What Is Addiction?

Addiction is a complex, chronic brain condition influenced by genes and the environment that is characterized by substance use or compulsive actions that continue despite harmful consequences.

For a long time, addiction meant an uncontrollable habit of using alcohol or other drugs. More recently, the concept of addiction has expanded to include behaviors, such as gambling, as well as substances, and even ordinary and necessary activities, such as exercise and eating.

Types of Addiction

While addiction to substances has often appeared clear-cut, there's some controversy about what substances are truly addictive. Current guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic tool used to diagnose different types of mental health conditions, indicate that most psychoactive substances, including medications, have the potential to be addictive.

Addictions vs. Substance Use Disorders

The term addiction is used to describe compulsive drug-seeking behaviors that continue in spite of negative outcomes, but it is important to note that addiction is not considered an official diagnosis in the DSM-5.

Rather than using the term "addiction," the DSM-5 classifies substance use disorders. While the diagnostic criteria vary for each type, the DSM-5 describes these disorders as a problematic pattern of use of intoxicating substances that leads to significant impairment and distress. These symptoms can result in impaired control, social impairment, risky use, and tolerance/withdrawal. 

While these conditions might be informally referred to as addictions, your doctor will officially diagnose you with some form of substance use disorder or one of the two behavioral addiction disorders that are officially recognized by the American Psychiatric Association (APA).

Substance Use Disorders

There are different substance use disorders found in the DSM-5:

• Alcohol-related disorders
• Caffeine-related disorders
• Cannabis-related disorders
• Hallucinogen-related disorders
• Opioid-related disorders
• Sedative-, hypnotic-, or anxiolytic-related disorders
• Stimulant-related disorders
• Tobacco-related disorders

Behavioral Addictions

The DSM-5 also recognizes two types of behavioral addiction:

• Gambling addiction
• Internet gaming disorder

Addiction Symptoms

The signs and symptoms vary from one addiction type to another, but some common symptoms of addiction include:

• An inability to stop
• Changes in mood, appetite, and sleep
• Continuing despite negative consequences
• Denial
• Engaging in risky behaviors
• Feeling preoccupied with the substance or behavior
• Legal and financial problems
• Losing interest in other things you used to enjoy
• Putting the substance or behavior ahead of other parts of life including family, work, and other responsibilities
• Secrecy
• Using increasingly larger amounts of a substance
• Taking more of the substance than you intended
• Withdrawal symptoms

Addiction vs. Dependence

It is important to distinguish between dependence and addiction. When people become dependent on a substance, it means that they experience drug tolerance and drug withdrawal:

• Tolerance means that the body has adapted to the presence of the drug so that it takes more of the drug to produce the same effects.
• Withdrawal occurs when people experience certain physical and psychological symptoms if the use of the substance is suddenly decreased or halted.

A person can become dependent on a drug without being addicted, although the two often occur together. Addiction occurs when people continue to compulsively use a drug despite harmful consequences.

Diagnosis

Addiction diagnosis usually requires recognizing that there is a problem and seeking help. Substance use is not always an indication of addiction, although drug use carries numerous health and social risks in addition to the risk of addiction.

Once a person has decided that they have a problem and need help, the next step is an examination by a healthcare professional. This involves questions about behaviors or substance use, an examination to assess overall health, and the development of a treatment plan that works best for the individual's specific addiction. 

The exact diagnosis a person receives will depend on the nature of their addiction. Commonly misused substances that can lead to addiction include:

• Alcohol
• Cocaine
• Hallucinogens
• Inhalants
• Marijuana
• MDMA and other club drugs
• Methamphetamine
• Opioids
• Prescription drugs
• Steroids
• Tobacco/nicotine

Because some substances have the potential to cause dangerous withdrawal symptoms, it is important to receive an appropriate diagnosis in order to get the best treatment.

If You Think You Might Have an Addiction

It is common, if not normal, to go through a stage of engaging in substance use or an addictive behavior without believing you are addicted. This is so common, in fact, that it has a name, the pre-contemplation stage.

If you are starting to think you might have an addiction, you have probably moved into the contemplation stage. This is a great time to find out more about the substance or behavior that you have been engaging in and to reflect honestly on whether you are experiencing any signs or symptoms of addiction.

Many people then decide to make changes. For some people, this is easy and manageable. For many others, quitting can lead to unpleasant withdrawal symptoms, even with behaviors, and can open up uncomfortable feelings that were being soothed or suppressed by the addictive behavior.

If this happens, or if you have been drinking or using drugs, such as opioids—illicit or prescribed, other prescription medications, stimulants, cocaine, or meth—you should seek medical help immediately.

Causes

Substances and behaviors can create a physical and psychological high. Over time, people develop a tolerance, meaning it takes more of something to achieve those same initial effects. Some of the factors that can contribute to addiction include:

• The brain: Addiction leads to changes in the brain's reward circuits over time.
• Family history: You may be more likely to become addicted if you have family members who also have addictions.
• Genetics: Research suggests that genetics increases the likelihood of developing an addiction
• Environment: Exposure to addictive substances, social pressure, lack of social support, and poor coping skills can also contribute to the development of addictions.
• Frequency and duration of use: The more someone uses a substance the more likely they will become addicted to it.

Addictions take time to develop. It is unlikely that a person will become addicted after using a substance once, although it is possible to develop a mental health problem or to die of an overdose or another complication after one use of some substances.

Treatment

Addiction is treatable, but not all routes to recovery are the same. Relapses are not uncommon, so the journey may take time. Some of the common treatment approaches that may be used include:

• Psychotherapy: Cognitive behavioral therapy (CBT) may be used to address thought and behavior patterns that contribute to addictions. Other therapies that might be used including contingency management, family therapy, and group therapy.
• Medications: This may include medications to help treat craving and withdrawal symptoms as well as other drugs to treat underlying mental disorders such as anxiety or depression. Medications that may be prescribed include methadone, buprenorphine, nicotine replacement therapies, and naltrexone.
• Hospitalization: In some cases, people may need to be hospitalized in order to treat potentially serious complications while they detox from a substance.
• Support groups and self-help: In-person and online support groups can be a great resource for education and social support as people learn new ways to cope during recovery.

Although there are some schools of thought that stress the need for complete abstinence, many people are able to learn to control addictive behaviors, such as drinking, eating, shopping, and sex. The approach that will be best for you depends on many factors and is best decided in collaboration with your doctor or therapist.

Coping With an Addiction

In addition to getting appropriate treatment, there are things that you can do that will make it easier to cope and aid in your recovery.

• Recognize the signs. Often people’s addictions become ingrained in their lifestyle, to the point where they never or rarely feel withdrawal symptoms. Or they may not recognize their withdrawal symptoms for what they are, putting them down to aging, working too hard, or just not liking mornings. People can go for years without realizing how dependent they are on their addiction.
• Learn about addiction. Remember help is always available. Educating yourself is a good start. You can greatly reduce the amount of harm to yourself and those around you, and maybe one day, you will be ready to change for good.
• Develop coping skills. The harm caused by addiction is particularly difficult to recognize when addiction is the person’s main way of coping with other problems. Sometimes other problems are directly related to the addiction, such as health problems, and sometimes they are indirectly related to the addiction, for example, relationship problems. Developing new coping skills can help you handle life's stresses without relying on substances or behaviors.
• Get support. Social support from friends and family is important. Joining a support group can be a great way to connect with people with shared experiences.