Addiction is a complex condition, a brain disease that is manifested by compulsive excessive substance / behavioral abuse despite harmful consequence. It is a multifaceted phenomenon, often characterized by intense and often uncontrollable cravings. These cravings often lead to extensive measures to obtain and use the substance of choice, and can persist even after extensive periods of abstinence.
While the path to addiction begins with the voluntary act of taking substances, over time a person’s ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning.
In this article, we’ll use our experience as former mental health professionals in inpatient psychiatric facilities (and a psychiatrist’s review) to provide a medically approved comprehensive explanation on the term ‘Addiction’ as it pertains to mental health.
Understanding addiction is crucial to combating its devastating effects. Addiction is not just a series of bad choices or a moral failing, but a chronic brain disease that changes both brain structure and function. Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain. This happens as the brain goes through a series of changes, beginning with recognition of pleasure and ending with a drive toward compulsive behavior.
The most common addiction, according to Addiction Center; as of 2020, 10.2% (or 28.3 million in the United States) people aged 12 or older reported struggling with an alcohol use disorder (AUD).
It is important to note that addiction is not limited to substances such as alcohol or drugs. It can also include behaviors such as gambling, eating, or even using the internet. These behaviors provide a rush of endorphins, similar to substances, which the person then becomes addicted to.
The brain and addiction
The brain is central to understanding the phenomenon of addiction. It is the organ that is affected by the substance or behavior and it is there that the symptoms of addiction manifest. The brain and its networks are responsible for all our actions, emotions, and thoughts, and it is also responsible for our survival instincts. The brain rewards us for fulfilling tasks that ensure our survival, such as eating, by releasing a neurotransmitter called dopamine which makes us feel pleasure.
Substances and addictive behaviors can release up to 10 times the amount of dopamine that natural rewards do. The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal. In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine in the nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex. Dopamine release in the nucleus accumbens is so consistently tied with pleasure that neuroscientists refer to the region as the brain’s pleasure center.
How does addiction develop?
The development of addiction is a gradual process that can take weeks, months, or even years to manifest. It usually starts with experimentation, often in social settings, and increases in frequency over time. As a person continues to use a substance or engage in addictive behaviors, they begin to build a tolerance, requiring more of the substance or behavior to achieve the desired effect.
“Not everyone who excessively uses substances or engages in compulsive addictive behavior will develop an addiction. The development of addiction is predicated by a combination of genetic, environmental and psychological factors.”Charlie Penwarden, Mental Health Consultant
Eventually, the person reaches a point where they cannot stop using or engaging in the behavior, despite negative consequences. At this stage, the person is said to have a substance use disorder or addiction. It is important to note that not everyone who uses substances or engages in potentially addictive behavior will develop an addiction. The development of addiction is influenced by a combination of genetic, environmental, and psychological factors.
The two main types of addiction
There are many different types of addiction, ranging from substance use disorders to behavioral addictions. Each type of addiction has its own unique features, but they all involve a compulsive need to use a substance or engage in a behavior, despite negative consequences.
Substance use disorders are the most commonly recognized form of addiction. These include addiction to alcohol, tobacco, opioids, prescription drugs, stimulants, hallucinogens, and other substances. Behavioral addictions, on the other hand, involve a compulsion to engage in a particular behavior, such as gambling, eating, or using the internet, despite negative consequences.
Substance use disorders
Substance use disorders occur when a person has a dependency on a harmful substance, such as alcohol, drugs, or tobacco. The official definition, according to the US National Institute of Mental Health is “Substance use disorder (SUD) is a treatable mental disorder that affects a person’s brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications.” Substance use disorders are often characterized by intense cravings for the substance, withdrawal symptoms when the substance is not used, and a loss of control over substance use.
Alcohol use disorder, for example, is a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It is not the same as alcohol abuse, which is defined as a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work.
Behavioral addictions, also known as process addictions, involve a compulsion to engage in a rewarding non-substance-related behavior, sometimes called a natural reward, despite any negative consequences to the individual’s physical, mental, social, or economic well-being. A person with a behavioral addiction derives pleasure from the behavior, experiences cravings when they cannot engage in the behavior, and may experience withdrawal symptoms when they try to stop.
Examples of behavioral addictions include gambling addiction, internet / social media addiction, pornography addiction and sex addiction. Unlike substance use disorders, behavioral addictions do not involve a substance that produces a physical withdrawal syndrome. However, they can still cause significant distress and impairment in a person’s life.
Social media addiction refers to the compulsive use of platforms like Facebook, Instagram, and Twitter, driven largely by their algorithmically-curated feeds designed to capture and retain user attention. These algorithms often prioritize content that evokes strong emotional responses, increasing user engagement. Furthermore, as people experience more idle time and lack genuine offline engagements, they gravitate towards these platforms seeking social interaction and validation, exacerbating the cycle of dependency.
Treatment of addiction
Despite the complexity of addiction, it is a treatable disorder. Treatment approaches must be tailored to address each individual’s drug use patterns and drug-related medical, psychiatric, and social problems. Some individuals may require detoxification, treatment for mental health issues, long-term follow-up and care, and multiple episodes of treatment.
Medications and behavioral therapies, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components.
Behavioral therapies help patients engage in the treatment process, modify their attitudes and behaviors related to drug use, increase healthy life skills, and persist with other forms of treatment, such as medication. Patients can receive treatment in many different settings with various approaches.
Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a behavioral health counselor on a regular schedule. Most of the programs involve individual or group drug counseling, or both. These programs typically offer forms of behavioral therapy such as cognitive-behavioral therapy, which helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs.
Medications can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions. Different types of medications may be useful at different stages of treatment to help a patient stop abusing drugs, stay in treatment, and avoid relapse.
For example, methadone, buprenorphine, and naltrexone are medications used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified.
Addiction is a complex but treatable disease that affects brain function and behavior. No single treatment is right for everyone. People need to have quick access to treatment. Staying in treatment long enough is critical. Counseling and other behavioral therapies are the most commonly used forms of treatment. Medications are often an important part of treatment, especially when combined with behavioral therapies.
Understanding addiction and its various aspects can help individuals, families, and communities manage the impact of this disease. With the right support and treatment, people with addiction can recover and lead healthy, productive lives.
What is addiction?
Addiction is a chronic brain disorder characterized by compulsive engagement in rewarding stimuli, despite harmful consequences. It can manifest as a substance addiction (like drugs or alcohol) or behavioral addiction (such as gambling).
What causes addiction?
Addiction is caused by a combination of biological (genetic predisposition), environmental (peer pressure, trauma, stress), and developmental (early exposure) factors. The brain’s reward circuits play a crucial role, leading to repeated behaviors or substance use
How can I recognize the signs of addiction?
Signs can vary but often include a strong desire to use the substance or engage in the behavior, difficulties in controlling its use, persisting in its use despite harmful consequences, neglect of alternative pleasures and interests, increased tolerance, and sometimes a physical withdrawal state.
Is addiction treatable?
Yes, addiction is treatable. Various therapeutic approaches, medications, and support groups can help individuals recover from addiction. The right treatment depends on the individual and the nature of their addiction.
Are relapses common in addiction recovery?
Relapses can be a common part of the recovery journey. It doesn’t mean treatment has failed; instead, it indicates that treatment should be revisited or adjusted. Relapse prevention strategies are crucial for sustained recovery.