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Addiction

Addiction is a chronic biopsychosocial condition that is caused by a combination of factors like genetics, brain structure, environment and life experiences. People addicted to certain behaviors or substances engage in compulsive activities even when it becomes damaging. However, it is a treatable disorder.

What Is Addiction?

It is a chronic and complex disorder involving psychological, biological, environmental and social influences in the onset and maintenance of the condition. It typically involves psychological dependence or compulsion to engage in certain behaviors or consume substances, like drugs or alcohol. People typically engage in an addictive activity or consume drugs voluntarily for the first time. This can eventually turn into compulsion and the person may become addicted and lose all self-control. An addicted person may mentally and physically be incapable of stopping themselves from engaging in addictive habits, although it may cause physical and psychological harm to them and others. It is a brain dysfunction that affects our memory, motivation, attitudes and reward. But treatment and prevention strategies tend to be helpful.

According to a 2006 study 1 , it is regarded as a clinical syndrome involving multifactorial genetic influence, coupled with environmental factors. “Addiction is a compulsive need for and use of a habit-forming substance. It is accepted as a mental illness in the diagnostic nomenclature and results in substantial health, social and economic problems,” add the researchers. Although initially the condition only involved the use of substances, now specific behaviors, like gambling and even basic functions, like eating and exercising, also fall in the ambit of this neurobiologic disease. Being addicted can alter our brain structure and chemistry by disrupting the manner in which pleasure is registered. This can also subvert inherent drives, like motivation and learning. It is primarily a loss of self control over engaging in behaviors, habits or consuming substances. The sufferer may be psychologically and physically dependent on a substance and feel compelled to consume the addictive substance despite experiencing obvious adverse effects.

Some of the most common features of this disorder may include:

  • Intense cravings for and dependence on substance or behavior
  • Compulsive use
  • Impaired control over addictive behaviors
  • Lack of self-control or willpower
  • Loss of emotional response
  • Avoidance of obvious harmful effects of addictive behavior
  • Continued use despite negative consequences

People addicted to something may also experience repeated relapse & remission, which indicates that the sufferer may have frequent mild & severe episodes. However, their condition will worsen with time, if left untreated. Such damaging behaviors and compulsions can affect the sufferers relationships, social reputation, financial stability, physical and mental health and their ability to function in daily life.

Understanding Addiction

The condition is mainly a chronic psychiatric disorder 2 , prone to relapsing and is marked by uncontrolled and compulsive use of an activity or a substance with destructive and maladaptive consequences. Even though the consumption of addictive substances is volitional, engaging in such behavior repeatedly results in the loss of volitional control. A 2015 study 3 defines the phenomenon as “a chronic relapsing disorder that consists of three stages: preoccupation/anticipation, binge/intoxication, and withdrawal/negative affect. These three stages are conceptualized as feeding into one other, becoming more intense over time, and ultimately leading to the pathological state known as addiction.” As per the brain disease model 4 , the development of the condition is determined by various psychosocial factors. However, the theory establishes that biological processes 5 related to repeated addictive behaviors form the main pathology in the onset and maintenance. The brain disease model claims that it is a dysfunction of the reward system in our brain which occurs due to epigenetic & transcriptional processes. But some experts 6 believe that the brain disease paradigm is flawed and defective.

Most people wrongly believe that this neurobiologic disease is a personality disorder or a character flaw driven by a need for self-gratification and strengthened by a lack of willpower or unwillingness to stop. However, experts argue that people become addicted to substances and behaviors primarily because they want to avoid emotional and physical discomfort. According to a 2008 study 7 , high emotional stress is associated with lack of impulse control, incapability to suppress inappropriate behaviors and increased vulnerability to addictive behavior. The study explains “Stress is a well-known risk factor in the development of addiction and in relapse vulnerability. A series of population-based and epidemiological studies have identified specific stressors and individual-level variables that are predictive of substance use and abuse.” Most people tend to use recreational psychoactive drugs either to self-medicate or to feel better about themselves. However, apart from drugs and alcohol, seemingly harmless and casual compulsions like being addicted to sugar or being a workaholic can also be psychologically, emotionally and physically damaging.

Some of the most common examples of behavioral and drug addictions include –

  • Gambling
  • Video games
  • Internet or smartphones
  • Sex or pornography
  • Food
  • Alcohol
  • Nicotine
  • Marijuana
  • Cocaine
  • Amphetamine
  • Opioid
  • Other substances

However, the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the ICD-10 by the World Health Organization (WHO) recognizes only gambling as a behavioral addiction 8 . But the ICD-11 has also added gaming addiction to the list.

Addiction At A Glance

  1. Addiction is a condition where a person is unable to stop using a substance or engaging in a behavior.
  2. It is a brain dysfunction that affects our memory, motivation, attitudes and reward.
  3. Repeated use of a substance or engagement in a particular habit-forming activity causing impairment is the core symptom of this phenomenon.
  4. In a person who becomes addicted, brain receptors become overwhelmed.
  5. Addiction is treatable, but not all treatment approaches are the same. Relapses are not uncommon, so recovery may take time.

Prevalence Of Addiction

As it depends on a number of cultural and social factors, the prevalence of people with behavioral or substance dependence tends to vary with time based on the region. According to a 2012 study 9, around 12% or adults are addicted to alcohol & 2-3% of adults have substance dependence in the United States of America. The researchers also found that in American youth, the lifetime prevalence of illicit drug use disorders is about 2-3% and around 8% for alcohol use disorders. “The striking increase in prevalence rates from ages 13 to 18 highlight adolescence as the key period of development of substance use disorders,” adds the study. Research 10 further reveals that approximately 4.7% of older adults aged 50 and above tend to have a lifetime prevalence of prescription drug use. In fact, people aged 65 or more are more prone to be addicted to “non-medical use of prescription-type drugs” (8%), more than using marijuana (0.4%). “Rates of non-medical prescription drug use are currently rising, particularly at both ends of the adult age spectrum,” add the researchers.

Another 2011 study 11 indicates that lifetime prevalence of different behavioral addictions in the US is around 5-6% for compulsive buying, 2.8% for binge-eating disorder, 5% for compulsive sexual behavior and 1-2% for pathological gambling. In Australia, prevalence of substance dependence has been observed to be around 5.1%, whereas in Europe, the prevalence 12 of alcohol dependence is approximately 18.4%, about 15.2% for smoking, 0.35% for cocaine and 3.8% for cannabis. Prevalence of substance dependence is not very high in Asia, but high levels of internet addiction have been observed in Hong Kong and the Philippines.

Symptoms Of Addiction

Repeated use of a substance or engagement in a particular habit-forming activity causing impairment is the core symptom of this phenomenon. It involves two primary facets that characterize the disorder. These include:

A. Abnormal addictive behavior

The addicted person is prone to engage in maladaptive behavior that can be problematic not just for them, but for people around them as well.

B. Repeated addictive behavior

They persistently and continually engage in addictive behavior regardless of the negative consequences that they may experience.

Here are some of the most common symptoms observed in someone addicted to substances or behaviors:

1. Behavioral symptoms

Some of the common behavioral symptoms of this condition are mentioned below:

  • Uncontrollable craving
  • Lack of self-control or ability to stop
  • Seeking substance or behavior despite adverse physical or psychological effects
  • Frequently engaging in risky or damaging behaviors
  • Constantly preoccupied with addictive substance or behavior
  • Maintaining secrecy or hiding behavior or substance
  • Constant need for larger volumes of addictive substance or behavior due to higher tolerance
  • Experiencing mood fluctuations and denial
  • Unsuccessful attempts at stopping engagement in substance or behavior
  • Changes in personality
  • Difficulty identifying or regulating emotions

2. Psychological & physical symptoms

The following physical and mental health symptoms are observed in people addicted to substances or behaviors:

  • Changes in appetite and weight
  • Sleep disturbances or insomnia
  • Memory loss
  • Increased sensitivity
  • Changes in physical appearance due to lack of self-care
  • Physiological withdrawal symptoms
  • Increased levels of stress, anxiety and depression
  • Other physical and mental health issues

3. Social symptoms

These social symptoms are also widely observed in someone struggling with addiction:

  • Experiencing financial and legal issues
  • Social withdrawal and isolation
  • Loss of interest in things previously enjoyed
  • Avoidance of different aspects of life, like education, work & responsibilities
  • Abusing loved ones and relationship problems
  • Problems in interpersonal and social interactions
  • Impaired ability to function in daily life & poor performance at work or school

The number of symptoms present in the sufferer can help to identify the severity of symptoms in them.

Types Of Addiction

The condition refers to a pattern of behavior that causes negative consequences for the individual. Most people assume that it refers only to those who have a compulsive need for a particular substance such as alcohol or drugs. However, in reality, it is possible to become addicted to almost anything. To be clear, this condition occurs when a person continues to do something despite knowing that it will have an adverse impact on his or her life. Because of the various causes and triggers, there are many different types of addictions. Someone can be addicted to drugs, alcohol, nicotine, caffeine, food, the internet, online gaming, gambling, social media, sex and even shopping. Here some of the most common types of addiction:

1. Drugs

Drugs are extremely powerful substances that can make the person crave drugs leading to obsession & dependence, according to research 13. Being addicted to drugs like cocaine, cannabis, opioids, hallucinogens and other drugs can be extremely damaging for our mental and physical health.

2. Alcohol

Alcohol dependence or alcoholism 14 is a progressive and chronic condition with severe negative outcomes like poor health, relationship problems, legal issues etc. It can lead to dependence as alcohol is a psychoactive substance and overuse can alter the brain’s stress and reward system.

Read More About Alcoholism Here

3. Gambling

Pathological gambling or problem gambling is the only behavioral addiction that has been recognized 15 by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is a progressive condition that can cause depression, anxiety, distress, migraine and other health issues.

4. Video games

Studies 16 show that internet gaming disorder can impair functioning in different aspects of life of an individual. Observed mostly in children and teens 17, this addiction can cause serious mental health issues 18.

5. Caffeine & nicotine

Considered as the most widely consumed drug worldwide by researchers 19, caffeine can be addictive when overused, even though it is scientifically not an addictive substance. However, nicotine 20 is addictive and smoking dependence can cause a number of negative outcomes.

Read More About Caffeine Use Disorder Here

Apart from these, there are many other types of addictions that someone can suffer from, such as –

  • Prescription drugs
  • Food
  • Sex
  • Smartphones
  • Internet
  • Social media
  • Shopping
  • Cosmetic surgery
  • Exercise
  • Work

Read More About Types Of Addiction Here

How Addiction Affects The Brain?

According to research 21, it is a chronic brain disease with severe mental, medical and social problems. The researchers explain that the disorder is a “condition of being addicted to a particular substance, thing, or activity,” with “long-lasting changes in the brain.” When you are addicted, your brain is impacted on multiple levels. Drugs, hallucinogens and stimulants like opioids, alcohol or nicotine, compromise certain chemicals which infiltrate into our bloodstream and brain when consumed. These chemicals, when present in the brain, can affect our thoughts, behaviors, attitudes and decision making which leads to loss of control over desires and impulses. As a result, an addict tends to seek and crave the substances they are addicted to.

When we become addicted to a substance or behavior, our brain desires the pleasure and reward associated with the addiction as the substance or behavior substantially stimulates the reward mechanism of the brain. This leads to chronic use or exposure to the substance or behavior over a prolonged period and results in strong pleasant feelings & abnormal behavioral traits. When a person is addicted to something for a significantly long period of time, they can develop serious brain damage 22.

How Addiction develops?

According to a 2015 study 23, addiction typically develops in three distinct stages, namely –

  • Anticipation or preoccupation
  • Intoxication or binge
  • Negative affect or withdrawal

The study shows that these three different stages have been found to be interconnected and support each other. As a result, these become stronger and severe with time “and ultimately leading to the pathological state known as addiction,” explains the study. Moreover, a 2009 study 24 revealed that according to human imaging studies the primary element of this neurobiologic disease is identified as “decreases in dopaminergic function.” This goes on to show the crucial role the neurotransmitter dopamine plays in the onset. “As a result of habitual intake of addictive drugs, dopamine receptors expressed in the brain are decreased, thereby reducing interest in activities not already stamped in by habitual rewards,” states a recent 2020 study 25.

Addictive substances and chemicals change brain function and chemistry which impacts our emotions, physical sensations, habits, compulsions and cravings. Substances tend to affect the brain’s limbic system 26 and produce intense pleasurable and positive emotions which influence our mind and body. When we engage in activities that make us feel good, our brain rewards us. As a result, the addicted person is motivated to consume more drugs to experience the strong feel-good emotions, which results in further rewards. This gives birth to a cycle of substance abuse until using drugs becomes normal without any feelings of pleasure or reward. “Repeated drug use arises from the drug’s neurochemical actions that produce positive reinforcing effects, progressively leading to neurobiological changes in the brain reward circuits and behaviors characteristic of addiction: tolerance, sensitization, dependence, withdrawal and craving,” explains another 2009 study 27.

Stages Of Addiction

Both substance and behavioral addiction often tends to develop in stages and becomes worse progressively. It is a multi-stage process that starts with initiation or experimentation and is followed by regular and problematic use, leading to dependence. Here the 5 major stages involved that you need to know about:

1. Experimentation

This stage involves exploring and experimenting with addictive substances and behaviors out of curiosity or peer pressure.

2. Regular use

The second stage is characterized by daily or frequent use, mostly for social reasons until it becomes a regular habit.

3. Problem or risky use

This stage is marked by excessive use of engagement even when experiencing adverse effects, often without any concern for complications.

4. Dependence & tolerance

At this stage, the person becomes tolerant and reliant on the addictive substance or behavior and craves higher amounts to experience the same pleasure or reward.

5. Addiction

This final stage is characterized by compulsive use or engagement, loss of self-control or willingness to stop and a complete lack of concern for adverse effects.

Read More About Stages Of Addiction Here

Causes Of Addiction

Although no particular cause has been identified, onset can be influenced by a number of risk factors. One study 28 found that causes can be hereditary, environmental, maturational, and even circumstantial. Another 2013 study 29 revealed that “Genetic factors account for roughly 50% of this individual variability in addiction vulnerability,” while “the other 50% of the risk for addiction is due to a host of environmental factors.”

Here are some of the common risk factors that influence the development of this condition:

1. Genetics

The condition is believed to run in families. Hence, you are likely to become an addict if a first-degree relative is addicted to some substance or behavior. Research 30 reveals that addiction can be “highly heritable” and about 40-60% of the risk for development is related with genetic predisposition, as per studies 31.

2. Environment

Onset of this condition is also influenced by different environmental factors 29, which can increase or decrease vulnerability when teamed with genetic susceptibility. Some of the most common environmental factors may include:

  • Family environment
  • Addiction in parents or family members
  • Peer pressure
  • Availability
  • Childhood abuse and maltreatment
  • Adverse experiences
  • Poverty

3. Other factors

Apart from genetics and environmental issues, there can be some other risk factors which can cause the disorder in someone, such as:

  • Brain chemistry
  • Psychiatric disorders
  • Frequency & duration of dependence
  • Male gender

Read More About Causes Of Addiction Here

Complications Associated With Addiction

Addiction, when left unaddressed or untreated, can cause certain serious long-term complications and consequences, such as:

  • Psychological complications, like mental health issues 32, loneliness, depression 33 and suicidal thoughts 34.
  • Physical complications such as heart diseases 35, sexually transmitted diseases (STDs) 36, fetal damage and other health issues 37.
  • Personal complications, like social interaction and relationship problems 38, criminal behavior 39 and financial problems.

However, it should be noted that different addictions have different consequences and result in varied health issues, some of which can even cause death or suicide.

Read More About Complications Of Addiction Here

Addiction And Mental Health

Being addicted to substances or behaviors can directly affect our mental health 40 and cause a host of co-occurring disorders such as anxiety, depression, social phobia, bipolar disorder, psychosis etc. A 2009 study 41 states “Epidemiologic studies indicate that co-occurring substance use disorders and psychiatric disorders are frequently found in clinical practice.” Moreover, some studies have shown that cell phone addiction 42, internet addiction 43 and prolonged use of social networking sites (SNS) 44 are associated with mental health problems. Coping with and overcoming alcoholism or substance abuse or dependence can be especially challenging when a patient has underlying comorbid conditions. Research 45 has also revealed that comorbidity tends to be high.

Such underlying psychiatric disorders tend to get worse with addiction and addicted individuals can abuse substances even more when mental conditions are left untreated. This can make the symptoms worsen and make it increasingly difficult for the individual to perform daily activities and function normally. This is why it is important for doctors to treat any underlying mental health problems while devising a treatment plan for this neurobiologic disease. “The most common type of treatment for those with mental illness, regardless of the level of impairment, is the use of prescription medication, followed by outpatient treatment and inpatient treatment,” suggests a 2012 scientific analysis 46.

Read More About Addiction And The Brain Here

Diagnosis Of Addiction

Using or abusing drugs does not necessarily indicate that the person is addicted, although substance use is one of the primary symptoms. Diagnosis begins with the patient realizing that they are addicted and that it can be damaging for their mental and physical health. Either the patient can seek professional help or their loved ones can encourage them to consult a healthcare professional. A doctor may conduct several tests and ask questions to understand about their addictive behaviors or substance use. The doctor may also conduct certain lab tests to check for any underlying conditions and to evaluate the patient’s overall health. “Lab values (blood and urine), imaging, and specific tests vary depending on the root of the addiction,” explains research 47 .

It is crucial that a proper diagnosis is made as the conditions, symptoms and side-effects associated with withdrawal tends to vary greatly depending on the drug used or the behavior engaged in. Once a diagnosis has been made, the doctor can develop a helpful and effective treatment plan.

Withdrawal

When an addicted person stops engaging in addictive behavior or consuming drugs or alcohol without consulting a doctor first, it can lead to certain withdrawal symptoms. In fact, trying to suddenly overcome substance dependence or stopping drug consumption with medications and treatment can prove to be fatal. Withdrawal typically involves the following symptoms:

  • High levels of anxiety
  • Changes in appetite and weight
  • Sleep disturbances
  • Vomiting & nausea
  • Tremors & shaking
  • Fatigue
  • Irritability

Treatment Of Addiction

It is a treatable condition as all types, whether substance or behavioral, can be treated effectively with therapy and medications. However, the method of treatment and duration of recovery may vary depending on the type, stage and intensity of addiction as well as the individual. Moreover, the treatment plan should also consider family members and others who may be affected by the patient. Treatment mainly focuses on enabling the patient to stop engaging in addictive substances or behavior and build a healthier mindset.

Some common treatment approaches may include –

1. Psychotherapy

Therapies such as Cognitive behavioral therapy (CBT), contingency management, counseling and family or group therapy are highly recommended. CBT 48 has been proven to be effective in treating thought & behavior patterns associated with the condition. Cognitive behavioral therapy for substance use disorders is a time-restricted and structured psychological intervention that “has demonstrated efficacy as both a monotherapy and as part of combination treatment strategies,” states a 2010 study 49 .

2. Medications

Medications can help to cope with underlying psychiatric disorders, like anxiety, depression, psychosis or schizophrenia. It can also be useful for managing cravings, dependence and withdrawal symptoms. Some common medications that can be recommended for this disorder are buprenorphine, disulfiram, naltrexone, acamprosate, methadone etc. According to a 2013 study 50 , medications work in combination with psychosocial interventions to make treatment more effective. The researchers state that pharmacotherapies “now play an important role in the treatment of SUDs (substance use disorders) at the levels of detoxification, initial recovery, and relapse prevention.”

3. Coping strategies & support groups

Self-help strategies, in addition to medical treatment, can also help to fasten and strengthen the recovery process. By learning new ways to cope with their disorder, patients can identify triggers and take steps to manage cravings or relapse. Moreover, treatment also necessitates support from loved ones and others. Support from family and friends, community and support groups can also help in recovery. However, ongoing care to cope with withdrawal and relapse is crucial.

4. Hospitalization

Depending on the severity of the condition, a doctor may also recommend inpatient treatment in a highly safe and controlled setting. Hospitalization may be recommended in rare cases, but it is important for treating severe complications,especially when the patient is at risk of harming themselves or others while detoxing.

According to a 2013 study 51 , “in order to be effective, all pharmacological or biologically based treatments for addiction need to be integrated into other established forms of addiction rehabilitation, such as cognitive behavioral therapy, individual and group psychotherapy, behavior-modification strategies, twelve-step programs, and residential treatment facilities.”

Recovery Is Possible

Addiction is a devastating and debilitating condition that can seriously affect not just the patient’s life but also their loved ones’. As there is a lot of stigma, shame and guilt associated with the condition, many sufferers do not seek help. However, it is important that you ask for support from your family & friends and seek medical help so that you can overcome this disorder. Although treatment may be a long and complicated process, one can fully recover with the help of therapies and medications. Moreover, educating yourself about the disorder can also help you in the recovery process.

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