Substance use disorder remains a disease denied disease status by many otherwise scientifically minded CRNAs. This denial leads not only to shame and lack of treatment of the affected provider, but also to injury of many patients provided suboptimal treatment. Neurochemical and neurobiological changes in the addict’s brain as a result to exposure to addictive substances will be described and detailed. Neuroplasticity, the ability of the brain to change, application to the development of addiction behaviors, relapse and recovery will be discussed. The risk factors and behaviors specifically associated with anesthesia provider addiction related impairment and diversion will be discussed.