It’s more than an overwhelming desire—it’s the need to do whatever is necessary to satisfy a compulsion. Whether it’s a substance or a behavior that’s in charge, it puts you on a relentless quest for more, despite the harm you know it’s causing you.  As one expert puts it, “addiction is compulsive good-now, bad-later behavior.”

The word “addiction” is often used loosely. A person with a sweet tooth may call themselves a “sugar addict.” An avid marathoner may say they are “addicted to running.” But a true addiction is a serious and chronic disorder, much like asthma and high blood pressure.

Whereas asthma affects your lungs and high blood pressure affects your circulatory system, addiction affects your brain, altering its functioning. It can have a detrimental effect on both your personal and professional lives, on your physical health, and on the well-being of those around you. And yet you continue wanting more of it.1

Defining Addiction

The term “addiction” is almost as complicated as the disease itself. Usage turns to addiction when a drug or activity triggers rewarding feelings—a high. Addictive drugs and behaviors can heighten or lower levels of certain key brain chemicals, called neurotransmitters, that play a role in regulating everything from mood to movement.2

Most addictive substances flood the brain with the neurotransmitter dopamine. Dopamine is NOT produced by the brain as a reward (a common misconception). It’s not about liking or pleasure but it is involved in wanting, drive, and desire. From what we know, dopamine triggers the drive of motivation. (Reward is more complex—it may be mediated only minimally if at all, by dopamine, but also by endorphins. It is not yet fully understood.)

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But when the brain is inundated with dopamine from a drug, it compels the use of that drug again and again to repeat the high effect. When the substance becomes associated with pleasure, the addiction becomes deeply rooted in the brain.2

Addiction experts note that avoidance can also trigger compulsive behavior.  Chronic opioid use disorder, for example, most often develops as a way to avoid the unpleasant symptoms of withdrawal.  The same is true with nicotine. Smoking has few rewards. Bad breath? Stinky clothes? A short-lived buzz? But withdrawal from nicotine, as anyone who has ever tried to kick the habit knows, is extremely unpleasant (shaking, anxiety, headaches, insomnia, irritability, etc.)

Traditionally, addiction was associated with the abuse of substances (alcohol drugs, and even sugar), but behaviors (gambling, pornography, etc.) can become addictive as well and are becoming more widely recognized.

Substance Addiction

Addiction per se is not recognized as an official diagnosis. An addiction to drugs or alcohol is diagnosed as a substance use disorder (SUD). Among the most likely substances that people can become addicted to are:3

  • Alcohol
  • Marijuana
  • Hallucinogens like PCP, LSD, among others
  • Inhalants like paint thinners and glue
  • Opioids, such as the painkillers codeine and oxycodone, and heroin
  • Sedatives, hypnotics, and anxiolytics
  • Stimulants like cocaine and methamphetamine, among others
  • Tobacco
  • Sugar, carbs, and food

The brain changes that result from drug addiction can make someone feel as if “the drug takes on the same properties as food, water, and sex,” says Brad Lander, PhD, a psychologist and addiction medicine specialist at Ohio State University Wexner Medical Center in Columbus. “And if you are starving to death, you’re willing to do anything you have to do to get food.”

[Click to Learn More How Addiction Impacts The Brain]

People who abuse drugs and alcohol often develop a tolerance to it, meaning that they need higher and higher doses of it to get the desired effect. With continued use, the brain and body become dependent on the presence of an addictive substance. When you try to quit abruptly, the body enters withdrawal, triggering a host of symptoms, which vary by substance.3

Addictive Behaviors

Much like drugs and alcohol, certain behaviors can also take over your life. Compulsive gambling is currently the only behavioral addiction disorder included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which mental health professionals use to diagnose mental conditions.4 Though other addictive behaviors might not be classified officially as an addiction, their effects can be devastating just the same. They include: 3, 5

While not considered unique mental health conditions, doing any one of these activities compulsively with a loss of control that causes harmful consequences can be just as destructive as a substance use disorder.5

Akin to drug and alcohol cravings, research suggests that people with behavioral addictions can feel intense urges to engage in their choice behavior. They may even feel a need to increase the intensity or frequency of that behavior to achieve the same high.5

Addiction or Habit: What’s The Difference?

Have you ever driven home from work or an errand and realized that you were on autopilot the whole way? Do you still remember a song you learned as a child?

Physical behaviors and tasks that you are able to do from memory (habits and routines), without really thinking about them, are stored in a part of the brain called the basal ganglia, says Emily Einstein, PhD, chief of the science policy branch at the National Institute on Drug Abuse (NIDA).2, 7

Habits and addictions are related because they are both stored in the same brain areas, according to Einstein. “I think people say habit-forming sometimes when they mean addictive. The important distinction is that addiction is a medical disorder, but habits are kind of a milder manifestation.”

One way to break a habit is through cognitive behavioral therapy (CBT), a type of therapy that also plays an important role in addiction treatment.

Cognitive behavioral therapy forces you to direct your thinking to the habitual behavior. “You try to really overtly think about what you’re doing and then what caused it,” Einstein says. “So if your habit is biting your nails, if you realize you’re biting your nails, and then you attend to the state of your body, you may realize that you’re biting your nails because you’re anxious. If you spend a lot of time focused on the links between these behaviors and these emotions, then you can start to break them.”

Addiction Symptoms

The symptoms and signs of addiction depend on what you are addicted to and the severity of the addiction. For substance use disorders, some of the primary symptoms are: 3

Compulsion

A strong drive to feel good and to not feel bad. In other words, using a substance as a way to relieve distress and bring pleasure.

Lack of Self-Control

Substance use disorders are often marked by intense and persistent cravings or an urge to use the substance. The urges may block out all other thoughts. Even if you have a desire to quit, without help you may fail in the attempt to do so.

Social Problems

Substance use disorders can cause you to fall behind on important tasks at work, school, or home. You may deprioritize relationships and vital elements of your life, such as work projects or leisure time activities, due to your preoccupation with substance use. People with an addiction often spend much of their time getting drugs, using drugs and recovering from their effects.

Risk-Taking

You may engage in risky behaviors like driving while under the influence or performing out-of-character acts such as stealing. You’re likely to continue to abuse substances despite obvious consequences that arise as a result.

Drug Effects

Tolerance and withdrawal symptoms can be clear warning signs. People who abuse drugs and alcohol may increasingly need more of the substance to get the same effect and show withdrawal symptoms when they stop using.

Occupational

Pharmacists, nurses, and other occupations where handling medication is part of the job description can make avoiding the addiction more challenging.

Health Consequences

Using drugs or alcohol despite developing physical symptoms (cirrhosis of the liver, for example)

Continued Use Despite Adverse Consequences

Poor health, jail time, loss of employment, estrangement from family and friends.

Behavior Addiction Symptoms

The symptoms of behavioral addictions are slightly different. Like substance use disorders, behavioral addictions may come with persistent urges to engage in a behavior (i.e. gambling), followed by a positive mood shift while engaging in said behavior. Over time, the action may become less pleasurable, but someone with a behavioral addiction may continue to do it as it becomes more habitual and ingrained.5

Because a gambling disorder is officially recognized as a type of addiction, according to the American Psychiatric Association in Washington, DC, its symptoms are more fully detailed. Signs of gambling disorder include:4

  • Spending an increasing amount of money on gambling
  • Needing to gamble more and more money to achieve the desired level of excitement
  • Difficulty cutting back or quitting gambling
  • Feeling restless or irritable when attempting to cut back or quit
  • Persistent, frequent thoughts about gambling such as planning bets, thinking about past gambling experiences and strategizing how to get more money to gamble with
  • Turning to gambling when feeling down or distressed
  • Continuing to gamble even after losing money in an attempt to break even
  • Suffering financial or social consequences as a result of gambling
  • Relying on others for financial support due to gambling losses

Addiction Causes: Who Is Most at Risk? 

About 70% of Americans are social or occasional drinkers. Even though they all drink the same liquor, wine, and beer, not everyone develops a problem. Around 15 million people in America have an alcohol use disorder or are addicted to alcohol. “It’s not the alcohol that’s the problem, it’s the vulnerability and the person,” said Edwin Salsitz, MD, a psychiatrist and attending physician at Mount Sinai Hospital in New York. “The same is true of all drugs and all activities—what could be addictive to you might not be addictive to me.”11, 12

So what makes someone vulnerable to addiction? Like other chronic conditions and mental health disorders, the causes of addiction can be broken down into two main categories:12

Environment

Environmental factors, including stress, history of trauma, history of neglect, and family, friends, and relationships, seem to affect someone’s vulnerability to addiction. Prevalent use of substances among your social groups and encouraging attitudes toward drugs in these groups may heighten the chances of initial drug use. Accessibility to substances and their cost as well as your community’s culture (what’s “normal” for example drinking alcohol every night in your family) also plays a role. Early adversity has far-reaching and lasting impacts.

Genetics

Some risk of addiction is genetic but this varies from substance to substance (cocaine has a much higher genetic component than hallucinogens, for example). Depending on your genes, you might be more or less vulnerable to addiction. Certain genetic traits may increase the feeling of reward you experience after using a drug or engaging in addictive behavior. Once you’ve started using a drug, the progression toward full-blown addiction may be delayed or expedited depending on your genetic tendencies.

More specifically, risk factors for addiction include:13

  • Addiction in your family history. Drug addiction is more common in some families. Having family members with addiction increases your risk.
  • Peer pressure. Peer pressure, especially in teens and young adults, can play a substantial role in encouraging drug use and abuse.
  • Family problems. Difficult family situations, lack of parental oversight, and weak bonds with family members can increase addiction risk.
  • Using drugs at an early age. When the brain is still developing, substance use can more easily influence neural networks and increase the likelihood of addiction.
  • Taking a drug that’s highly addictive. Some drugs are more addictive than others. Addiction may develop faster if you take drugs such as stimulants, cocaine, or opioids.
  • Having another mental health disorder. Many people experience mental illness and addiction together. An existing mental illness may make someone more vulnerable to addiction, or an existing addiction may trigger or worsen a mental disorder. People with anxiety, depression, bipolar disorder and personality disorders, or post-traumatic stress disorder (PTSD) may turn to drugs to numb their emotional pain and cope with their feelings. Drugs may deliver a pleasurable effect initially, but with continued use, these feelings will fade. People with attention-deficit/hyperactivity disorder (ADHD) are also at increased risk of addiction but the issue for them involves impulsivity and stimulus seeking.

Addictions are mental health disorders. Approximately 50% of people who suffer from a mental illness at some point in their lives will also develop a substance use disorder, and vice versa. It is clearly known that conferring of risk is bidirectional. In other words, having a SUD or other addiction increases the risk of other mental illnesses (e.g. predominantly depression, anxiety, but also psychosis with cannabis and meth). We also know that having a mental illness also increases the risk of developing an addiction. What is often needed is the history of what happened first to determine causation, experts say.14

“There are hypotheses about whether people who are starting to experience mental illness than are more likely to take drugs in response to the feeling,” Einstein says. “And then also drugs change the brain in a way that could make one more vulnerable to developing a psychiatric condition.”

The answer, according to Einstein, is that “both of these things are probably true.” It may be that addiction can trigger a mental health problem, or that mental health problems can lead people to rely on addictive substances.15

Some of the mental illnesses that are often diagnosed alongside addiction include:13

How Is Addiction Treated? 

Although there is no cure for addiction, and there is always a risk of readdiction, it is also highly treatable, according to Einstein. Treatment strategies will depend on the person and the addiction. You may need multiple rounds of treatment, a combination of treatment approaches, and even lifelong management. Buprenorphine seems to make withdrawal more tolerable by blocking symptoms. In truth, most patients notice no euphoria at all when treated with buprenorphine but do report a lifting/brightening of their mood.

Treating addiction can also promote the rewiring of the brain. “The brain acts kind of like a muscle, so if we can get the person doing positive behaviors, healthy behaviors, then you can write over those old addiction networks,” Lander says.

Treatment options include:12

  • Medication. Various medications can be used to control drug cravings and relieve severe symptoms of withdrawal. For example, at specified doses, drugs like buprenorphine and methadone keep opioid withdrawal symptoms at bay without triggering the same high. Alcohol addiction can be treated with acamprosate which seems to dampen the desire for alcohol but doesn’t work for those in withdrawal. Another medication, disulfiram, can help break the cycle of alcohol abuse because it triggers an unpleasant reaction when people consume alcohol.17People with addiction as well as another mental health disorder will benefit from treatment for that disorder as well, such as managing depression with antidepressants. Trauma (including neglect) should also be treated (group therapy can be extremely effective) as about 80 to 90% of victims of addiction have a history of significant childhood trauma. 16
  • Treatment programs. People with substance use disorders need to be able to safely and quickly detox from the substance they are addicted to. This may involve a stay at a hospital or treatment center to manage withdrawal symptoms, which can be quite severe, depending on the substance. Treatment programs may be outpatient, residential, or inpatient, depending on what level of care a patient requires. They usually mandate a drug-free environment and offer individual, group, or family therapy sessions.
  • Therapy. On its own or as part of a treatment program, therapy can help you recognize and understand your addiction and learn strategies to break the cycle.
  • Mutual-Help Groups. Popular programs such as Alcoholics Anonymous and Narcotics Anonymous can help you overcome addiction by providing a support system and a forum to discuss addiction without shame. Available both in person and online, if you opt for the support group model you’ll likely work with a sponsor, recovery coach or recovery mentor. With regards to 12-step groups (like AA) research shows that they only really work if you go to the meetings, talk regularly with a sponsor, and actively go through each one of the steps. Other recommended options include SMART Recovery, free, mutual support meetings and Celebrate Recovery, a Christian-based program.
  • Community Reinforcement and Family Training, or CRAFT, is an approach designed specifically for families who have a loved one struggling with substances, but who is not motivated to make changes or get help. CRAFT teaches parents and siblings an effective way to communicate with and support a loved one that increases the likelihood of that person making a real change.

Addiction By The Numbers

The cost of addiction is high and the numbers, staggering on many levels.

  • $740 billion: The annual cost related to crime, lost work productivity, and health care as a result of abuse of tobacco, alcohol, and illicit drug use in the United States.6
  • 4 million: The number of people aged 12 or older who used a substance, including alcohol, tobacco, or an illicit drug, in the past month.8
  • 4 million: According to the 2019 National Survey on Drug Use and Health, this is the number of people aged 12 or older, with a substance use disorder. More specifically:8
    • 5 million people had a past-year alcohol use disorder
    • 3 million people had a past year illicit drug use disorder
    • 6 million people had a past year opioid use disorder
    • 4 million people had a past year prescription pain reliever use disorder
    • 1 million people had a past year cocaine use disorder
    • 904,000 people had a past year methamphetamine use disorder
    • 4 million people had both an alcohol use disorder and an illicit drug use disorder in the past year.
  • 67,300: The number of Americans who died from a drug-involved overdose in 2018, including illicit drugs and prescription opioids.9
  • 37,329: The number of alcohol-induced deaths in 2018, excluding accidents and homicides.10
  • 23,172: The number of alcoholic liver disease deaths in 2018.10

Helpful Resources for Addiction

National Institute on Drug Abuse. The organization’s fact sheet, “Treatment Approaches for Drug Addiction” provides information on the most recent and comprehensive treatment options for drug abuse and addiction and is updated periodically.

The Substance Abuse and Mental Health Services Administration (SAMHSA). This organization operates a confidential, 24-hour treatment referral helpline. Call 1-800-662-HELP(4357) to help people find treatment programs and other assistance. You can also use SAMHSA’s online resource Behavioral Health Treatment Services Locator for finding mental health treatment facilities and programs in your state.

National Institute of Mental Health (NIMH). NIMH is the lead federal agency for research on mental disorder. Here you’ll find the latest research, news, and statistics on addiction and related mental health disorders, and you can explore the idea of participating in an upcoming clinical trial for finding new and better treatments.

Clinical Trials Network (CTN) If you’re interested in participating in a clinical trial or learning more about upcoming clinical trials, you can find one via the Clinical Trials Network.

Alcoholics Anonymous (AA). Visit the group’s website to find a local AA meeting near you.

Narcotics Anonymous (NA). Visit the group’s website to find a local NA meeting near you.

Recommended Books

Recovery: Freedom from Our Addictions by Russell Brand.
Finding Your Best Self, Revised Edition: Recovery from Addiction, Trauma, or Both by Lisa Najavits.

 

FAQs

What is addiction?

Addiction is a chronic brain disease that compels you to repetitively use a substance or engage in a behavior despite detrimental consequences to mind, body, and general well-being. The reward or high that addictive substances or behaviors trigger acts as an incentive. Over time, people with addiction become reliant on addictive substances or behaviors, causing long-lasting brain changes.

What causes addiction?

Addiction is caused by a combination of genetic and environmental factors. Certain genetic traits or a family history of addiction can make you more vulnerable. A wide range of life experiences and exposures, such as trauma, weak social ties, and other mental health conditions, can make someone more likely to try addictive substances in the first place or increase the likelihood that they become addicted.

How can I break an addiction?

To break an addiction, the brain and body need to relearn how to exist and cope without the presence of an addictive substance or behavior. This requires treatment and lifelong follow-up to avoid relapsing. The type of treatment will depend on the individual and substance or behavior you’re addicted to.

Why is addiction a disease?

Like other chronic diseases, addiction damages the normal and healthy functioning of a critical organ in the body, in this case, the brain. The brains of people with addiction become dependent on the presence of an addictive substance or behavior and the reward or high that it triggers.

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Last Updated: Dec 29, 2020