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Adina Silvestri
Feb 26, 2015

Neuropsychology of Addiction

Every brain will become addicted. Think about that sentence for a minute. Every brain will become addicted.  How is it that at some point or another every one of us does not have enough will power to stop a behavior that we have a strong urge to perform?

Of course, some brains are more vulnerable than others because of genetics. Everyone does not become addicted to heroin, for example, but there are addictions large and small that impact our lives.  The chemical make-up of an addict’s brain changes as a result of their condition. One example is, drug withdrawal. The brain has adapted, requiring more of the drug to get the same effect and/or creates adverse physical symptoms that result from the absence of a substance. As a counselor, do you know how to best help your clients struggling with this disease?

Abuse vs. Dependence

Drug abuse creates a pattern of problems in social, occupational, and personal functioning. Chemical dependence involves permanent changes in the brain caused by the substance over-use, and this is exacerbated by genetic vulnerability. I do not believe addiction falls into any one category. Rather, studies suggest addiction occurs on a continuum. It is important when developing relapse plans to know what level the person is experiencing: mild, medium, or severe addiction.

Hijacking of the Brain

One of the best docudramas around on addiction is Bill Moyers, Close To Home. In his special, he talks about the science of addiction and how it “hijacks” one’s brain. Due to increased levels of tolerance, physical changes occur. It is like the body is the loyal host, and the disease overtakes the brain  and is unwilling to rest until the job of complete annihilation of the former self occurs. The brain adapts to this change, requiring more of the drug to get the same effect and/or creating adverse physical symptoms that result from the absence of a substance—we know this as withdrawal. Then the hijacking of the brain’s motivation/reward system occurs, and this spells further trouble. 


Dopamine is the number 1 neurochemical in compulsive behaviors and addictions. In fact, all drugs of abuse and potential compulsive behaviors release Dopamine at unnaturally high levels. This naturally occurring chemical is released when anticipating or desiring a reward. It creates the push or motivation for the reward.

This is precisely why a person can desire something they know is not good for them. The dopamine signals the motivation for the drug or behavior despite the consequences. A few of these dopamine-releasing agents include alcohol and other sedative/hypnotics, opiates/opioids, cocaine, amphetamines, entactogens (MDMA), entactogens/hallucinogens, dissociants (PCP, ketamine), cannabinoids, inhalents, nicotine, caffeine, food, and binging and Purging.

Relapse Prevention Plan

As a lover of Solution Focused Therapy (SFT), I always had trouble implementing a “plan” with my Substance Abusers. SFT trainers tell me that we are to allow the solutions to come from the client. This has not necessarily been the case. The solutions are difficult to find when all the brain wants is what it is dependent upon.

Relapse always happens in a moment. It is never:

Step 1) Call Adina if you think you are going to take that drink.

Step 2) Call Adina after you take that drink.

In a perfect world-perhaps!

It is more like, I took the drink, and now I feel shame, failure, and guilt, and I may or may not tell Adina.

Recommendations to stop the dopamine-driven moment include:

1) Assisting with developing skills to refrain from acting on the motivation to engage in compulsive behavior or addiction (e.g. visualization).

2) Helping them remember what they REALLY want in that moment. Assist with creating new motivations to compete with the old motivation for compulsive behavior or substance use.

Addiction is a nasty word for many counselors. The success rate is not that great, and unless you have a high tolerance for manipulation, these individuals can catapult us into early retirement. I, for one, have a counselor to help coach me throughout my work with these challenging clients. Sometimes, all we need is someone to lend an ear. And other times, we need a miracle :-)

Addiction and recovery is without a doubt one of my favorite things to blog about.  I love it because I am still learning. I am in a way obsessed with seeking out new information vital to the cause of treating Addiction. Neuropsychology is a game changer in the treatment of addiction. 


Adina Silvestri is a licensed professional counselor, researcher, and counselor educator who works with adults and children in her private practice, Life Cycles Counseling.It is her passion to work with individuals with addiction through counseling, research and advocacy efforts with the hope of raising awareness to the lack of gender specific treatment and recovery programs. Read more about her at 








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  1. 2 Hanalei 29 Mar
    Very helpful information.  Advisorsguidance/addiction
  2. 1 Nate Borgerding 16 Nov
    My name is Nate and I am a 17 year old student at Verona Area High School here in Wisconsin. I've been very interested in the addicted brain for a long time, and would love to pursue my career in Neuropsychology, or any type of Addictions Psychology. I was just wondering is there anything I can do to get a head start on my career goals while still in high school? I'm very interested in these topics and would love to learn more and get started on my career goals early.  


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