It is not about willpower or morality. Addicts are not bad, crazy or stupid.

Perhaps the most harmful misconception is that addicts must hit rock bottom before they’re ready for treatment, she said.

"Addicts and alcoholics are more likely to recover if they still have a job, if they still have a spouse, if their family still lets them in the door," Brady told a packed MUSC-sponsored luncheon last week at Daniel Island Club. "If you let them slip past the point of no return, the chances of recovery are less. The earlier in the addiction process that you can intervene and get someone help, the more they have to live for, the more they have to get better for."

An internationally renowned expert on substance abuse, the MUSC psychiatrist appeared in HBO’s acclaimed "Addiction" documentary series earlier this year. Her research has focused on the connection between stress and addiction with an emphasis on post-traumatic stress disorder.

While addiction takes an awful toll on U.S. society, precious little is spent on treatment or prevention, according to Brady.

"Treatment really works and it’s getting better all the time," she said, noting that individualized treatment plans incorporate medications as well as behavioral and psychiatric therapies. "One of the biggest myths is that treatment doesn’t work. That’s simply not true. It’s just that the people who are successfully into recovery are not talked about. The first time is not always going to work but it’s by no means hopeless…There are a whole lot of people who are in good, solid recovery who are contributing in major ways to society. Unfortunately, the failures are incredibly visible to everyone; the treatment successes are not."

Treatment is cost-effective, too, when compared to jail, Brady said.

"We’ve criminalized a lot of drug-related behaviors over the years," she said. "I’m by no means soft on crime, especially when it comes to drug violence. But if it’s just the act of procuring and taking a drug, put them on probation or in an ankle bracelet and get them into treatment, not prison."

Because of advances in neurobiological and behavioral research, scientists are gaining new insights into addiction, according to Brady.

"No one thing causes substance-use disorders," she said. "It’s a constellation of events that merge together that are likely to be different for each person."

One key component is the dopamine neurotransmitter system, which is commonly called the pleasure pathway. Drugs produce rapid and large dopamine surges and the brain reacts by reducing normal dopamine activity. Prolonged abuse can result in key changes to the brain. If someone depletes their dopamine source, their brain has a harder time feeling pleasure from even the normal events that would make them feel happy.

But the dopamine pathway is not the only part of the brain affected by addiction, according to Brady. Chronic overuse of drugs and alcohol can alter the brain’s stress and anti-stress systems and affect desires, emotions and the ability to make decisions and exercise good judgment. This, in turn, can lead to compulsive abuse.

Genetics can help trigger addiction, too, Brady said. But it’s not an all-or-nothing proposition.

"People with no family history can develop addiction," she said. "And people can have an absolutely loaded family history and not develop the disorder."

Stress and environmental factors also play a key role, according to Brady.

"One of the biggest disorders associated with addiction is PTSD or post-traumatic stress disorder," she said. "People with PTSD are four to five times more likely to develop substance-abuse problems."

Recent studies indicate that brain changes can occur from maternal isolation and other traumatic events.

"If you take a young animal and isolate it from its mother for a critical period of time and then return it to the pack, that animal that was isolated is 10 times more likely to choose drugs," Brady said. "Those animals will have a difference in their dopamine receptors. To think that the pleasure pathway can actually be altered by an early childhood event is an amazing concept."

Early drug use can unmask a vulnerability to other psychiatric disorders, especially in adolescents, Brady said.

The good news is that medications, coupled with behavioral treatment and support, can help abusers discover a new drug-free lifestyle. New brain scan studies show that behavioral treatments and medications work similarly in changing brain function. Consequently, addiction is a brain disease that can be treated by changing brain function through several types of treatments.

Medications can help reduce drug craving and help with additional medical or emotional illnesses that the addict might have. Individual, group and family therapy helps assist with understanding the specific issues that may have led to the addiction and that will have to be faced after treatment.

Brady said early intervention is key and it can come from frontline medical providers, family members or friends.

"My theory is that just about nobody comes in for treatment because they woke up one day and said, ‘Gosh, I need to stop drinking,’" she said. "There’s usually somebody who is twisting their arm, providing leverage to get them to face their problem… Don’t let an opportunity to intervene go by and don’t underestimate how important it can be."