Engage in Treatment: Choose therapies and supports that address each aspect of the disease process.

This handout provides the foundation. In our next steps, you’ll apply these insights through discussion, worksheets, and role-play to strengthen your recovery journey.

Addiction Disease Process Worksheet

Instructions

Read the Disease Process Overview Handout. Then complete the sections below. Use the space provided to reflect on your own experiences.

1. Identifying Brain Regions Affected

1. Name two brain regions described in the reading and explain how each is altered by substance use (e.g., changes in dopamine signaling, decision-making, stress response).
   
   
   
   
   
   
2. Reflect: How might changes in these brain regions influence your thoughts, emotions, or behaviors when you use or when you try to stop?
   
   
   
   
   
   

2. Mapping Physical and Behavioral Symptoms Over Time

1. Describe one physical symptom you experience during intoxication or withdrawal. When does it occur, and how intense is it on a scale of 0–10?
   
   
   
   
   
   
2. Describe one behavioral change you notice in yourself or others related to substance use (e.g., social withdrawal, risky actions). How has this behavior changed over time?
   
   
   
   
   
   

3. Personal Reflections and Application

1. Tolerance & Withdrawal: Provide a personal example of how tolerance built up or how withdrawal symptoms drove you to continue using.
   
   
   
   
   
   
   
   
   
   
   
2. Coping Strategy: Identify one healthy strategy you can use when a craving hits. Explain how this strategy addresses a biological, psychological, or social factor of addiction.
   
   
   
   
   
   
   
   
   
   
   

Optional Extension
Think of a specific cue (person, place, or emotion) that triggers a craving for you. Write it below. In the next session’s role-play, you will practice responding to this cue.

Disease Process Discussion

Discussion Guidelines

• Confidentiality: What’s shared here stays here. Respect each person’s privacy.
• Respect & Listening: Allow others to finish before speaking. Validate different experiences.
• Nonjudgmental Space: No shaming or blaming—focus on understanding and growth.
• Active Participation: Share your thoughts, but only as much as you feel comfortable.

1. Exploring Biological Changes

Question: Which biological change from the Disease Process Overview Handout resonated with you most—neurotransmitter flood, reward circuit adaptation, or impact on the prefrontal cortex and amygdala? Why?

• Follow-up: How does recognizing tolerance or withdrawal as brain adaptations change the way you think about your substance use?
• Follow-up: Can you recall a moment when you first noticed these changes in yourself?

2. Unpacking Psychological Components

Question: The handout describes how cues (people, places, moods) become linked to use. What specific cue have you noticed triggers intense cravings for you?

• Follow-up: How has this cue influenced your thoughts or behaviors over time?
• Follow-up: Based on your answer in the Addiction Disease Process Worksheet (Optional Extension), what healthier response could you practice when that cue appears?

3. Reflecting on Social & Environmental Factors

Question: Think about family, friends, or life stressors that have affected your use. Which relationship or situation has had the biggest impact—positive or negative—and how?

• Follow-up: What changes in your environment or support network could help reduce risk of relapse?
• Follow-up: Are there community resources or groups you’d like to explore for additional support?

4. Shifting Perspectives: Disease vs. Moral Model

Question: How does viewing addiction as a chronic disease (rather than a moral failing) influence your feelings about yourself and your recovery journey?

• Follow-up: What one negative belief about yourself or addiction would you like to let go of today?
• Follow-up: How can understanding the disease process strengthen your motivation and guide your next steps in recovery?

5. Sharing Insights & Takeaways

• Invite each participant to name one new insight gained from today’s discussion and how they might apply it this week.
• Record key themes on the whiteboard under headings: Biological, Psychological, Social, and Mindset Shift.

Next Steps

• Transition to the Role-Play Activity: Practice illustrating neuron communication and coping strategies in real-time.
• Remind participants to use their worksheet reflections to inform their role-play scenarios.
• Preview next session focus on building personalized coping plans and trigger management strategies.

Neuron Pathway Role-Play Activity Guide

Objective

Participants will physically and verbally illustrate how neurons communicate under normal conditions versus when influenced by addictive substances, deepening understanding of brain changes in addiction.

Materials

• A small soft ball (or crumpled paper) to represent a dopamine signal
• Two chairs or floor markers ~6 inches apart to mark the synapse
• Optional: headbands or name tags labeled “Neuron” and “Dopamine Pathway”

Roles

• Typical Neuron: Represents a healthy presynaptic neuron releasing dopamine signals at a steady pace.
• Over-Stimulated Pathway: Represents the brain’s dopamine pathway when flooded by substances—sending rapid, overwhelming signals.

Setup (1 minute)

1. Form pairs and stand or sit facing each other, with one chair/marker for each.
2. Agree on a nonverbal cue (hand raise or clap) to indicate that a “signal” has been sent.

Round 1: Healthy Communication (2 minutes)

1. The Typical Neuron holds the ball.
2. Every 5 seconds, the Neuron says “signal” and gently tosses the ball across the synapse to its partner’s lap.
3. The partner catches the ball, says “received,” and returns it after 3 seconds.
4. Repeat until time’s up, noticing the steady rhythm and ease of transmission.

Debrief Prompt

• How did this normal pace feel?
• What does this represent in terms of healthy dopamine release and reception?

Round 2: Drug-Induced Flood (5 minutes)

1. Switch roles or keep the same pair focusing on the Over-Stimulated Pathway role.
2. The Over-Stimulated Pathway now holds two balls.
3. Every 2 seconds, they shout “flood!” and toss both balls rapidly to the partner.
4. The partner tries to catch and return them but begins to drop or slow down over time.
5. Notice the partner’s stress and juggling—simulating receptor overload, tolerance, and miscommunication.

Debrief Prompts

• What happened to signal transmission under the flood?
• How did it feel to be the receptor receiving too many signals?
• What might this illustrate about tolerance (needing more) and withdrawal (when signals don’t come)?

Switch Roles & Repeat (5 minutes)

1. Swap roles so each person experiences both sides.
2. Run one healthy round (1 minute) and one flooding round (3 minutes).

Group Debrief (4 minutes)

• Communication Breakdown: What did you observe about how the receptor (Typical Neuron) adapted or struggled?
• Real-World Link: How do these role-play dynamics mirror changes in your own brain chemistry during use and abstinence?
• Recovery Insight: What strategies could help “regulate the flood” in real life (e.g., medication, therapy, coping skills)?

Tips for Facilitators

• Encourage participants to narrate their experience: describe physical sensations, frustrations, or surprises.
• Validate all reactions and tie observations back to biological concepts: receptor down-regulation, stress response, craving cycles.
• Keep energy positive and supportive—this is a learning tool, not a performance.

Use this activity to cement the idea that addiction changes not only how much dopamine is released but also how effectively the brain can receive and process those signals.