What is Addiction?

Alcohol, gambling, drugs; these substances and activities are commonly used by people seeking to relax and have fun, but when they become an escape or coping mechanism trouble often follows.

Over time, these activities and substances can make you feel that you need them in order to cope with stress or enjoy your life.

This seemingly innocuous series of events often leads to dependence and addiction for those who don’t keep a careful eye on their habits and consumption.

Of course, there’s a difference between a habit, a dependency, and an addiction.

Knowing what causes the development of addictions, and which situations and behaviours are most likely to trigger them is key in recognising when you or someone you love is in danger of falling into a destructive and compulsive pattern of behaviour.

What is Addiction?

While habit is something we do as a matter of course, often without thinking, because we are used to doing so, and a dependency is the use of a substance or action to cope with stresses, an addiction is something more serious and biological.

In simple terms, addiction is a chronic dysfunction of the brain which involves the way we perceive rewards, our motivations, and our memory; it is characterised by the compulsive or obsessive use or pursuit of a substance or experience without concern for the consequences that may follow.

An addiction, according to the American Psychiatric Association, is a brain disease or disorder which manifests in the compulsive abuse of substances or involvement in activities and behaviours despite harm to health, finances, family, and career [1].

People can develop an addiction to anything that relieves stress, stimulates pleasure centres, or gives a sufficient ‘rush’ but the most common addictions are [2]:

Alcohol
Marijuana
Opioids such as painkillers or heroin
Sedatives, hypnotics, and anxiolytics (medications for anxiety)
Tobacco
Cocaine, methamphetamine, and various other stimulants
PCP
LSD
Other hallucinogens such as mushrooms
Inhalants like paint thinner and glue
Gambling
Gaming
Pornography
Sex

While all of these substances and activities can be indulged in casually, there is often a tipping point at which a habit or dependent relationship becomes a chronic addiction that requires intervention and treatment.

Signs That a Habit has Become an Addiction

There are many signs and symptoms of addiction when you know what to look for, but if you’re uncertain there are certain strong indicators which are hard to mistake.

Someone you love may be affected by addiction if they [3]:

Uncontrollably or compulsively seek drugs, alcohol, or gambling experiences
Uncontrollably or compulsively engaging in harmful, habit-forming behaviours
Neglect or lose interest in activities they previously enjoyed in order to pursue drugs, alcohol, or other harmful substances and behaviours
Have difficulty in maintaining relationships because of this behaviour
Lash out at anyone who questions their dependency
Seem incapable of stopping the behaviour despite health problems and personal issues (e.g. employment troubles or relationship breakdown)
Hide their behaviour or the level of their consumption
Increasingly take risks in order to access the substance or activity
Change in appearance (drastically), e.g. a marked abandonment of hygiene, extreme weight loss or gain, etc

If you or a loved one exhibit more than 2 of these symptoms in any 12 month period it may be time to seek medical help or guidance.

Addiction and Your Brain

The key difference between an addiction and a habit, in a medical sense, is the way in which addictions are formed in, and interact with, our brains.

This is what makes addiction so tough to fight, and it’s what accounts for the way people change when they are struggling with alcohol or drug addiction.

What Causes Addiction?

The truth is that there’s no single cause or factor; addiction is a complex and often mystifying condition which seems to be as social as it is genetic.

Though there is no concrete answer, most professionals agree that there are 4 key ‘red flags’ which signal the potential for addiction [4]:

A family history of addiction
Traumatic experiences like car crashes, assaults, warfare, or childhood abuse and neglect
Mental illnesses such as depression and anxiety
Early drug use or alcohol abuse

Furthermore, in the case of narcotics, it seems that the method of administration also affects the possibility of developing a chronic addiction. Some suggest that smoking or injecting a drug increases its addictive potential [5].

As such, many psychologists break the risk factors into three main categories: biological, psychological, and environmental.

Biological factors are genetics, physiological makeup ( certain liver enzymes, for example, are thought to increase the risk of alcoholism), and gender [6], while psychological factors are personality, trauma, abuse, and mental health [7].

Finally, environmental factors include family relationships, accessibility to drugs and alcohol, employment, and our peer group [8].

The Pleasure Principle

While all of these factors may contribute to a person’s risk of forming an addiction, recent scientific consensus also recognises the role that pleasure has to play in the formation of addictions.

You see, scientists such as Dr Stanton Peele found that our brains register all pleasures, in the same way, no matter where they originate [9]. As such, our brains register the pleasures of psychoactive drugs, a monetary reward, a good meal, and a satisfying sexual encounter in exactly the same way; with the release of dopamine.

So, why don’t we get addicted to eating, for example?

Well, first and foremost there are people who struggle with food addiction; all activities and substances which give pleasure have the potential to become addictive.

There are simply less and more common addictions. The likelihood of an addiction-forming is partly predicated by the speed and intensity of the dopamine release which an activity or substance causes (as well as the reliability of release) [10].

his is why taking the same drug in different forms (i.e. injecting or smoking as opposed to ingesting) can change the likelihood of addiction.

Addictive substances in general, but highly addictive drugs like heroin in particular, provide a short-cut to the brains’ pleasure and reward system by flooding the nucleus accumbens with a potent rush of dopamine.

As a result, the hippocampus (the memory centre) creates strong memories of this intense and immediate satisfaction, and the amygdala creates a conditioned response to relevant stimuli [11]. When this is reinforced sufficiently, an addiction can form frighteningly quickly.

Of course, the way in which drugs function in our system, in particular, the withdrawal stage, reinforces this pattern which is why they are so much more addictive than, for example, food or sex.

Substances and Behaviours Which Act as Triggers

With this in mind, it is no surprise that there are specific substances and behaviours which can act as triggers for addiction, especially in those who are already classed as ‘at risk’ thanks to their mental health, genetics, or environment.

The substances most likely to trigger addiction are, of course, narcotics and alcohol, but any substance or activity which provides or enhances pleasure can become addictive under the right circumstances.

In most cases, with the exception of highly addictive drugs such as stimulants and opioids, our behaviours are just as influential as the substances and activities themselves. For example, if you surround yourselves with peers who use or abuse alcohol and drugs, or use these substances to cope with stress and reward yourself the risk of addiction increases.

Of course, once addiction takes hold few people are concerned with how it formed; the focus is on the effect it has on a persons life, and how they can successfully combat it in order to regain control of their life.

Addiction in ‘Real Life’

For many people, addiction is not a medical or psychological concept but a lived experience that has a real effect on every aspect of their lives, and the lives of their loved ones.

Broadly speaking there are two types of addiction; substance use disorders and compulsive, behavioural addictions.

Within these general headings, there are many specific addictions which have unique manifestations as well as shared commonalities.

Substance Use Disorders

In medical terms, substance use disorders are categorised by the class of drug used and as a result, there are 10 separate substance use disorders. While each of these disorders shares core defining features, some can be distinguished easily.

The 10 separate substance use disorders, as defined by Psychology Today, are [12]:

Alcohol Use Disorder: also called alcoholism, this is one of the most common addictions in the world today. Alcohol is a depressant which permeates most facets of our lives, now, and its prevalence in social and cultural rites of passage may well be influential in the fact that roughly 12.4% of adult men and 4.9% of adult women struggle with this disorder [13]
Caffeine Intoxication: less commonly recognised than alcoholism and drug addictions, but nonetheless common and potent
Cannabis Use Disorder: cannabis use disorder is most common amongst younger people and decreases with age, dropping significantly after the age of 30
Hallucinogen Use Disorder: substances which alter perception are addictive because of the experience they provide as well as the pleasure they give
Inhalant Use Disorder: inhalant substances such as glue, paint thinner, and fuels produce psychoactive effects. These substances are most commonly used from the ages of 12 to 17
Opioid Use Disorder: opioids are some of the most addictive substances in the world today. Including illicit drugs like heroin and pharmaceuticals such as oxycodone, codeine, and morphine, opioids and opioid use disorders affect around about 2 million people in America alone (according to a 2016 study by the American Society of Addiction) [14]
Sedative or Anxiolytic Use Disorder: sleeping pills and other tranquilisers are highly addictive substances which depress the brain in the same way that alcohol does
Stimulant Use Disorder: covering substances such as cocaine, Ritalin, and other amphetamines, stimulant drug use disorders are most common in those ages 18 to 25 [15]
Tobacco Use Disorder: the nicotine in tobacco can be highly addictive, and while many people are habitual smokers, as many as 68% may actually be struggling with addiction [16]
Unknown Substance Use Disorder: used to denote addiction to a range of less common substances such as antihistamines and steroids

Each of these biochemical substances can provoke addiction which requires long-term help and support in order to achieve a state of steady sobriety once more.

Behavioural Addictions

Addictions can also form as a result of behavioural opportunities for immediate satisfaction and reward. Activities such as gambling are the most common examples of activities which lend themselves to compulsive habit-forming due to the fast feedback they offer.

Other activities include ‘thrill-seeking’ and gaming, but gambling is by far the most common example.

Signs of behavioural and compulsive disorders include [17]:

The need to partake in the activity with increasing intensity or risk in order to achieve the same feeling of excitement
Restlessness and irritability when attempting to reduce or eliminate this behaviour
Preoccupation with the activity
Lying to conceal the extent of involvement
Turning to the activity as a release or coping mechanism when stressed or upset
Jeopardizing personal and social obligations in order to partake in the activity
Financial difficulties as a result of pursuing the activity
Repeated and unsuccessful attempts to stop

Other excessive behavioural addictions may include pornography consumption, eating, and shopping.

The Stages of Addiction

In real-world terms, addictions take hold in four stages.

The first stage is experimentation, wherein a person partakes in the activity or tries a substance out of curiosity. Usually undertaken in a social situation, there is no guarantee that experimentation will lead to even social or regular use, let alone addiction.

The second stage is social or regular consumption. In this stage, usage may be regular, or even above suggested limits, but it is not necessarily compulsive and is undertaken for social reasons or in specific situations.

The third step is problem or at risk usage, wherein consumption or behaviours become severe and consequences are disregarded.

The final stage is addiction or dependency. In this stage, an individual engages in daily consumption or activity despite negative consequences.

They may also begin to hide the extent of their compulsion and abandon other hobbies and obligations in order to pursue their behaviour.

The Costs and Complications of Addiction

The costs associated with addiction differ from the personal to the institutional level. In the USA alone healthcare costs associated with addiction reach the hundreds of billions; tobacco addition costs roughly $168 billion per year, while alcohol costs $27 billion and illicit drugs cost $11 billion [18].

The personal costs, however, are arguably more devastating for individuals. For example, alcohol abuse and addiction is one of the most common causes of divorce and separation in the UK and USA [19].

Those struggling with addiction are also more likely to lose their jobs and homes if they receive no treatment.

Likewise, the abuse of substances and the side effects of compulsive behaviours have long-term effects on health and wellbeing in both mental and physical terms.

Those affected by substance abuse or compulsive behaviours face an increased risk of heart disease, neurological damage, psychological and emotional distress and disorders, and social damage such as relationship breakdown.

This is why treatment and recovery are a priority for many people who live with and love those struggling with addiction,

Addiction Treatment

All forms of addiction are treatable, thankfully, but often require tailored approaches and patience as relapses are common.

The very best treatment plans are well-rounded, comprehensive, and have a social element which enables an individual to work on changing their environment as well as promoting abstinence and wellness.

The most commonly available, and effective, treatment options include:

Psychotherapy such as group therapies, cognitive behavioural therapies, and talk therapy.
In-patient treatment centres.
Medical intervention to aid detox (often required in cases of long-term addiction to substances like heroin and alcohol, which have intense withdrawal symptoms).
Mutual help and support groups.
Medications to control and treat triggering stressors such as depression and schizophrenia.

In all cases, it is wise to visit your doctor for a medical evaluation and advice. This is especially important in cases of substance abuse, however, as withdrawal symptoms can often cause severe pain or even damage to the body.

In cases of prolonged or intense use, it may be necessary to slowly reduce intake rather than simply stopping all consumption. In some cases, in-patient treatment or replacement therapies (such as the methadone program) may be suggested by your doctor.

Overcoming any addiction is a long and difficult process which is often made easier by having a strong support network.

This is where mutual help groups like AA, NA, CA, and SAA come in handy; the social element of these groups has been shown to have a beneficial effect on those struggling with addiction.

Nonetheless, if you are living with someone fighting addiction and the situation you find yourself in has become unsafe, you must put your own wellbeing first.

While it is only natural to want to help, there are times when the best thing you can do is remove yourself and offer support from the sidelines, or even cut off contact altogether.