Addiction is a chronic condition in which a person engages in the use of a substance or behaviour for which the rewards provide a compelling incentive to repeatedly pursue the behaviour despite negative consequences.
Addiction may involve the use of substances such as alcohol, inhalants, opioids, cocaine, nicotine, and others, or behaviors such as pornography, internet, social media, gaming, or gambling.
Addiction symptoms and signs include:
- Fixation on addiction
- Loss of control over addiction
- Psychological or physiological withdrawal if not engaging in addiction
- Feeling a need to engage in the addiction more and more
- Low self-esteem
- Feeling a loss of control
- A history of abuse
- Depression or another mental illness
Addictive behaviours include:1
- Obsessing about the addiction. For example, always talking about it and trying to get others to do it with them.
- Seeking out and engaging in the addiction, over and over, even if it hurts themselves or others
- Not being able to control the addictive behaviours
- Engaging in more of the addiction than desired
- Denial of addictive behaviours and the existence of a problem
- Hiding of the addiction behaviours
- Failure when attempting to stop addiction; relapse
Recurrent use of a substance or engagement with an activity leading to impairment or distress, is the sine qua non of an addictive disorder. The diagnosis is based on the presence of at least two of a number of features:
- The substance or activity is used in larger amounts or for a longer period of time than was intended.
- There is a desire to cut down on use or unsuccessful efforts to do so.
- Pursuit of the substance or activity or recovery from its use consumes a significant amount of time.
- There is a craving or strong desire to use the substance or activity.
- Use of the substance or activity disrupts role obligations at work, school, or home.
- Use of the substance or activity continues despite the social or interpersonal problems it causes.
- Participation in important social, work, or recreational activities drops or stops.
- Use occurs in situations where it is physically risky.
- Use continues despite knowing it is causing or exacerbating physical or psychological problems.
- Tolerance occurs, indicated either by need for markedly increased amounts of the substance to achieve the desired effect or markedly diminished effect of the same amount of substance.
- Withdrawal occurs, manifest either in the presence of physiological withdrawal symptoms or the taking of a related substance to block them.
- The severity of the condition is gauged by the number of symptoms present. The presence of two to three symptoms generally indicates a mild condition; four to five symptoms indicate a moderate disorder. When six or more symptoms are present, the condition is considered severe.
Types of addiction range from everyday drugs like alcohol and cocaine to behaviours like gambling and stealing. Some types of addiction are specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) while others are more controversial and have been identified by some addiction professionals.
Addiction is both psychological and behavioural. They are characterised by craving, compulsion, an inability to stop using the drug and lifestyle dysfunction due to drug use.
Substance Use Addictions
- Opioids (like heroin)
- Prescription drugs (sedatives, hypnotics, or anxiolytics like sleeping pills and tranquilisers)
- Cannabis (marijuana)
- Amphetamines (like methamphetamines, known as meth)
- Phencyclidine (known as PCP or Angeldust)
- Other unspecified substances
Impulse Control Disorders
The DSM-5 lists disorders where impulses cannot be resisted, which could be considered a type of addiction. The following is a list of the recognized impulse control disorders:2
- Intermittent explosive disorder (compulsive aggressive and assaultive acts)
- Kleptomania (compulsive stealing)
- Pyromania (compulsive setting of fires)
It has been suggested one of the types of addictions is behavioral addiction. The following is a list of behaviors that have been noted to be addictive:3
- Food (eating)
- Pornography (attaining, viewing)
- Using computers / the internet
- Playing video games
- Spiritual obsession (as opposed to religious devotion)
- Pain (seeking)
A unified cause of addiction is not known.
An “addiction gene” has not been located, but addiction often runs in families suggesting a link between addiction and genetics. Studies on twins also lends support to the impact of genetics on addiction.2
As researchers continue to look at the science of addiction, more addiction theories are found. The idea of an “addictive personality” is one such theory. Addictive personalities are those that are more likely to become addicted to a substance or behaviour. It is thought people with addictive personalities have personality traits like:3
- Impulsive behaviour
- Lack of interest in goals and achievement
- Social alienation
- High stress levels
Addiction and the Brain
The impact of addiction on the brain is better understood for psychoactive substances such as alcohol and cocaine. While each substance impacts the brain differently, the addiction cycle tends to be similar:
- Psychoactive substances initially quickly produce euphoria from the flood of certain chemicals in the brain.
- After the euphoria, unpleasant withdrawal symptoms occur.
- The addict, wishing to again experience the euphoria, or to escape unpleasant withdrawal (craving), is highly motivated to use the substance again.
This cycle is thought to be, in part, because of the reward circuit in the brain. When the brain finds something rewarding (pleasurable), it creates a pleasurable memory and increases the motivation to experience pleasure again. This can alter the brain’s neurotransmitters (chemicals). Parts of the brain linked to the reward circuit and addiction include:4
- Ventral tegmental area (VTA)
- Nucleus accumbens
- Locus ceruleus
- Dopaminergic mesolimbic system
- Frontal cortex
- GABAergic inhibitory fiber system (GABA)
Addiction as a Disease
Just as an addiction gene has not been found, neither has a satisfactory decision been reached about whether addiction is a disease. Researchers and doctors can’t determine what causes addiction or how it should be treated. While the most common model of addiction treatment involves abstinence from the substance, this clearly does not work for behavioral addictions like sex addiction and food addiction (if one considers those to be addictions).
1. Recognise Triggers
This might seem like a simple task, but because triggers can be absolutely anything, it’s important to give thoughtful consideration to people, places, social situations and any feelings that normally bring about a desire to use alcohol or drugs.
Over time, many people in recovery discover triggers that they weren’t even aware of. Learning what your triggers are and developing the ability to recognize them ahead of time will help to offset the difficulties of cravings.
2. Plan Ahead
Once a person has a solid grasp of their triggers, they can act accordingly.
This might be as simple as taking a different route home from work in an effort to avoid passing a place where drugs and alcohol are used.
If you must attend a function, such as a wedding where you know alcohol will be served, create a mocktail recipe and share it with the bartender so you won’t feel out of place.
3. Accept The Urge
Rather than fight the intense craving to drink or use drugs, accept the urge and ride it out. This overwhelming feeling to drink won’t kill you and given enough time, it will subside.
Many urges will disappear in 10 to 15 minutes. If they do not, remove yourself from the situation you’re in which could possibly be triggering your urges.
In the past, you may have had a drink to cover up emotional or physical discomforts but now is the time to work through them and understand that discomforts in life are inevitable and are perfectly okay.
4. Rational Thinking
We’ve all heard the term “Stinking Thinking.” Challenge your thoughts when an urge arises and ask yourself, “Is this really what I want to do?”
“Do I want to wake up hung over, ashamed, feeling guilty and riddled with anxiety?”
Thoughts like “There is no way I can fight this” or “I might as well have a drink and get it over with” are counterproductive.
These thoughts need to be examined and stopped immediately. If a situation is causing you to want to drink, examine your thoughts.
For example, you’re having a bad day at work and the boss just reamed you out.
Instead of rushing off to the local pub, analyse the conversation and pull out nuggets of information that you can improve on to better perform at work.
5. Distractions and Replacement
If a stressful situation can’t be avoided, distractions are a great way to overcome urges.
Create a list of healthy distractions that you can refer to if a craving is overwhelming so you don’t have to think too much.
Distractions can be anything from a brisk walk or run, swimming laps, calling a friend, reading a book or cleaning.
Choosing an exercise, offers the added bonus from a boost of endorphins, which will help to reduce the stress and anxiety you may be feeling.
Practice mindful meditation to find a peaceful resolution. Visualise yourself going through the motions of your distraction to help you to get started.
This will ease any anxiety and fear that can trigger cravings. Keep a positive attitude, and understand that with practice, healthy habits will override negative ones.
6. Participate in Relapse Prevention Therapy
There are many 12 step and non-12 step alternatives where people in recovery from drugs and alcohol can learn the necessary skills to avoid relapses.
Cognitive Behavioral Therapy is an incredibly useful tool that develops a positive skillset in recovery and helps people understand the relationship between thoughts, emotions, and behaviours.
The most important thing to remember is that recovery from addiction takes time and relapse is a natural part of the disease, just as experiencing triggers or cravings are a normal part of recovery.
Instead of feeling guilty or depressed, staying focused and positive can lead to a happy and healthy sober lifestyle.
While addiction treatment has been primarily studied in the areas of substance abuse, many of the same therapies are used in other types of addiction as well. Addiction treatments include:
- Psychopharmacology (drug therapy)
- Inpatient rehabilitation
- Outpatient treatment programs
- Support groups
- Self-help programs; lifestyle changes
- Therapeutic community living
Addiction treatment plans often include multiple forms of treatment for the best results. Quality addiction treatment centres will also take into account the possibility that more than one addiction, or mental illness, may be present in an individual.
The following types of addiction therapy have been shown effective through scientific study:1
- Cognitive Behavioral Therapy (CBT) – focuses on altering the addict’s faulty beliefs which perpetuate the addiction. The goal is to change addiction-related behaviours.
- Multidimensional Family Therapy – an addiction therapy primarily created for adolescent addicts and their families; designed to improve overall family functioning.
- Motivational Interviewing – enhances and capitalises on an individual’s willingness to treat their addiction.
- Motivational Incentives – primarily used in drug addiction treatment. This addiction therapy uses rewards for positive drug screening tests as a motivational tool to continue staying clean.
- Individual and group counselling – a variety of help for addiction can occur in these formats. Common in individual addiction therapy is psychodynamic therapy, while group addiction therapy is often in the form of a support group.
Addiction rehabilitation, or rehab, is simply the process by which an addict gets better. Addiction rehab can happen at residential addiction treatment centres, hospitals or outpatient clinics. There is no standard form of addiction rehab but most programs offer combinations of education, therapy, support and focus on overall health and life skills. The most effective addiction treatment services offer treatment customised for the individual and are available for a longer period of time, such as six months or more.
While addiction is complex, overcoming addiction is possible with proper addiction treatment. Each person’s addiction treatment plan is different and must be adhered to if an addiction is to be overcome. Elements of an addiction treatment plan that require ongoing adherence include:2
- Taking medication as prescribed
- Attending all medical and therapeutic appointments
- Creating a network of people who can support you while you overcome addiction
- Learning about the addiction and its treatment
- Proper diet and exercise
- Reducing life stressors and learning how to cope with stress to avoid relapse
- Getting additional addiction treatment help when needed
- AIHW. (2017). National Drug Strategy Household Survey (NDSHS) 2016 – key findings. Retrieved from www.aihw.gov.au.
If you are struggling with addictions, a Life Psychologist may be able to help.
- Life Psychologists are highly trained and qualified professionals, skilled in providing effective interventions for a range of mental health concerns, including addictions.
- A Life Psychologist can help you to identify and address factors that might be contributing to your addiction and the most effective ways to address addiction using techniques based on best available research.
- Life Psychologists usually see clients individually, but can also include family members to support treatment where appropriate.
A medical check-up with a GP might also be helpful to see if there is an underlying health issue.