What is Addiction?

What Is Addiction?

Addiction is a long-lasting, complex psychiatric disorder of the brain and body. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), defines it as "the recurrent use of alcohol or drugs, which causes significant impairment." (1) The American Medical Association also defines addiction as a disease. (2)

Compulsive substance use can impact an individual's health—and their ability to work, study, and have healthy relationships. According to the Centers for Disease Control and Prevention, one in seven U.S. citizens reports having a substance use disorder (SUD). (3)

Addiction recovery is challenging, typically requires professional guidance, and isn't a case of using willpower or having a better moral compass. (4) As with many diseases, a range of risk factors makes people vulnerable to substance use disorders. (5)

How Does Addiction Work?

Unhealthy drug-seeking behavior is driven by habit rather than rational decision-making. (6) Addiction causes changes to the brain, including the reward circuits that encourage people to repeat survival behaviors such as eating. Substances overwhelm these circuits by delivering ultra-intense hits of dopamine. These hits are stronger and more pleasurable than healthy rewards and trick the brain into prioritizing seeking that substance. 

Studies show that people who have all their needs met and who have no trauma are unlikely to develop addictions. (7) Individuals with SUDs may have risk factors such as an impulsive personality, exposure to substance use at a young age, and mental illness. (8) 

What Are the Signs of Addiction?

According to the DSM-5, substance use disorders have 11 symptoms. They range in severity based on the number of symptoms present. A severity of two to three represents a mild SUD, four to five indicates a moderate SUD, and six or more points to a severe SUD. (9)

The 11 criteria are split into four categories: (10)

Impaired control:

• Regularly using a substance in higher quantities or more often than intended
• Intending to cut down but not being able to
• Having intense cravings that are impossible to ignore

Social problems:

• Struggling to complete daily tasks at home, school, and work
• Neglecting personal responsibilities and loved ones
• Giving up hobbies and activities in favor of alcohol or drug abuse
• Spending a disproportionate amount of time seeking and using the substance

Risky use:

• Continuing addictive behaviors despite negative outcomes
• Putting themselves at risk while intoxicated or seeking the substance

Physical dependence:

• Needing to take more to get the same effect as before
• Experiencing withdrawal symptoms when not taking the substance

Some people can hide the signs of alcohol or drug addiction well. Although they might experience the symptoms listed above, many can be masked.

Subtle behavioral signs of addiction include:

• Changing friendship groups or withdrawing socially
• Spending a lot of time alone
• Making excuses to take trips to the bathroom or a different room
• Strange smells
• Burn marks on the fingers or around the mouth
• Poor personal hygiene
• Mood swings
• Lack of energy
• Unusual speech patterns
• Bloodshot eyes 
• Dilated pupils
• Sleep disturbances
• Changes in eating habits
• Being secretive or deceptive (11)

What Causes Addiction?

There are several things that may cause addiction. Addiction is caused by neuroadaptations (changes in brain structure and functioning) that shift controlled, occasional use to chronic misuse. (12) Addiction has a big effect on the brain’s reward system. That doesn't mean everyone who uses substances develops addiction. Biological factors of addiction, age of first use, psychological factors of addiction, environmental factors, exposure to stress, and access to social support impact a person's susceptibility to addiction.

There's no single gene, life experience, or event that causes someone to misuse substances. There are also protective factors that limit someone's likelihood of developing an SUD.

Risk factors for addiction include:

• Genes, which account for between 40% and 70% of a person's risk
• Adverse early life experiences (13)
• Use of addictive substances while the brain is still developing
• Personality factors, such as emotion regulation, impulsivity, and propensity for sensation-seeking behaviors   
• Mental disorders, such as anxiety, depression, bipolar disorder, and schizophrenia 
• Availability of substances
• Exposure to substances in the childhood living environment
• Socioeconomic status
• Cultural norms

Protective factors, often related to childhood and adolescence, include:

• Personality factors, such as high self-esteem, optimism, mindfulness, strong anti-substance use beliefs, and desire to maintain health
• Robust support network
• Parental involvement 
• High parental awareness of substance misuse
• Enjoyment of school
• Participation in structured activities (14)
• Spirituality (15)

What Are the Withdrawal Symptoms of Addiction?

People with substance use disorder develop a dependence on their substance of choice, which means their body adapts to its presence. Eliminating or cutting back on drugs or alcohol can trigger discomfort as the central nervous system gets used to operating in a sober state.

Everyone experiences withdrawal slightly differently—and the type of substance, duration of use, and method of withdrawal can impact how symptoms manifest. Many people have intense cravings and experience mental and physical discomfort during addiction withdrawal. 

Alcohol withdrawal symptoms: (16)

• Nausea and vomiting
• Agitation
• Sound disturbances
• Headaches
• Shaking
• Sweating
• Seeing distorted light, such as flashing or shimmering 
• Disorientation
• Anxiety
• Inability to concentrate

Opiate (heroin, fentanyl, codeine, hydrocodone, morphine, oxycodone, etc.) withdrawal symptoms: (17)

• Muscle aches
• Anxiety
• Yawning
• Runny nose
• Sleep disturbances
• Tearing
• Agitation
• Sweating
• Dilated pupils
• Nausea, diarrhea, and vomiting
• Goosebumps
• Cramps

Methamphetamine withdrawal symptoms: (18)

• Irritability and agitation
• Depressed mood
• Muscle aches
• Increased sleeping
• Increased appetite
• Paranoia
• Delusions and hallucinations
• Distress
• Self-harming behaviors

Cocaine withdrawal symptoms: (19)

• Restlessness and agitation
• Fatigue
• Depression
• Increased appetite
• Discomfort
• Vivid nightmares
• Slow movements
• Difficulty concentrating
• Sensitivity to light and sound

Cannabis withdrawal symptoms: (20)

• Anger, irritability, and aggression
• Anxiety and nervousness
• Difficulty sleeping
• Depression
• Decreased appetite that could lead to weight loss
• Abdominal pain
• Headache
• Fever or chills
• Sweating
• Vivid dreams
• Difficulty concentrating

Types of Addiction Treatment

There are research-based methods that help people stop using substances and get into recovery. (21) As with type 1 diabetes or heart disease, there isn't a cure for addiction. Instead, medical and mental health professionals help a person bring the substance use disorder into remission to stop symptoms from impacting daily life. 

Most people require ongoing addiction treatment for several years, if not indefinitely. A mixture of the following is typically most successful:

• Outpatient treatment
• Inpatient treatment
• Behavioral therapy
• Group therapy
• A robust support network 
• Medication-assisted treatment

Principles of addiction treatment: (22)

1. Addiction is highly complex and causes changes to behavior and brain function
2. Successful treatment looks a little different to everyone
3. Treatment should be easy to access
4. For treatment to work, it must address the individual's needs and not just their symptoms
5. Most people require at least 3 months of addiction treatment
6. Behavioral therapy is the most common form of SUD treatment
7. Many people in recovery benefit from the use of medication
8. Treatment plans should be assessed continually and modified if needs change
9. Many people with addiction also have an underlying mental illness
10. Detox is only the first step in recovery
11. Involuntary treatment as a last resort can be effective
12. Providers should monitor substance use during treatment
13. Testing individuals for infectious diseases and providing treatment can limit substance-related and other high-risk behaviors   

How to Cope With Addiction

Some skills and tools that make managing addiction easier include:

• Mindfulness and meditation, which help individuals concentrate on the present moment and sit with feelings as they arise (23)
• Patience and restraint as the body and mind get used to not having huge hits of dopamine
• Honesty with the self and others to keep the person in recovery rooted in reality
• Regular exercise to release stress in the nervous system and increase the body's natural feel-good hormones (24) 
• Hobbies, fun activities, and exploration to keep the mind occupied and help stave off cravings
• Journaling to provide an outlet for emotions and help people understand themselves better
• An addiction app to help you during the recovery process. 
• A whole foods diet to nourish the body, as a diet high in processed food can impair mental health, making it harder to resist cravings (25)

How to Help Someone With Addiction

Many experts call addiction a family disease because of the ripple effect the sufferer's symptoms have on loved ones. (26) Here are seven tips to help family members support someone who's struggling with addiction: (27)

1. Learn about addiction and how it impacts people
2. Attend a support group for the families of addicted individuals 
3. If a loved one's addiction is making it difficult to function, consider seeking therapy
4. Allow them to experience the consequences of their addiction without enabling them and simply suggest (without being controlling) seeking addiction treatment
5. Hold them accountable without having unrealistic expectations
6. Avoid arguing 
7. Practice self-care 

Addiction can take a toll on someone's personal, professional, financial, and physical well-being. Luckily, treatment for substance use disorders is more advanced and accessible than ever. With a personalized approach to recovery, anyone can get free from drugs or alcohol and gain control over their health and future.   

Sources

1. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013)
   
2. https://www.asam.org/quality-care/definition-of-addiction
3. https://www.cdc.gov/stopoverdose/stigma/index.html
4. https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction
5. https://drugfree.org/article/is-addiction-a-disease/
6. https://www.yalemedicine.org/news/how-an-addicted-brain-works
7. https://thenextep.org/why-do-some-people-get-addicted-to-drugs-and-others-not/
8. https://news.uchicago.edu/story/increase-pleasurable-effects-alcohol-over-time-may-predict-alcohol-use-disorder
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767415/
10. https://www.addictionpolicy.org/post/dsm-5-facts-and-figures
11. https://medlineplus.gov/druguseandaddiction.html
12. https://www.ncbi.nlm.nih.gov/books/NBK424849/
13. https://www.frontiersin.org/articles/10.3389/fpsyt.2022.871459/full
14. https://www.samhsa.gov/sites/default/files/20190718-samhsa-risk-protective-factors.pdf
15. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11906-2
16. https://www.ncbi.nlm.nih.gov/books/NBK441882/
17. https://medlineplus.gov/ency/article/000949.htm
18. https://www.ncbi.nlm.nih.gov/books/NBK310652/
19. https://medlineplus.gov/ency/article/000947.htm
20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9110555/
21. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
22. https://www.va.gov/HOMELESS/nchav/resources/docs/interventions/contingency-management/NIDA-principles-of-drug-addiction-treatment-a-research-based-guide-third-edition-508.pdf
23. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions
24. https://www.apa.org/topics/exercise-fitness/stress
25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805706/
26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725219/
27. https://drugfree.org/article/want-help-adult-family-member-friend-drug-alcohol-problem-7-suggestions/