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)

Rethinking Addiction

Why It’s Not About Morality

When we reduce addiction to a question of right or wrong, we miss the pain, the history, and the human beneath it. Here’s why morality can’t explain addiction and what can.

Written by Emma Nagle, LCSW } November 10, 2025

Addiction is not a “moral failing” or a reflection of weak character.

It is a complex and multifaceted response to pain, stress, and trauma. Many people who develop substance use disorders are attempting to manage overwhelming emotional states, intrusive memories, or chronic distress that feel intolerable without external relief.

Substances temporarily alter the nervous system, dampening hyperarousal responses, numbing painful emotions, or filling the void created by disconnection and loss.

Over time, these coping mechanisms, though initially adaptive in their intent to reduce suffering, become maladaptive and self-perpetuating as the person increasingly relies on substances to regulate mood and function.

Repeated substance use fundamentally changes brain chemistry, particularly within the reward, motivation, and stress regulation systems. The brain begins to associate substance use with survival, reinforcing cravings and compulsive behaviors even when the individual intellectually understands the harm. This neurobiological conditioning can override logic and willpower, creating a cycle of craving, use, and shame that deepens the sense of helplessness.

By understanding the driving forces and the science behind addiction, treatment can become more integrative. This means programs and providers can address co-occurring mental health conditions simultaneously with therapy and psychotropic medication when necessary. Additionally, treatment can become more individualized. Providers can reach the person suffering by beginning to understand the experiences that led to self-medicating. Treating addiction from the viewpoint of moral failing sends the message to a person addicted that they are of weak character or lack of willpower. This type of messaging can risk causing further shame and emotional pain that perpetuates the cycle of using.

Understanding addiction through a biopsychosocial lens rather than through one of morality, allows for compassion, accountability, and effective treatment that targets the underlying trauma and emotional pain driving the behavior. If you are struggling with substance use or know someone who is, consider: What is this drug treating?  This might give you the key to the next step in unlocking how to recover from the cycle of addiction. 

If you or a loved one are struggling with addiction, help is available. You can book a consultation call with me here, to see if individual therapy is right for you, or find help and support near you on SAMHSA’s website.

How to Support a Loved One with Addiction

A CRAFT-Based Guide to Staying Connected Without Enabling

Written by Emma Nagle, LCSW | April 23, 2025

When someone you care about is struggling with substance use, it’s natural to feel helpless, scared, and unsure of what to do. You want to help, but you don’t want to enable. You want to set boundaries, but you don’t want to push them away. It’s a painful and confusing space to be in.

That’s where the CRAFT model comes in.

CRAFT stands for Community Reinforcement and Family Training. It’s a research-backed approach designed to help family members and close support systems learn how to effectively encourage a loved one toward treatment without ultimatums, guilt-tripping, or cutting them off.

As a therapist, I’ve seen CRAFT empower families and partners with tools that are not only compassionate and practical—but actually work.

Here’s a guide of how it works:

1. Understand What You’re Dealing With

CRAFT starts by educating loved ones on what addiction is: Not just a series of bad decisions, but a complicated behavioral pattern shaped by reward, habit, and pain systems in the brain.

Knowing this helps shift the mindset from:

“Why won’t they just stop?” to “What’s reinforcing this behavior, and how can we shift that?”

2. Notice What is Reinforcing the Substance Use

CRAFT teaches that people keep using substances because something about it “works” for them, whether it’s escaping stress, numbing pain, or just feeling normal for a moment. Their substance of choice should give insight into what they may be “treating” within themselves.

Your job isn’t to fix them, but to start recognizing how your responses might be (unintentionally) supporting the behavior.

Examples:

• Are you giving money when they’re short because they spent it on substances?

• Are you cleaning up their messes so they don’t face consequences?

This isn’t about blame. It’s about becoming more conscious of what’s keeping the cycle going.

3. Use Positive Reinforcement for Healthy Behavior

Here’s something refreshing: CRAFT isn’t about punishment. It’s about learning how to reinforce positive change, even in small doses.

Did they come home sober one night? Keep a therapy appointment? Go 24 hours without using?

Notice it.

Name it.

Appreciate it.

When you consistently reward healthier choices (with time, attention, calm conversation), you’re giving their brain a reason to keep trying.

4. Improve Communication Without Fighting

CRAFT encourages clear, kind, and assertive communication. That means less yelling, fewer power struggles, and no more walking on eggshells. Try using “I” statements and avoid blaming language. 

Instead of saying:

“You’re ruining your life!”

You might try:

“I care about you, and I get scared when I see how much you’re using. I’d love to talk when you’re ready.”

This approach respects both your boundaries and their autonomy—two things that are crucial when trying to keep connection without enabling.

5. Support Treatment—But Let It Be Their Choice

A major goal of CRAFT is helping loved ones be more likely to accept help without being forced. CRAFT has been shown to be more effective than interventions that rely on confrontation or cutting people off.

You’re not trying to control their timeline. You’re helping create an environment where choosing help feels safe and supported. When they are ready to accept help, be ready to help. Have resources available or someone for your loved one to speak to further about their addiction.

final thoughts

Supporting someone through addiction is emotionally exhausting, but you don’t have to choose between doing everything and doing nothing.

CRAFT offers a third option: Stay connected. Set boundaries. Reinforce hope. All while taking care of yourself, too.

If you’re navigating this with someone you love, consider finding a therapist or support group to help ensure you are prioritizing your own emotional needs. Al Anon is one commonly sought out mutual aid resource for family and friends who have been affected by a loved one’s addiction. Support groups are a helpful reminder that you are not alone in this struggle. With the right tools, it is possible to make meaningful change—without losing your sanity, your compassion, or your connection.

Want a printable version of this guide? Click Here.