What Is Addiction?
Addiction is a condition that results when a person ingests a substance (for example, alcohol, cocaine, nicotine) or engages in an activity (such as gambling, sex, shopping) that can be pleasurable but the continuation of which becomes compulsive and interferes with ordinary responsibilities and concerns, such as work, relationships, or health. People who have developed an addiction may not be aware that their behavior is out of control and causing problems for themselves and others.
The word addiction is used in several different ways. One definition describes physical addiction. This is a biological state in which the body adapts to the presence of a drug so that drug no longer has the same effect, otherwise known as tolerance. Another form of physical addiction is the phenomenon of overreaction by the brain to drugs (or to cues associated with the drugs). An alcoholic walking into a bar, for instance, will feel an extra pull to have a drink because of these cues.
However, most addictive behavior is not related to either physical tolerance or exposure to cues. People commonly use drugs, gamble, or shop compulsively in reaction to stress, whether or not they have a physical addiction. Since these addictions are not based on drug or brain effects, they can account for why people frequently switch addictive actions from one drug to a completely different kind of drug, or even to a non-drug behavior. The focus of the addiction isn’t what matters; it’s the need to take action under certain kinds of stress. Treatment requires an understanding of how it works.
When referring to any kind of addiction, it is important to recognize that its cause is not simply a search for pleasure and that addiction has nothing to do with one’s morality or strength of character. Experts debate whether addiction is a “disease” or a true mental illness, whether drug dependence and addiction mean the same thing, and many other aspects of addiction. Such debates are not likely to be resolved soon. But the lack of resolution does not preclude effective treatment.
Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will causes problems. Yet a number of effective treatments are available and people can recover from addiction and lead normal, productive lives.
People with a substance use disorder have distorted thinking, behavior and body functions. Changes in the brain’s wiring are what cause people to have intense cravings for the drug and make it hard to stop using the drug. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory and behavior control.
These substances can cause harmful changes in how the brain functions. These changes can last long after the immediate effects of the drug — the intoxication. Intoxication is the intense pleasure, calm, increased senses or a high caused by the drug. Intoxication symptoms are different for each substance
The word “addiction” is often used to refer to any behaviour that is out of control in some way. People often describe themselves as being addicted to, for example, a TV show or shopping. The word is also used to explain the experience of withdrawal when a substance or behaviour is stopped (e.g., “I must be addicted to coffee: I get a headache when I don’t have my cup in the morning”).
However, experiencing enjoyment or going through withdrawal do not in themselves mean a person has an addiction.
Because the term “addiction” is commonly used in such a vague way, there have been many attempts to define it more clearly.
One simple way of describing addiction is the presence of the 4 Cs:
- loss of control of amount or frequency of use
- compulsion to use
- use despite consequences.
People with addictions often cannot quit on their own. Addiction is an illness that requires treatment. Treatment may include counseling, behavioral therapies, self-help groups, and medical treatment. People often assume that those with addictions should be able to quit by simply making up their minds to do so. Addiction is thought to be possible for a wide range of chemical substances. Dependence, most often related to physical symptoms, can occur for a subset of the chemicals that cause addiction. For instance, rarely an individual is prescribed a medication by a doctor for a legitimate reason (such as pain after an injury) and this can lead to physical withdrawal symptoms if this medication is stopped. Rarely, this post-medical treatment drug dependence can lead to drug abuse. People with drug abuse problems are individuals whose brain biochemistry has been altered by alcohol or drugs.
Addiction (or drug abuse) is often confused with dependence.
Many drugs can affect the brain. Some of these cause changes in behavior and can result in dependence or abuse.
Why do people take drugs?
In general, people begin taking drugs for a variety of reasons:
People at a night club
To feel good. Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the “high” is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction.
To feel better. Some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction.
To do better. Some people feel pressure to chemically enhance or improve their cognitive or athletic performance, which can play a role in initial experimentation and continued abuse of drugs such as prescription stimulants or anabolic/androgenic steroids.
Curiosity and “because others are doing it.” In this respect adolescents are particularly vulnerable because of the strong influence of peer pressure. Teens are more likely than adults to engage in risky or daring behaviors to impress their friends and express their independence from parental and social rules.
How Is Addiction Treated?
Effective treatments for addiction are available.
The first step on the road to recovery is recognition of the problem. The recovery process can be hindered when a person denies having a problem and lacks understanding about substance misuse and addiction. The intervention of concerned friends and family often prompts treatment.
A health professional can conduct a formal assessment of symptoms to see if a substance use disorder exists. Even if the problem seems severe, most people with a substance use disorder can benefit from treatment. Unfortunately, many people who could benefit from treatment don’t receive help.
Because addiction affects many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s situation and any co-occurring medical, psychiatric and social problems can lead to sustained recovery.
Medications are used to control drug cravings and relieve severe symptoms of withdrawal. Therapy can help addicted individuals understand their behavior and motivations, develop higher self-esteem, cope with stress and address other mental health problems. Treatment may also include:
Therapeutic communities (highly controlled, drug-free environments) or sober houses
Many people find self-help groups for individuals (Alcoholics Anonymous, Narcotics Anonymous) as well as their family members (Al-Anon or Nar-Anon Family Groups) useful.
Why do people keep using substances?
Substance use can be hard to change. One thing that makes change so difficult is that the immediate effects of substance use tend to be positive. The person may feel good, have more confidence and forget about his or her problems. The problems caused by substance use might not be obvious for some time.
The person may come to rely on substances to bring short-term relief from difficult or painful feelings. The effects of substances can make problems seem less important, or make it easier to interact with others. The person may come to believe that he or she cannot function or make it through the day without drugs. When the person uses substances to escape or change how he or she feels, using can become a habit, which can be hard to break.
Continued substance use, especially heavy use, can cause changes in the body and brain. A person who develops physical dependence and then stops using may experience distressing symptoms of withdrawal. Changes to the brain may be lasting. These changes may explain why people continue to crave the substance long after they have stopped using, and why they may slip back into using.
What are the signs & symptoms of addiction?
There are two important signs that a person’s substance use is risky, or is already a problem: harmful consequences and loss of control.
The harms of substance use can range from mild (e.g., feeling hungover, being late for work) to severe (e.g., homelessness, disease). While each time a person uses a substance may seem to have little impact, the harmful consequences can build up over time. If a person continues to use substances despite the harmful consequences, he or she may have a substance use problem.
The harms of substance use can affect every aspect of a person’s life. They include:
- injuries while under the influence
- feelings of anxiety, irritability or depression
- trouble thinking clearly
- problems with relationships
- spending money on substances rather than on food, rent or other essentials
- legal problems related to substance use
- loss of hope, feelings of emptiness.
Loss of control
Some people may be aware that their substance use causes problems but continue to use, even when they want to stop. They may use more than they intended, or in situations where they didn’t want to use. Some people may not see that their substance use is out of control and is causing problems. This is often referred to as being in denial. This so-called denial, however, may simply be a lack of awareness or insight into the situation. Whether people realize it or not, lack of control is another sign that substance use is a problem.
Alcohol and other drug education
Learning about the effects of alcohol and other drugs can help prepare people to make informed choices. Some treatment programs also offer alcohol and other drug education to family members.
Medications used to help treat addictions include:
- nicotine patch, gum or an inhaler, or taking the medication buproprion (Zyban) (for smoking cessation)
- methadone or buprenorphine (for people who are dependent on heroin or other opioids, (pain medications such as codeine, Percodan, OxyContin).
- Medications to treat other types of addiction are limited. One is naltrexone (Revia), which can reduce cravings to drink in people who are alcohol dependent. Naltrexone can also be used to block the effects of opioids. Another medication used to treat alcohol dependence is disulfiram (Antabuse), which causes people to feel sick and nauseous if they drink alcohol.
People sometimes need short-term help dealing with substance use withdrawal. Withdrawal management helps them manage symptoms that happen when they stop using the substance. It helps prepare clients for long-term treatment. Clients also learn about substance use and treatment options.
- A holistic approach to treatment
Many treatment programs offer a variety of other supports and services, including information and counselling about:
- stress or anger management
- grief and trauma
- finding a job or going back to school
- healthy eating
- accessing safe, affordable housing
- getting social assistance or disability benefits
- managing money and budgeting
- developing parenting skills.
Addictions and habits
With a habit you are in control of your choices, with an addiction you are not in control of your choices.
Addiction – there is a psychological/physical component; the person is unable to control the aspects of the addiction without help because of the mental or physical conditions involved.
Habit – it is done by choice. The person with the habit can choose to stop, and will subsequently stop successfully if they want to. The psychological/physical component is not an issue as it is with an addiction.
Addiction to substances or activities can sometimes lead to serious problems at home, work, school and socially.
The causes of addiction vary considerably, and are not often fully understood. They are generally caused by a combination of physical, mental, circumstantial and emotional factors.
Addiction, often referred to as dependency often leads to tolerance – the addicted person needs larger and more regular amounts of whatever they are addicted to in order to receive the same effect. Often, the initial reward is no longer felt, and the addiction continues because withdrawal is so unpleasant.
Addiction or substance abuse is a complex brain disease. A person with an addiction experiences cravings that persist even in the face of extremely negative consequences. During a craving, a person with an addiction misses the habit-forming drug terribly, and often he or she experiences symptoms of withdrawal.
Evidence strongly suggests that genetic susceptibilities and biological traits play a role in addictions; however, the development of an addiction is also shaped by a person’s environment (for example, a person with alcoholism cannot become addicted without access to alcohol). The “addictiveness” of a drug is related to how strongly the drug activates the reward circuits in the brain. For instance, when the methamphetamine found on the street is purer (meaning that it stimulates the dopamine reward circuits more), then the number of first-time drug users who become drug abusers is higher.
Addictive substances or behaviors change the reward circuits in the brain. In other words, the brain responds to the addictive substance in the same way that it responds to very pleasurable experiences. This explains, in a general sense, why people with addictions sometimes forsake all other life activities and obligations and even their own health in pursuit of the addictive substance.
According to the Diagnostic and Statistical Manual of Mental Disorders, substance use is considered abusive or addictive if the person has experienced three or more of the following signs during a 12-month period:
Tolerance is evident when (1) a need exists for increased amounts of a substance to achieve intoxication or desired effects or (2) the effect of a substance is diminished with continued use of the same amount of the substance.
Withdrawal is evident when (1) characteristic, uncomfortable symptoms occur with abstinence from the particular substance or (2) taking the same (or closely related) substance relieves or avoids the withdrawal symptoms.
The substance is used in greater quantities or for longer periods than intended.
The person has a persistent desire to cut down on use of the substance, or the person’s efforts to cut down on use of the substance have failed.
Considerable time and effort are spent obtaining or using the substance or recovering from its effects.
Important social, employment, and recreational activities are given up or reduced because of an intense preoccupation with substance use.
Substance use is continued even though some other persistent physical or psychological problem is likely to have been caused or worsened by the substance (for example, an ulcer made worse by alcohol consumption or emphysema caused by smoking).
Drug abuse can occur with or without tolerance or withdrawal. Tolerance and withdrawal indicate physical dependence. A key issue in evaluating addiction is if a person is unable to stop using the harmful substance (loss of control). Often people who are addicted to a drug do not have insight into their inability to stop drug use and falsely believe they could stop if they “wanted to.” This is called denial.
No single event or criterion is indicative of an addictive disorder; drug use becomes addiction (drug abuse) only after a pattern of behavior that takes place over time. In many ways, current definitions of addiction are limited and mostly incorporate behavioral symptoms in the definition.
Common Characteristics of People with Addictions
People with addictions have the opportunity to obtain the substance or to engage in the activity that will addict them, and they have a risk of relapse no matter how successful their treatment is.
People with addictions tend to be risk takers and thrill seekers; the changes in brain circuitry lead drug abusers to expect a positive reaction to their addictive substance or activity before they use it or experience it.
Self-regulation and impulse control around the person’s drug of choice are difficult for people with addictions. However, often these same people retain impulse control in most or all other areas of their life. This is more true with drugs like alcohol and less true with drugs like methamphetamine. Again, this difference is thought to be related to how stimulating the drug is to the reward circuits (dopamine tracts) in the brain. Methamphetamine is much more rewarding to the brain than alcohol.
When to Seek Medical Care for Addiction
Some people are able to recover from an addiction without help. However, it is thought that most people need assistance. Many times medical, psychiatric, or psychological assistance is needed. With treatment and support, many individuals are able to stop their drug abuse.
If there are known or suspected health problems related to substance abuse, it is wise to consult with a primary-care physician for a full history and physical exam. Examples include assessing for liver damage in advanced cases of alcohol addiction or dental damage due to methamphetamine abuse.
When talking with a loved one about addiction, having a third party present who is professionally trained and knowledgeable about addiction may be helpful. Being in a relationship with a drug abuser can change the relationship and lead to a decreased ability to communicate with each other.
How addictions can affect you
The strain of managing an addiction can seriously damage your work life and relationships. In the case of substance abuse (for example, drugs and alcohol), an addiction can have serious psychological and physical effects.
Some studies suggest addiction is genetic, but environmental factors, such as being around other people with addictions, are also thought to increase the risk.
An addiction can be a way of blocking out difficult issues. Unemployment and poverty can trigger addiction, along with stress and emotional or professional pressure.
Drug rehabilitation is also called drug rehab or simply rehabs, is a way of medically or psychotherapeutic management of the addict person, for its dependency on psychoactive elements such as alcohol, prescription drugs, narcotic drugs like heroin, morphine, amphetamines (methylphenethylamine). The main purpose of drug rehabilitation is to ensure that the addict person start to cease substance abuse, in a way to dodge the psychological, legal, financial, social, and physical concerns; that can be triggered, especially by extreme abuse.
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