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5 Common Ways Substance Use Disorders are Misunderstood

Clinicians, researchers, public policymakers, and society as a whole have made significant gains in our understanding of addictive behavior and substance use disorder (SUD) in particular. Over the years here at Boston Drug Treatment Centers, we’ve seen positive changes in the attitudes and viewpoints of people seeking help for loved ones with drug or alcohol problems.

However, even with all the advances in our scientific knowledge, some myths and misconceptions continue to surround SUD. This understanding has been complicated by the politicization of drugs and healthcare and by the persistence of some outdated or even outright malicious ideas.

Below are just some of the common and potentially dangerous ways SUD is misunderstood.

1.) Addiction is a moral failureThis was the prevailing view of substance use disorder for centuries. This view is repeatedly mentioned or implied in different religious texts, philosophical writings, and even legal codes throughout millennia, usually in reference to alcohol.However, today it is understood that genetics is, at least, partially responsible for determining whether a person develops compulsive substance-taking behavior. Even back then, writers observed that drunkenness was often more common among people with worse economic circumstances. These both imply a lack of full agency in whether one develops an SUD. Without full agency, where does one’s moral culpability begin?

Speaking even more broadly, anyone can become addicted to a wide variety of substances and actions that cause the brain to reward itself with dopamine. Gambling, video games, and social media are just some of the examples of the things that aren’t substances that people nonetheless can get hooked on.

If addiction is a so-called moral failure, it begs the question of it’s somehow different for these or other innocuous things like caffeine or gossiping, given the changes to the brain are extremely similar.

2.) Rehabs are useless

We can’t deny that the practice of drug rehabilitation, as it is, may need an overhaul. It’s also clear that some rehab programs are worse than others. There are even an unfortunate few that are outright cash grabs. But this discounts all the millions of people who have recovered from SUD due to the services of legitimate treatment and rehabilitation programs.

Vetted and certified rehab programs that can be frank about their recovery rates tend to be on the level. These programs use evidence-based treatments (EBT), which significantly raise their success rates over those using traditional or so-called alternative approaches that are not supported by science.

3.) SUDs are incurable

It is true the being fully cured of an SUD is rare. However, it does happen. Moreover, even in the cases where an individual is not “cured”, most of the time they should be able to make a full recovery. This means that even if they may continue to have an SUD, they have it under control to the point it no longer makes a negative impact on their life.

Today, it’s understood that repeated substance misuse can cause brain trauma and permanently alter the brain’s functioning. Despite this, however, the brain will heal when substance use is safely stopped.

Given enough time, the brain will form fresh connections and it will no longer require substances to feel normal. Old traces of the trauma may remain, much like an invisible scar. However, the recovered individual will be able to enjoy an excellent quality of life, regardless.

4.) Prescription drugs are safer than street drugs

While this is broadly true, the liberal way with which prescriptions for certain medications have been given out has been a cause of concern for the past two decades. The current opioid crisis has been blamed by the National Institute on Drug Abuse on the way American doctors readily prescribed opioid painkillers starting in the 2000s to the present day.

ADHD medications like Adderall and anxiolytics like Xanax, Valium, and Klonopin have also been receiving attention for their relatively high potential for abuse. Their combined use with other substances like alcohol and street drugs have also figured in a spate of fatalities and emergency room visits in the past decade. The Centers for Disease Control even tag prescription drugs as the single most lethal category of drugs by sheer numbers.

In short, prescription drugs are only safe when used as prescribed. Even then, risks are still present of which patients should be fully aware.

5.) A detox is all you need

While a detox may remove many of the immediate dangers of having harmful substances in your system, it will do nothing to address any alterations that may have already occurred in the brain’s function. To put it simply a detox won’t help recovering individuals lose their cravings.

On the contrary, with alcohol, benzodiazepine, and opioid use disorders, a person may feel even more compelled to consume more because of the extremely uncomfortable withdrawal symptoms that usually follow a detox.

For these reasons, detox sessions should always be supervised by a physician for safety to prevent an immediate relapse and followed up with psychotherapy to help the individual cope with cravings.


For us to effectively deal with substance use disorders, we must understand their true nature. While it is true that this understanding is constantly in flux, it’s important for all of us, including the families of patients and their clinicians, to keep on top of the science. By keeping ourselves updated, we’re all better equipped to help not just people with SUDs, but everyone else who may be in danger of developing one as well.


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