Shining light on addiction myths

Written by Emma Nagle, LCSW | May 5, 2026

There are many common misconceptions people have around addiction, which is better categorized as a substance use disorder. Viewing it along a spectrum (mild, moderate, severe, in remission/partial remission), helps move us away from rigid ideas about what it is and how it’s treated.

Below are some common myths I’ve come across in my work ranging from what “counts” as an addiction, to who is affected by it. The reality is much more nuanced and treatment is never a one-size fits all. Let’s shed some light on the reality of substance use disorders.

Myth: Willpower is all that is needed to stay sober.

Reality: Extensive substance use can rewire the brain, causing intense cravings that override areas of the brain responsible for impulse control. Because brain chemistry changes when addiction occurs, it typically takes a multi-pronged approached to treating a substance use disorder.

Myth: Addiction is a choice.

Reality: Addiction is seen as a mental health disorder, classified in the DSM-5 as a substance use disorder. Furthermore, it is considered a chronic and progressive brain disease given the changes in brain circuitry in reward, stress and impulse control pathways. These changes affect decision-making where substance use is not always in someone’s control. This is why you may see someone highly motivated to achieve sobriety and yet still struggle to do so.

Myth: Those with addiction have to hit “rock bottom” first to recovery from addiction.

Reality: There is no evidence to suggest that one has to lose everything or reach the most significant consequences in life in order to affect change in their life. In fact, given the impact on the prefrontal cortex overtime, waiting for addiction to progress until it has reached its most severe stage only makes it more difficult to treat.

Myth: Using medications is not true sobriety or replaces one drug for another.

Reality: Medication Assisted Treatment (MAT) is proven to be an effective treatment intervention in managing withdrawal symptoms and cravings. Some are used temporarily while others can be used for long-term management of the SUD when used properly. As a society we would not withhold medicine as an intervention option that helps to treat any other disease, so why would we have that expectation for those with an SUD? This myth stems from old rhetoric about addiction being a moral failing and willpower being what’s needed to cure this.

Myth: Mandated or forced treatment will always fail.

Reality: While it certainly helps the process to have a willing participant in their own treatment towards recovery, this is often not where many begin. Because of the widespread consequences that can ensue from one’s addiction, many can find themselves connected to treatment, such as an outpatient program, by external factors like loved ones, court systems, employers, licensing boards etc. Oftentimes the person “mandated” to some kind of treatment is in a stage of extreme ambivalence about getting sober, but is more clear about not wanting the alternative consequence of a divorce, jail time, unemployment, loss of licensure etc. Overtime, as someone stops using, mental clarity comes back, neural pathways heal, one experiences less consequences and along the way, develop internal motivation for sobriety.

Myth: “Tough love” must be used to help an addicted person change.

Reality: Many believe that kicking out their addicted love one will force them to change, but instead this typically pushes that person deeper into isolation, shame and using. While many think tough love and threats will demonstrate discipline, it misses the mark on what the driving force is for the addiction, which is usually emotional pain and mental illness. Tough love is blaming and therefore shaming and shame, is what keeps addiction alive. It is undoubtedly a difficult position to be in as a loved one of someone with an SUD, and takes education and practice to set firm and compassionate boundaries that demonstrate empathy and connection. Learn more here on how to support a loved one with addicton.

Myth: If substance use is not daily, or can be stopped for periods of time, then there is no addiction.

Reality: A substance use disorder is not defined by the amount of days in a week a substance is consumed. Nor is the quantity of the substance consumed. Instead, it is defined in the DSM-5 by a set of 11 criteria, of which one only needs to reach two for us to assess for a mild disorder. Think about the consequences of the substance use and impact on one’s life as a better gauge as to whether it could be problematic. For example, someone might “only drink on the weekends,” but experience black outs, lose important items, and engage in risky behaviors that trigger anxiety, shame and social isolation for weeks afterwards.

Myth: Being addicted is a character flaw.

Reality: Addiction is driven by an interplay of genetics, environment, and mental health factors, rather than a personality defect. Epigenetics plays a significant role in the development of addiction as well as the long-term risk of relapse due to the brain’s “memory” of drug exposure. It’s not a character flaw or a moral failing, it’s a maladaptive coping mechanism for emotional pain.

Myth: Addiction only happens to certain types of people.

Reality: Addiction has a universal impact and does not discriminate based on race, socioeconomic status, age or profession. Because of its biological nature, anyone can develop a substance use disorder. Because there is more exposure to marginalized groups facing addiction due to lack of resources and poor policy, this inadvertently reinforces the stereotype that addiction happens to the underserved. The high-achieving population may have a greater ability to hide their substance use disorder behind their successes.

Addiction is far more nuanced than many of the narratives we’ve been given. When we move away from rigid assumptions, we create more space for effective treatment, compassion, and earlier intervention. A more informed understanding doesn’t just change how we see addiction… it changes how we respond to it.

Looking for a therapist to help you navigate substance use or boundary-setting with a loved one who is using? Book a consultation with me here.

For additional substance use support and resources including a treatment locator, visit SAMHSA or the National Helpline: 1-800-662-HELP (4357)