What Is Addiction?

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Addiction is a complex, chronic brain condition influenced by genes and the environment that is characterized by substance use or compulsive actions that continue despite harmful consequences.

People who suffer from addiction have an uncontrollable urge and compulsion to use dangerous substances such as alcohol or other drugs or to engage in harmful activities despite knowing the negative consequences these may have on their lives. They’re physically or mentally unable to stop even when they try to do so.

Depressed man drinking hard liquor at home.

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Types of Addiction

Current guidelines in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), the diagnostic tool used to diagnose different types of mental health conditions, indicate that most psychoactive substances, including certain prescribed medications, have the potential to be addictive.

The term addiction is used to describe compulsive drug-seeking behaviors that continue in spite of negative outcomes, but it is important to note that addiction is not considered an official diagnosis in the DSM-5.

Rather than using the term "addiction," the DSM-5 classifies substance use disorders.

While the diagnostic criteria vary for each type, the DSM-5 describes these disorders as a problematic pattern of use of intoxicating substances that leads to significant impairment and distress. These symptoms can result in:

  • Impaired control
  • Social impairment
  • Risky use
  • Tolerance/withdrawal

How Common Is Addiction?

According to the 2019 National Survey on Drug Use and Health (NSDUH), 20.4 million people aged 12 or older had a substance use disorder in the previous year.

Substance Abuse Disorders

There are different substance use disorders found in the DSM-5. These include:

  • Alcohol-related disorders
  • Cannabis-related disorders
  • Hallucinogen-related disorders
  • Opioid-related disorders
  • Sedative, hypnotic, or anxiolytic-related disorders
  • Stimulant-related disorders
  • Caffeine-related disorders
  • Tobacco-related disorders

Gambling Addiction

In the DSM-5, gambling disorder is included in a new category of nonsubstance-related disorders. This reflects research findings that gambling disorder is similar to substance-related disorders in many ways. Recognizing these similarities will help people with gambling disorder get needed treatment and services, and may help others better understand the challenges.

Internet gaming disorder is included in DSM-5 in the section on disorders requiring further research. This reflects the scientific literature showing that persistent and recurrent use of internet games, and a preoccupation with them, can result in clinically significant impairment or distress. The condition criteria do not include general use of the internet or social media.

Other Behavioral Disorders

There is still much debate about whether many behavioral addictions are “true” addictions. More research is needed to clarify this issue.

While shopping addiction, sex addiction, and exercise addiction are often noted as behavioral addictions, the DSM-5 does not officially recognize these as distinct disorders.

Conditions listed in the DSM typically have a long history of research with plenty of empirical data on symptoms, prevalence, and treatments to back up their inclusion.

For many of the proposed disorders missing in the DSM, this research simply is not there—at least not yet.

Symptoms

If you do not have a substance use disorder, you may be deterred by the effects of excessive alcohol use such as vomiting or hangovers. But those with addiction carry on with behaviors despite discomforts and impairments.

Symptoms of substance use disorder are grouped into four categories:

  • Impaired control: A craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use
  • Social problems: Substance use causes failure to complete major tasks at work, school, or home; social, work, or leisure activities are given up or cut back because of substance use
  • Risky use: Substance is used in risky settings; continued use despite known problems
  • Drug effects: Tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance)

Changes in the Brain

Brain imaging studies of people with addiction show physical changes in areas of the brain that are critical to:

  • Judgment
  • Decision-making
  • Learning and memory
  • Behavior control

These changes help explain the compulsive nature of addiction.

Causes

Experts believe a range of biological and environmental factors can significantly increase someone’s risk for addiction. Addictive substances and behaviors can create a pleasurable “high” that’s physical and psychological.

Genetics

If you have a family history of addiction, you are at a higher risk of developing a substance use disorder. According to the National Institute on Drug Abuse, about 40% to 60% of addiction risk stems from genetic factors.

Neurobiological Factors

Nearly all addictive drugs directly or indirectly target the brain’s reward system by flooding the circuit with dopamine.

When activated at normal levels, this system rewards our natural behaviors. Overstimulating the system with drugs, however, produces effects that strongly reinforce the behavior of drug use, teaching the person to repeat it.

Environmental Factors

A combination of lifestyle and environmental factors also contribute to developing an addiction. These factors include:

  • Violence
  • Poverty
  • Having access to substances
  • Taking drugs during adolescence
  • Extreme stress or trauma

ADHD and Addiction

Research has shown that those with attention deficit hyperactivity disorder (ADHD) have an increased risk for substance use. Although estimates vary, between 11% to 25% of adolescents and adults with substance abuse disorders have a lifetime diagnosis of ADHD.

Diagnosis

Addiction diagnosis usually requires recognizing that there is a problem and seeking help.

Substance use is not always an indication of addiction, although drug use carries numerous health and social risks in addition to the risk of addiction.

Once a person has decided that they have a problem and need help, the next step is an examination by a healthcare professional. This involves:

  • Questions about behaviors or substance use
  • An examination to assess overall health
  • The development of a treatment plan that works best for the individual's specific addiction and readiness for change

Because some substances have the potential to cause dangerous withdrawal symptoms, it is important to receive an appropriate diagnosis in order to get the best treatment.

Criteria for Substance Use Disorders

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:

  1. Taking the substance in larger amounts or for longer than you're meant to.
  2. Wanting to cut down or stop using the substance but not managing to.
  3. Spending a lot of time getting, using, or recovering from the use of the substance.
  4. Cravings and urges to use the substance.
  5. Not managing to do what you should at work, home, or school because of substance use.
  6. Continuing to use, even when it causes problems in relationships.
  7. Giving up important social, occupational, or recreational activities because of substance use.
  8. Using substances again and again, even when it puts you in danger.
  9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
  10. Needing more of the substance to get the effect you want (tolerance).
  11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Severity of Substance Use Disorders

The DSM-5 allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified. It is broken down as:

  • Two or three symptoms indicate a mild substance use disorder
  • Four or five symptoms indicate a moderate substance use disorder
  • Six or more symptoms indicate a severe substance use disorder

Treatment

There is no universal treatment when it comes to substance use disorder.

Keep in mind that treatment will vary depending on the person as well as the type of substance the person is addicted to. As a result, it is important that the treatment matches the person's needs and issues. Doing so will help increase the likelihood that the person will experience success.

Often, a treatment plan includes a combination of:

  • Counseling
  • Group support
  • Healthcare provider-prescribed/supervised medication

Natural Recovery

Many individuals achieve alcohol abstinence or low-risk alcohol use (commonly referred to as moderation) without any treatment whatsoever—a process known as natural recovery. However, little is known about who is most likely to succeed without treatment.

Natural recovery is a popular choice in smoking cessation. Less than one-third of adult cigarette smokers use cessation counseling or medications approved for cessation by the Food and Drug Administration (FDA) when trying to quit smoking.

Trying to stop an addictive substance suddenly, without medical help, can be dangerous, so please discuss this with your medical provider.

Group Support

Many people manage addiction with the help of a support group, such as Alcoholics Anonymous or Narcotics Anonymous.

Groups like Al-Anon support family members and friends of people with substance use disorders. These groups offer people the opportunity to share experiences and find ongoing encouragement.

Clinical Treatment

There are many clinical options that have been successful in treating substance use disorder, including:

  • Medications: This may include medications to help treat craving and withdrawal symptoms as well as other drugs to treat underlying mental disorders such as anxiety or depression.
  • Therapy: Many behavioral health treatments including cognitive behavioral therapy (CBT) are commonly used in the treatment of substance use disorders. Individuals with substance use disorders often have negative, unhealthy patterns of thinking. CBT focuses on challenging and changing cognitive distortions and behaviors, while also improving emotional regulation.
  • Hospitalization: In some cases, people may need to be hospitalized in order to treat potentially serious complications while they detox from a substance.

Withdrawal

Withdrawal is the combination of physical and mental effects that a person experiences after they stop using or reduce their intake of a substance such as alcohol and/or drugs.

If you have been using a substance with a high potential for dependency and you stop suddenly or abruptly or you cut down your use drastically, you can experience a variety of withdrawal symptoms such as:

  • Fatigue
  • Irritability
  • Muscle pain
  • Shakiness
  • Sleeping difficulties
  • Sweating
  • Tremors
  • Vomiting

Withdrawal can be unpleasant and potentially dangerous in some cases. For this reason, you should always talk to your healthcare provider before stopping or reducing your use of a substance.

Addiction and Mental Illness

Some estimates report that about half of people who experience a mental illness will also experience a substance use disorder at some point in their lives.

Prognosis 

Addiction is considered a highly treatable disease, and recovery is attainable. Like other chronic diseases such as heart disease or asthma, treatment for substance use disorder usually isn't a cure.

The chronic nature of addiction means that for some people relapse—or a return to drug use after an attempt to stop—can be part of the process. The relapse rate for substance use disorders is estimated to be between 40% to 60%.

When a person recovering from addiction relapses, it indicates that the individual needs to speak with their healthcare provider to:

  • Resume treatment
  • Modify it
  • Try another treatment

Since 1971, the National Survey on Drug Use and Health has tracked the rates of substance use disorder in the United States. The tool is invaluable for measuring tobacco, alcohol, and drug use, as well as mental health and other health-related issues. But it has only started asking questions related to the most positive outcome of having a substance use disorder—recovery from it—since 2018, so data is limited.

In the 2019 National Survey on Drug Use and Health, among the 28.2 million adults aged 18 or older who perceived that they ever had a problem with their use of alcohol or other drugs, 75.5% considered themselves to be in recovery or to have recovered from their alcohol or other drug use problem.

Health Complications

An addiction that’s left untreated can lead to long-term consequences. Different substances and behaviors have different effects on a person’s health. These can include:

  • Cancer; for example, mouth and stomach cancer are linked to alcohol abuse and dependence
  • Infection with HIV, or hepatitis B or C through shared needles
  • Problems with memory and concentration through hallucinogen use
  • Cardiovascular disease from smoking
  • Drug overdoses, which can even prove fatal

Seek Help

If you or someone you know is struggling with substance abuse or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357. SAMHSA also provides an online treatment center location.

If you or someone you know is having thoughts of suicide, contact the National Suicide Prevention Hotline at 800-273-8255 (800-273-TALK).

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13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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