FANTASY? –
Mar. 12, 2026 – What’s the most addictive drug? Newly published research indicates that when focusing on persistent drug memory, craving, and addiction, the most addictive illegal drug is cocaine. In contrast, the drugs most likely to cause immediate death are opioids. My work focused on the dopamine hypothesis. The dopamine (DA) surge from cocaine is far greater than DA increases from food, sex, or social interactions.
The brain interprets cocaine use as extraordinarily valuable, cementing this association and reinforcing the behavior producing it.
But this DA-centric model doesn’t explain why relapses occur months or years after stopping cocaine. If DA levels normalized after detoxification and recovery, how could intense craving persist? Now we know that cocaine changes the brain itself. Repeated cocaine exposure does not simply alter DA; It alters gene expression, neuronal excitability, and neural circuitry in the brain.
