Understanding 1: Dignity helps the nervous system settle
Respect and recognition reduce threat and support regulation—this is part of why good care works.
What you can do: Ask for what you need directly: dignity, clarity, consistency.
Understanding 2: Compassion is not softness—it’s effective medicine
Treatment works better when people feel seen, safe, and not punished for symptoms.
What you can do: Choose providers/communities that treat addiction as illness, not moral failure.
Understanding 3: Recovery is “circuit repair” + belonging
Medication, therapy, and community restore balance in stress/reward/control systems—and restore life.
What you can do: Build a three-part plan: body + mind + people.
Opioids bind to μ-opioid receptors (MORs)located on GABAergic interneuronsin the ventral tegmental area (VTA).
(Johnson & North, 1992; Fields & Margolis, 2015)
MOR activation inhibits GABA neurons, which disinhibits dopamine neurons, increasing dopamine release into the nucleus accumbens (NAc).
(Matsui et al., 2014; Volkow & Morales, 2015)
Result:Dopamine-driven euphoria, reinforcement, and motivational salience.
(Koob & Volkow, 2016)
Clinical implication:This indirect mechanismexplains why opioids feel both rewarding and stabilizing, but also why tolerance and dependence develop rapidly.
(Lüscher, 2016; Volkow et al., 2019)
You can think of the VTA as a harbor — dopamine neurons are the ships waiting to set sail.
GABA neurons act like the dock chains that keep them anchored. When opioids bind to μ-receptors on those GABA cells, they release the chains — suddenly dopamine floods out into the open sea of the nucleus accumbens.
That’s euphoria — but it also means the brain’s harbor master loses control. Each wave of dopamine release reshapes the coastline of motivation, and tolerance is the storm that follows.
Adaptation to this signalliing from exogenous opioid is almost. There is a downregulated response within minutes to drug that is still on board. This means: the brain’s reward neurons stop responding to the same signal very quickly — hedonic tolerance begins after a single exposure.
