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What is addiction, really? What is the difference between substance and behavioral addictions, and what do they have in common?

What's the first thing you think of when you hear the word "addiction"? Chances are that it's a substance addiction — an addiction to alcohol, illegal drugs like cocaine or heroin, cigarettes, or prescription medications. Many people will also think of gambling, a well-known non-substance addiction.

What are the differences between substance and behavioral addictions, what do they have in common, and what kinds of things do people get addicted to?

What is addiction?

You may know what addiction looks like externally — addicts just "have to" have or do the thing they're addicted to. They may fool themselves into thinking they could stop at any time, but once they try, that proves to have been easier said than done. Addicts are preoccupied with the thing they are addicted to and will do pretty much anything to get it. In the process, they often put their health or even life at risk, lose social support, and get heavily into debt. 

On the physical side of things, addiction rewires the brain in such a way that its pleasure and reward centers — which can serve very healthy purposes in encouraging people to, for instance, be productive, exercise, or socially bond with romantic partners and children — start centering around the addiction. On the other side of this equation, the addicted brain can also trick addicts into believing they are in danger when they're not using the substance in question or engaging in the activity they are addicted to. When not actively engaged in the addicting behavior or using the addictive substance, addicts then feel extremely anxious and even threatened. 

Addiction is, then, a brain disease — and a chronic and often progressive disease at that. It is not caused by a lack of willpower or a personality flaw, and though kicking an addiction is very much possible, it's also incredibly hard. 

What is the difference between substance and behavioral addictions?

Substance addictions are addictions to psychoactive components — things that alter the way in which your brain works, and that have physical consequences as well. Examples include alcohol, illegal drugs (such as cocaine, heroin, opium, cannabis, ecstasy, and so on), nicotine, and prescription drugs like benzodiazepines. 

In many cases, these substances are inherently addictive. About one in four people who try cocaine will become addicted. Though many people can use alcohol recreationally without becoming addicted, a shocking one in every 12 American adults are estimated to abuse alcohol or to be physically dependent on it. The fact that the effects of using nicotine kick in within seconds but wear off after mere hours means that cigarettes are incredibly addictive. Meth and opioids very quickly lead to tolerance, causing those who use them to seek more and more just to feel "normal". 

When substance addiction is coupled with physical dependence, quitting isn't just a mental process, but also a physical process. This can, in some cases, be extremely dangerous. Heavy alcohol abusers cannot simply go "cold turkey, for example, as this can result in severe withdrawal symptoms known as delirium tremens — which can lead to a whole host of symptoms, including seizures. 

Behavioral addictions, also called process addictions, are different. Instead of being addicted to a substance that inherently alters brain function, a person becomes addicted to a behavior or experience. Examples include gambling, video games, shopping, sex, and exercise. Eating disorders also have an addictive component — a person can be "addicted" to the feeling of not eating, as well as to overeating. 

While physical dependence doesn't play a role in behavioral addictions, the brain changes seen in people with behavioral addictions are similar to those present in people with substance addictions. Just like people who are addicted to alcohol or drugs cannot stop using even if they want to, people who are addicted to gambling or sex cannot just stop, often despite many attempts to do so. 

What do all addictions have in common?

Features common to all addictions are: 

  • The addiction plays a central role in an addict's life. 
  • Taking the substance, or engaging in the activity, the person is addicted to leads to a "high", buzzed, or euphoric feeling — in the beginning, anyway.
  • Over time, the effects small "doses" of the addiction are no longer potent, and the addict needs more to achieve a similar effect. 
  • The addict experiences "withdrawal symptoms" when they either don't have access to the addictive substance or activity or attempt to free themselves from the addiction. In the case of substances, this can be both physical and psychological. In the case of behavioral addictions, the withdrawal is psychological. Being away from the addictive activity causes severe mental distress that can only be relieved by seeking out the addictive activity. 
  • The addiction causes problems in daily functioning and relationships with others, as well as in the addict's relationship with themselves — guilt, regret, anxiety, and depression are common.
  • Trying to abstain from the addictive substance or behavior often leads to failure, with the addict continuing to have the same level of addiction when they return to the thing they are addicted to. 

A final word

If you believe you are addicted, seek help. Treatment is available. Behavioral addictions, though broadly acknowledged in the scientific community, may not have matching diagnostic labels — but that does not mean you cannot seek help from your family doctor, therapist, or rehab center to overcome them. Anyone who has tried to quit multiple times unsuccessfully should know that this doesn't mean it's impossible — but it does point to a need for professional help. 

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