There are many misconceptions about what addiction is, making it a highly misunderstood condition. Many believe addiction is a sign of moral weakness, and that stopping the addictive behavior is simply a matter of willpower.
Scientific studies have proven this is not the case and have proven that certain structural changes in the brain make recovering from addiction much more challenging. Another common misconception is that all people who use drugs or alcohol regularly are addicted, and that being “addicted” describes being physically dependent on a substance. In reality, addiction is not that simple. Some people who use drugs and alcohol regularly are not addicted, and others who are addicted may not be physically dependent on the substance.
So… what is addiction?
Addiction is a non-medical term that refers to a wide range of mental disorders called Substance Use Disorders. There are a variety of different types of Substance Use Disorders, including Alcohol Use Disorder, Stimulant Use Disorder, and Cannabis Use Disorder, just to name a few. Regardless of the type of Substance Use Disorder, health and mental health professionals use to look for the same signs and symptoms in order to diagnose these disorders.
Symptoms of Substance Use Disorders include frequent use, prolonged use, cravings to use, and an inability to stop or cut back. The hallmark symptom of a Substance Use Disorder is continued use even after a person has experienced negative consequences because of their use (American Psychiatric Association, 2013). These consequences might include conflict in important relationships, being unable to meet expectations at a job, getting a DUI, or experiencing financial strain as a result of their use of drugs or alcohol. Continuing to use even after having had some of these consequences indicates that a person has likely formed some type of dependence (also called addiction,) to the substance they are using. There are some people who use drugs or alcohol frequently or heavily but who would not meet the criteria to be diagnosed with a Substance Use Disorder. If a person has not experienced any negative impacts, consequences, or impairment as a result of their use of drugs or alcohol, they would not be diagnosed with a Substance Use Disorder, although they are probably at higher risk of developing one.
A person struggling with addiction might go to great lengths to hide their drug or alcohol use from others, making it difficult to detect. People who suspect that a loved one is struggling with addiction might notice concerning changes in a person’s behavior. They might notice that the person is acting in ways out of character for them, like becoming less reliable and not following through on things they agreed to do. Other warning signs might include unexplained financial difficulties, unemployment, or the loss of a relationship. Sometimes, a person struggling with addiction might deliberately fall out of contact with their loved ones, not calling for a prolonged period. People struggling with addiction might also develop changes in their mood or thinking. They might become more irritable, less engaged, appear drowsier, or say things that seem far-fetched or that do not make sense.
Where Does Addiction Come From?
Addiction develops over time, as a person continues to use a substance and grows more dependent on it. Certain drugs, like nicotine and heroin, have more addictive qualities and people who use these drugs may be at higher risk of dependence earlier on than people abusing drugs with lower addictive qualities, like alcohol or marijuana. In these ways, a person’s decision to use and to continue using certainly increases their risk for addiction, but there are other involuntary factors involved in the process as well.
Addiction affects a person’s inhibitory control over their behavior as well as the brain circuits involved in motivation, reward, memory and learning. Specifically, drug and alcohol use triggers the release of Dopamine, a neurotransmitter which causes pleasurable feelings. The brain begins to form associations between the pleasurable feeling and the use of the substance, creating a “reward pathway” in the brain that acts as a strong incentive to continue using the substance (American Society of Addiction Medicine, 2011). This is experienced by the individual as a strong urge or craving for the substance, increasing the risk of continued use. Interestingly, these same areas of the brain are known to be involved in specific behaviors that, for some people, become compulsive and problematic. Examples of behaviors known to interact with the reward pathways in the brain include eating, gambling, risky behaviors, and sexual behaviors. While health and mental health professionals do not formally recognize behavioral addictions as diagnose conditions, there is a general consensus that there are many similar features found between people with these problem behaviors and people with drug and alcohol use problems (Grant, J. E., Potenza, M. N., Weinstein, A., & Gorelick, D. A., 2010).
Even though the initial decision to drink or take drugs was probably voluntary, the changes in brain chemistry caused by repeated drug or alcohol substance abuse is an involuntary response that affects certain users. Research indicates that some people might be more at risk for developing these reward pathways based on a number of factors including genetics, an underlying mental illness, as well as the experience of stressful or traumatic life experiences (American Society of Addiction Medicine, 2011). Scientists have also discovered that the frontal lobe in the brain is essential to being able to delay gratification and avoid impulsive actions (American Society of Addiction Medicine, 2011; Crews, F. T., Boettiger, C.A., 2009). In some people, an underdeveloped prefrontal cortex might be placing them at higher risk of developing an addiction. Since this part of the brain develops even beyond adolescence and into early adulthood, teens and young adults might also be at higher risk for developing addictions (Crews, F. T., Boettiger, C.A., 2009).
While addiction does result in specific changes to the structure of the brain, including the development of reward pathways, it is still possible for people to reverse this damage. In fact, scientists now understand that the brain can change in response to our behavior, even into adulthood. People who have developed addictions can rewire their brain circuitry in ways that reduce their risk of addiction by not using drugs or alcohol for a prolonged period. Recovering from addiction is difficult and often is a non-linear process that includes several trials and errors, but receiving treatment can significantly improve the likelihood of a successful recovery.
How Does Addiction Progress?
Over time, an untreated Substance Use Disorder often progresses and gets worse. A person might begin to use more frequently and might stop other important activities in order to do so. A person might also develop a tolerance to the substance, needing to use more of it in order to get the same effects, which can heighten the risk for further consequences. Depending on the substance being used, a person may begin to develop a physical dependence on the substance, resulting in uncomfortable or even dangerous withdrawal symptoms when they stop using. Others might not become physically addicted, but may notice they have become more dependent on the substance in other ways; they may use drugs or alcohol to cope with stress, numb painful emotions, or to be able to face daily tasks and activities. This growing dependence on the substance could be described as addiction, regardless of whether the dependence is physical in nature or not.
Is Addiction Treatable?
People in the early stages of addiction, or with just a few signs of dependence, might be suffering from a Mild Substance Use disorder and people with many signs and symptoms is likely suffering from a Moderate or Severe Substance Use Disorder. With proper treatment, a person with a Substance Use Disorder can effectively get rid of their symptoms and put their disorder into remission, regardless of the severity of their disorder. The severity of the disorder may influence what treatment is recommended.
There are a variety of available treatments, including treatments provided in outpatient settings, inpatient settings, and treatments that may incorporate individual, family, and/or group therapy. Talking with someone who is more knowledgeable about the services available in your community is a recommended first step. Often, this first point of contact would be a health or mental health professional like a primary care physician, psychiatrist, social worker, or therapist. In other cases, a person might contact their insurance company to get additional information about what treatments are covered under their insurance plans.
Once enrolled in a treatment program, a person can begin learning the skills and strategies needed to regain control of their lives and begin repairing some of the damage done while they were using. Often, this process includes taking inventory of the consequences of the drug or alcohol use, identifying risks and triggers for continued use, learning skills to overcome cravings, and developing routines and habits which support a healthier lifestyle. A person might complete the treatment and achieve remission but may still need to continue to use their support system and learned skills and strategies to protect against a future relapse. Because of the risk of relapse, Substance Use Disorders are considered chronic in nature, meaning that people in remission are still at higher risk for addiction than people who have not had these disorders. Often, people in long periods of remission might not need active treatment but may still benefit from participation in recovery communities or groups like Alcoholics or Narcotics Anonymous.