Around 1,200 people in Scotland die every year from a fatal overdose linked to psychoactive substances, not counting alcohol. Add alcohol back in and that figure climbs by another 800. Professor Alexander Baldacchino, Chair of the World Psychiatric Association’s Addiction Faculty and a scientific adviser to both the European Union Drugs Agency and the World Health Organization, opened a recent TEDx talk at the University of St Andrews with those numbers, then spent the next eighteen minutes dismantling the ideas most people use to explain them.

The moral choice myth

Baldacchino’s central argument is blunt: there is no evidence that addiction is a moral choice. Most people, he suggests, picture addiction happening somewhere else, to someone else, a distant “them” doing illegal things and not caring about the consequences. That framing lets everyone else off the hook, and it’s wrong on two counts. People who become dependent on drugs are often among the most disadvantaged individuals in their communities, and the brain changes in addiction he goes on to describe can happen to anyone, regardless of background, intelligence or social status.

How industry rewrote the narrative

Baldacchino points to a deliberate shift in messaging over the past three or four decades around legal drugs: alcohol, tobacco, and increasingly cannabis and vaping. The message has moved toward personal responsibility: drink responsibly, vape responsibly, smoke responsibly. Adverts built around exactly that idea, glossy, upbeat, designed to make consumption look good and posh, are everywhere. He argues this is a conscious effort by industry to frame addiction as a question of individual responsibility rather than a consequence of what the product itself does to the brain.

Natural rewards, hijacked

Baldacchino grounds the science in something universal: humans are wired to seek reward. Good food, relationships, a beautiful evening, all of it registers as what he calls a natural reward, and everyone can relate to chasing more of it. Alcohol and other psychoactive substances tap into that same system, at first. But taken repeatedly, and in increasing amounts, they start to hijack it. Artificial rewards from substances become stronger and more compelling than the natural ones, and the brain’s circuitry changes as a result. That process has nothing to do with responsibility. “It has nothing to do with responsibility,” as Baldacchino puts it.

Three systems, one brain

Baldacchino breaks the underlying neuroscience into three interacting components. Cognitive control acts like an internal air traffic controller, balancing impulsivity against restraint and deciding when acting on impulse is appropriate. Negative emotionality reflects how vulnerable, tired or unloved someone feels at a given moment, which shapes how they interpret and respond to situations. Incentive salience is where reward itself lives, the pull toward something because of the payoff it promises. Day to day decisions run through all three, and which one dominates shifts depending on context: withdrawal tends to bring negative emotionality to the front, active use amplifies incentive salience, and anticipation leans more on cognitive control.

What brain scans actually show

To make the case concrete, Baldacchino cited a structural MRI study, part of a television programme with Brian Cox, comparing people who had used heroin for extended periods against people with no history of substance dependency. Participants played a simple game with real money at stake. On day one, people without a history of dependency showed a clear reward response in their brain scans when they knew a payout was coming. People with substance use histories, even when clinically stable, showed almost no reward response lighting up at all. On top of that blunted response, Baldacchino noted a second problem: the same group struggled to learn from mistakes once they’d made them, compounding the difficulty of recovery.

Beyond drugs and alcohol

Baldacchino extended the same framework to behaviours involving no psychoactive substance at all: gambling, gaming, and problematic phone or internet use, including among children. He referenced a recent court case in which Meta lost after resisting the argument that its algorithms were designed to be addictive, framing it as evidence that the same reward-hijacking mechanism he’d just described applies well beyond drink and drugs.

The takeaway

Baldacchino’s closing message was less about blame and more about maintenance: take care of your brain, and look for real natural rewards rather than reaching for more alcohol or another night of bingeing television. Understanding the brain changes in addiction, he argued, is the first step toward treating addiction as what the evidence shows it to be, a disorder of the brain’s reward system, not a failure of character.

Watch the full talk: Brain changes in addiction | Professor Alexander Baldacchino | TEDxUniversityofStAndrews.

Source: dbrecoveryresources