Addiction

What Is Addiction?

Addiction is a condition that results when a person ingests a substance (e.g., alcohol, cocaine, nicotine) or engages in an activity (e.g., gambling, sex, shopping) that can be pleasurable but the continued use/act of which becomes compulsive and interferes with ordinary life responsibilities, such as work, relationships, or health. Users may not be aware that their behavior is out of control and causing problems for themselves and others.

The word addiction is used in several different ways. One definition describes physical addiction. This is a biological state in which the body adapts to the presence of a drug so that drug no longer has the same effect, otherwise known as a tolerance. Another form of physical addiction is the phenomenon of overreaction by the brain to drugs (or to cues associated with the drugs). An alcoholic walking into a bar, for instance, will feel an extra pull to have a drink because of these cues.

However, most addictive behavior is not related to either physical tolerance or exposure to cues. People compulsively use drugs, gamble, or shop nearly always in reaction to being emotionally stressed, whether or not they have a physical addiction. Since these psychologically based addictions are not based on drug or brain effects, they can account for why people frequently switch addictive actions from one drug to a completely different kind of drug, or even to a non-drug behavior. The focus of the addiction isn’t what matters; it’s the need to take action under certain kinds of stress. Treating this kind of addiction requires an understanding of how it works psychologically.

When referring to any kind of addiction, it is important to recognize that its cause is not simply a search for pleasure and that addiction has nothing to do with one’s morality or strength of character. Experts debate whether addiction is a “disease” or a true mental illness, whether drug dependence and addiction mean the same thing, and many other aspects of addiction. Such debates are not likely to be resolved soon. But the lack of resolution does not.

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Symptoms of Addiction

The cardinal symptom of addiction is the inability to limit use of a substance or activity beyond need leading to clinically significant impairment.

There is a craving or compulsion to use the substance or activity.

Recurrent use of the drug or activity escalates to achieve the desired effect, indicating tolerance.

Attempts to stop usage produce symptoms of withdrawal—irritability, anxiety, shakes, nausea.

Recurrent use of the substance or activity impairs work, social, and family responsibilities, creates psychological impairments and interpersonal problems, has negative effects on health, mood, self-respect, exacerbated by the effects of the specific substance itself.

There are many symptoms created by the specific substance/activity that is used.

All addictions have the capacity to induce feelings of shame and guilt, a sense of hopelessness, and feelings of failure. In addition, anxiety and depression are common conditions among those with substance and behavioral addictions.

Causes of Addiction

There are no specific causes of any addiction aside from use of a substance or activity, and there is no way to predict who will become dependent on use.

Any substance or activity that has the capacity to be pleasurable can provide the conditions for addiction.

All addictions impact various neural circuits of the brain, including those related to reward, motivation, and memory.

Treatment of Addiction

Addiction is a treatable condition. The first phase of treatment from is withdrawal from the problem substance/activity. There are both physical and psychological effects that occur when substance-taking stops, including such physical signs as nausea and vomiting, chills and sweats, muscle cramps and aches, sleeplessness, shifts in heart rate, even fever. Emotional effects include depression, anxiety, irritability, and mood swings. Withdrawal symptoms typically last three to five days. While they are rarely life-threatening, medical supervision is usually provided in residential treatment programs, and medications may be given to ameliorate the acute discomfort of withdrawal.

Behavioral therapy and counseling are important elements of treatment. Cognitive behavioral therapy is often used to help patients identify, avoid, and cope with situations in which they are most likely to abuse drugs or activities. The technique of motivational interviewing is often employed to remind people of their values, as a way of avoiding use. Family therapy may be provided to help the patient maintain a supportive environment and improve family functioning.

Rehabilitation programs are often needed to help patients regain necessary job and other skills.

Relapse of Addiction

Relapse is now seen as the rule rather than the exception in addiction recovery. And it is no longer viewed as a catastrophe but as an opportunity for learning more and better strategies for overcoming urges and for identifying the moods and situations that are likely to be difficult.

What is inappropriate is black-and-white thinking about success that turns a slip-up into a disaster and sees it as a sure sign of defeat. The fact is that it takes time to change all the mental apparatus that supports any particular habit-the memories, the situations that trigger craving, and more. Addiction changes brains, and it takes time to change brains back.