What exactly is addiction?
Most people will know that addiction holds its victims in an iron grip — compelling them to repeatedly abuse substances or engage in harmful behaviors. Even as an addict’s whole world comes crashing down around them and their personal relationships, work performance, finances, mental and physical health, and daily functioning suffer, they continue to come back for more.
A desperate wish for a life free from addiction, and repeated attempts to stop, often turn out not to be enough. This is not, as many believed in the past, because addicts lack willpower or because they’re moral failures.
We now understand that addiction essentially enslaves the brain.
A healthy brain sends out feel-good chemicals to encourage healthy behaviors — like eating and exercising — while dispatching danger signals to keep us out of harm’s way. When somebody becomes addicted, that system is messed up. The parts of the brain involved in creating feelings of pleasure and reward now become oversensitive, causing an addict to seek more and more of the substance or behavior. At the same time, attempts to abstain can lead to extreme anxiety.
The American Society of Addiction Medicine defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.”
Like other chronic conditions, addiction very often features periods of remission (during which the addict abstains, often after medical and psychological treatment) as well as relapse. The rate of relapse among addicts is, at 40 to 60 percent, comparable to those seen in other chronic medical conditions, like asthma and hypertension.
Though addictions come in a shockingly wide variety of flavors, they can broadly be separated into two categories — substance addictions and behavioral addictions. A substance addict abuses drugs or alcohol, while someone with a behavioral addictions include compulsive gambling, shopping, gaming, or eating.
What are the symptoms of addiction?
All addictions have unique features and risks, but their symptoms are incredibly similar, as are the diagnostic criteria for different addictions. A look at the current version of the diagnostic and statistical manual of mental disorders (DSM-5) — which focuses on substance use disorders over behavioral addictions — reveals common denominators across all addictions.
The characteristics that tell you that you have — or another person has — a problem include:
- Using the substance, or engaging in the behavior, more often, over a longer period of time, or in higher doses than intended.
- Continued use despite an intense desire to stop using the substance or engaging in the behavior, or repeated but unsuccessful efforts to cut down or quit.
- Spending a lot of time using the substance or engaging in the behavior, trying to get a “fix”, or recovering from the use or behavior.
- Experiencing cravings for the substance or behavior.
The DSM-5 also lists a set of features that all basically boil down to continued addiction despite the fact that the substance or behavior has a profound negative impact on a person’s social relationships, daily obligations, or physical and mental health.
Tolerance and withdrawal mark the final two symptoms of addiction.
Tolerance means that an addict no longer receives the same effect from the same amounts, or needs more to achieve the same effect. Many substances, including alcohol and heroin, cause a physical tolerance. Behavioral addictions can build up to a similar situation — a gambling addict may, over time, need to gamble with larger amounts of money or engage in riskier gambles to achieve the same mental “buzz”.
Withdrawal is the set of symptoms that ensue when an addict stops using the substance or engaging in the behavior. The addict’s brain has grown used to the addiction and reacts violently when it’s suddenly withdrawn. Some substances cause physical dependence — meaning the body has adapted to their presence and needs it to function "normally". Addicts experience physical consequences when they stop using. In some cases, as with heavy alcohol use or heroin addiction, withdrawal can be dangerous and even life-threatening.
Behavioral addictions can produce “psychological withdrawal”, however. When an addict stops gambling or whatever behavior they are addicted to, they can experience extreme anxiety and agitation, and feel compelled to go back for more to make these feelings stop.
What kind of things do people become addicted to?
Addictive substances include:
- Nicotine (tobacco)
- Coffee (caffeine)
- Prescription opioid painkillers (including oxycodone and hydrocodone)
- Cannabis (marijuana)
The most common substance addictions involve more “socially accepted” substances. An estimated 4.9 percent of the global population struggles with alcoholism, for instance, a statistic that encompasses over 240 million real-life people. Over 22 percent of the world’s people remain slaves to tobacco, and about 3.5 percent (or 174 million people) abuse marijuana. Though these substances are associated with less stigma than, say, heroin or cocaine, abusing them can have serious health consequences. In the case of alcohol and tobacco, they can easily cost you your life.
Behavioral addictions are a slightly different beast, since, with the exception of gambling, they are not all recognized as representing true addictions by every policy-making entity. To make it even more complicated, some of these addictions feature behaviors that are completely normal, healthy, and often even essential for survival unless they spin out of control — like food, sex, and shopping.
While research backing the idea that they have addictive features exists, official diagnostic categories lack. Nonetheless, someone struggling with a behavioral addiction can receive the help they need to achieve remission.
Examples of currently-recognized behavioral addictions include:
- Sex addiction
- Food addiction
- Shopping addiction (oniomania)
- Sun tanning addiction
- Gaming addiction, smartphone addiction, and internet addiction
What are the risk factors for addiction, and can addiction be prevented?
Why do some people become addicted while others don’t? This commonly-asked question doesn’t come with an easy answer, but some factors can certainly increase a person’s risk of addiction. They include:
- Genetics. Genetic factors are thought to account for a shocking 50 percent of a person’s overall risk of addiction, and several addiction-related genes have been identified. Mental disorders can run in families, as well, and it has been established that people who suffer from conditions such as depression, bipolar disorder, obsessive compulsive disorder, and anxiety disorders have a higher risk of falling victim to substance use disorders. This is largely because drugs and alcohol can temporarily reduce or “block out” the symptoms of these conditions and the person is (subconsciously) trying to “self-medicate”.
- Environment. This would include being around people who abuse substances, suffering trauma, facing poverty, and, of course — having access to substances.
- Age. Adolescents’ brains are particularly vulnerable to addiction, since the portions involved in responsible decision-making aren’t yet fully developed.
Far from everyone who is more vulnerable to addiction actually develops a substance use disorder or behavioral addiction, however, and plenty of people who don’t have recognized risk factors do become addicted.
Addiction can also be prevented — educating people, especially young people, about the risks of using substances greatly reduces the odds that they’ll end up in the clutches of a substance use disorder. Having strong ties in the community, being emotionally healthy and content, academic success, and a supportive, involved family all lower the risk that a young person will become addicted.
What red flags warn you a loved one is addicted, and what can you do to help?
Can relatives and other loved ones always tell if someone they care about has developed an addiction? Not necessarily — but behavioral changes and, often, changes in health and appearance, can certainly warn you that something is wrong.
Different substances are associated with unique physical red flags. Someone using marijuana may have bloodshot eyes, uncontrollable laughing spells, and experience binge eating episodes, for instance, while a drunk person will exhibit slurred speech, swaggering movements, and slowed reaction times. Loved ones may further spot paraphernalia related to drug use, or physical needle marks on the body.
Though each addiction is different, research has identified the general alarm bells that could point to a possible addiction:
- (Marked) changes in behavior and mood.
- Social withdrawal.
- A change in the person’s social circle.
- Impaired judgment and concentration.
- In the case of substance abuse, changes in the appearance of the person’s skin, weight changes, fatigue, bloodshot eyes, dilated or pinpoint pupils, needle marks, or nosebleeds.
If you suspect that someone you care about might be facing an addiction, you can play an important role in getting them the help they need — but it’s important to be cautious about how you approach your loved one if you want to help someone overcome an addiction, rather than just making them shut you out.
Try to choose a quiet, relatively stress-free, setting — do not confront the loved one you are worried about during a fight or while they are so intoxicated that they cannot take your words in. Be supportive. Don’t sling accusations at your loved one, but instead ask them what they are struggling with and convey that you are worried but there to help. Listen to them, and be a friend.
If you have established that someone you care about is indeed facing a substance or behavioral addiction, steer them toward treatment, but be patient. Set boundaries to protect your own mental and physical safety, but do not think threatening them will encourage your loved one to reach out for the help they need.
What are the treatment options for addiction?
Successful approaches to addiction treatment vary greatly on the severity and nature of the addiction. Someone who has been abusing caffeine, marijuana, or tobacco may have an incredibly tough time quitting, but nonetheless succeed without medications or therapy. In contrast, heavy long-term alcohol or heroin abusers will need medically-supervised detoxification to safely stop using.
Broadly speaking, addiction treatment can draw on any of the following aspects:
- Medical detoxification
- Medications to help the person stay clean or sober
- Behavioral approaches — individual or group therapy
- Peer support and strong community support
People who have been abusing alcohol, prescription and illicit opioids, benzodiazepines, or barbiturates daily over a prolonged period of time will almost certainly have developed a significant physical dependence on these substances.
They will require medical supervision, and often medications, to go through withdrawal safely. Inpatient “rehab” or hospitalization may be the safest setting for detox, but in some cases, addicts may be able to go through a medically-supervised detox at home.
Medications are now available to help people with many substance addictions get clean and stay there. Examples include:
- Smokers and other tobacco users can benefit from nicotine replacement therapy, but also the two medications bupropion (Zyban) and varenicline (Chantix), if non-medical ways to quit have not proven successful.
- Opioid addicts may benefit from methadone, buprenorphine (Subutex), or naltrexone, among other medications. In the case of an overdose, naloxone can quickly reverse the effects of opioids.
- Alcoholics often receive treatment with naltrexone as well as disulfiram and acamprosate.
Recovering addicts who become depressed, anxious, or suffer from other mental health struggles can further be prescribed adequate medications to help them manage these conditions.
Psychotherapeutic approaches are often another crucial part of addiction recovery. Therapy can help addicts reevaluate their life, goals, and feelings about their drug use or behavioral addiction. It can teach them ways to break free from their old life, offer valuable coping tools, and start looking forward to the future. In the case of behavioral addictions, therapy is the main treatment strategy.
Numerous different philosophical and practical approaches to therapy exist, and no one therapy is right for every single person. Some of the most common approaches include:
- Cognitive behavioral therapy, which allows a person to recognize faulty thought patterns and take control by replacing old patterns that no longer serve their mental and physical health with healthier ones.
- Contingency management, which seeks to minimize addictive behaviors through a reward system.
- Motivational enhancement therapy, which helps addicts overcome barriers to treatment and gain clearer insights into their goals — how their life could be better if they reached remission.
Other approaches that can be used in the treatment of addiction include experiential therapy and eye-movement desensitization and reprocessing (EMDR).
Talk therapy often involves both individual and group sessions in an inpatient or outpatient rehab setting, but it can also include the recovering addict’s family. Family therapy allows families affected by addiction to start processing the pain the addiction caused and the relatives of the recovering addict to learn how they can best support their loved one.
Peer support and a strong community
Many addicts will find comfort — as well as practical tips for coping with the daily grind — in support groups for recovering addicts. Twelve-step programs, which take a spiritual approach, are among the most well-known of these peer-to-peer recovery groups. Many others exist, however, and some are completely secular.
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Relatives, friends, and members of the community also play a crucial role in recovery. Research has established that addicts with strong ties in the community, and those who have supportive relatives and romantic partners, are more likely to successfully break free from their addictions. What’s more, they also suffer fewer mental health challenges in the process.