Addiction Explained

Addiction refers to not having control over the use of a substance or repetition of a behaviour which may be causing harm to the individual or to people around them (1). The word addiction is derived from a latin term meaning “enslaved to” (2). It is possible to be addicted to anything, since the addiction refers not to the substance or behaviour itself, but rather to it’s impact on the person’s life and the sense of feeling unable to gain control over it.

Addiction alters brain chemistry and the way that the individual engages with the object of their addiction and with other parts of their life as well. There are three main ways that addictions influence the individual (2):

  • Craving for the object of their addiction
  • Loss of control over the use of the object
  • Continuing use of the object of addiction despite the fact that it is causing physical or psychological harm to their life

Some of the more common addictions in our society are smoking, gambling, use of illicit substances, misuse of prescription medications, sexual addiction and more recently, addiction to technology. Some addictions occur with issues that may be part of ordinary life, however the way that the addicted person engages with this activity or substance may differ from ‘ordinary usage’ in that the way the person engages with it may be reckless or harmful and may be associated with a feeling of being outside of the person’s control, such as in the case of a shopping addiction, or compulsive over or under-eating.

Addictions can have negative consequences on all areas of your life. Substance misuse difficulties can cause harmful effects on the body and mind. In addition the very nature of addiction can cause people to withdraw from family and friends, and to experience difficulties at work. These issues lead to stronger feelings of isolation and difficulties in living which can reinforce the desire to engage in addictive behaviours as a means of escape and coping with stress.

Causes of Addiction

Someone may start to engage in a behaviour without expecting it to develop into an addiction. Behaviours can occur in social contexts, such as trying cigarettes, alcohol or illicit substances for the first time. Alternatively someone may seek out the behaviour as a way to ‘fix’ a problem, such as gambling due to financial concerns.

Addiction is recognised as a chronic disease which alters the structure of the brain and the way it functions (3). Genetic vulnerability contributes to the risk of developing an addiction, but by no means predicts that addiction will occur. In order to understand the cause of addiction, we need to understand the pleasure principle (3).

The Pleasure Principle

All pleasurable activities are experienced in the brain the same way, through a release of the neurotransmitter dopamine in a particular region of the brain called the nucleus accumbens. This is known as the ‘reward centre’ of the brain. The likelihood that a particular activity or substance will lead to addiction is directly related to the speed and amount of dopamine that is released in response to it (3). Addictive substances such as cocaine, amphetamines and “legal highs”, etc. operate by flooding this part of the brain with dopamine artificially. Smoking or injecting a drug cause a faster release of dopamine than swallowing a tablet, making substances that are ingested this way more addictive to the brain.

The reward circuitry of the brain is closely connected with the way that learning and memory are formed as well (via another related neurotransmitter, glutamate). It is hypothesised that because the brain is flooded with dopamine and glutamate when a highly pleasurable activity takes place, the brain learns to form a strong association between the behaviour and the release of pleasure, causing the individual to have a strong urge to seek out this behaviour again and again.

Addictive drugs and behaviours can cause a release of dopamine that is up to 10 times more powerful than that provided by more natural pleasures in life. This is something that the brain cannot cope with and the brain receptors become overwhelmed. In response to being overwhelmed by floods of dopamine, the brain then needs to protect itself. It starts to produce less dopamine in response to the trigger, and also in response to anything else in the person’s life. It may even reduce the number of dopamine receptors available to ‘receive’ the dopamine. These are two strategies the brain may use to protect itself from excessive dopamine secretion. The result of this is reduced pleasure from regular activities and reduced pleasure from the addictive stimulus that caused the overwhelming release of dopamine in the first place. In effect, the addictive substance feels like it is no longer ‘working’, which means that it is not producing the same dopamine high as it did previously. This process is known as tolerance.

At this point, compulsion takes over. The person no longer gets the same sense of pleasure from the substance or behaviour that they were used to. However they continue to crave the pleasure which the brain now associates with that particular substance or activity. The person’s behaviour may become increasingly reckless as they take more and more of the substance, or engage more and more with the activity that produced the original ‘high’, desperately trying to get back to the feeling that they had when they first started. This will never be possible however, because the brain has changed it’s structure to cope with the dopamine differently. As a result, the individual may start to experiment with different substances, or different behaviours, trying to attain that same state of pleasure as before.

In addition to the tolerance described above, the part of the brain associated with memory and learning, which has also been flooded during the reward circuit, has been taking in environmental and situational cues which have become strongly connected with the sense of pleasure that the substance or behaviour produced This means that being in the same environments or even with the same people can cause intense cravings. This explains why someone who is working on their journey towards sobriety can feel very overwhelmed with cravings when they encounter the same or similar environment to one they connect with their addiction, for instance a bar or casino, the sight of drug paraphernalia or the friends that they normally engage in the pleasurable behaviours with.

Types of Addiction

Someone can be addicted to anything since addiction refers to the way the person engages with a substance or behaviour, rather than the substance or behaviour itself. However, typically, the following list covers the most common kinds of addictions:

  • Alcohol addiction 
  • Behavioral addictions 
  • Cannabinoid addiction 
  • Nicotine addiction 
  • Opioid addiction  
  • Psychostimulant addiction 
  • Food addiction 
  • Gambling addiction 
  • Sexual addiction 

The Stages of Addiction

The process of developing an addiction to a substance or to certain activities or behaviours can be broadly broken down into 5 stages.

Stage 1: Pattern of usage 

After the first time using a substance or engaging in an addictive behaviour, the person may begin a habit of using it regularly. This usage may have characteristic features, such as ‘track marks’ on the arms of a heroin user. Signs of a shopping or gambling addiction may be that the person begins to complain of financial difficulties or to appear as though they are struggling with their finances. The signs of each different form of addiction will have their own characteristic features which could indicate that the person is beginning to develop a habit of using the substance or behaviour. 

Stage 3: Tolerance 

When the brain becomes flooded with excess dopamine, it may seek to self-regulate by decreasing the amount of dopamine released in response to a substance or behaviour, or even removing dopamine receptors (the neurons that ‘receive’ the dopamine) so that the brain is less overwhelmed. The addicted person becomes tolerant to that particular substance or behaviour and no longer able to attain the desired state of pleasure. This is experienced as frustrating, and the person then seeks to regain that level of ‘high’. In doing so, their behaviour may become more risky. Pleasure in other activities will diminish, meaning that the cravings start to take on a very central role in that person’s life. 

Stage 2: Recklessness 

The way the person engages with the habit may become more reckless as their brain and body adjust to the substance or activity and get more used to it. This may mean engaging in more reckless decision-making, or combining a range of substances because the high from one alone no longer feels like enough. This is incredibly risky because the dangers of misusing substances are increased when they are combined. 

Stage 4: Dependence 

Once the person is regularly using substances or engaging in addictive behaviours and has become tolerant, they will start to experience unpleasant effects when not using the substance or behaviour. This is known as ‘withdrawal’ and can be extremely unpleasant. The person may not be able to tolerate withdrawal symptoms and as a result becomes dependent on the substance. Whether they wish to or not, the person may feel that they have to take it or engage with the activity to avoid the withdrawal symptoms.

Stage 5: Substance Disorder

By this stage, the person is so embroiled with the substance and their dependence on it that their quality of life is suffering because of it. It may be damaging their work life, family life, social life, health, however the person feels powerless to disengage from the cycle.

Psychology of Addiction

Psychology looks at understanding the emotional and mental health reasons underlying a particular kind of behaviour. Although neurobiology can help us to an extent to understand how addiction takes place, it doesn’t necessarily explain why an individual may start to use substances in the first place, or why one person might be more likely than another to develop an addiction. To understand this we need to look to psychology to understand the traits and personal qualities that may make one person more susceptible than another. Psychologists have found that impulsivity and sensation seeking qualities might be strongly linked to the vulnerability to developing an addiction (4).

It has also been found that people who come from a background of trauma or abuse might be more susceptible than others to developing a substance misuse disorder. This may be because they are using the substance to ‘self-medicate’. Self-medication refers to a person’s attempt to alleviate painful feelings or unmanageable levels of stress or psychological discomfort through the use of substances. Finally, it is well established that there is a strong link between ‘comorbid’ (meaning occurring at the same time) addiction problems and mental health issues. The two may be linked in a cyclical manner so that one problem may exacerbate the other and create a ‘downward spiral’. This is known in medical settings as ‘dual diagnosis’ and requires different treatment options to addiction treatment alone.

Understanding Addiction and Physical Dependence

Behavioural psychology looks at two opposing modes of control which can influence how a person engages with addictive substances or activities. These are known as stimulus control and cognitive control.

  • Stimulus control of behaviour refers to the way that the brain associates particular stimuli with pleasure, and treatment that uses a stimulus control approach would seek to understand what kind of stimuli the individual associates with their addiction. For instance, it may be that a specific location triggers strong cravings, in which case the work would be assisting the person to create plans and strategies to avoid going to that location.  
  • Cognitive control of behaviour refers to the cognitive mechanisms for controlling behaviour to avoid the substance or activity that they are addicted to.
    It has been found that measures of cognitive control are impaired in people with addictions. Cognitive therapy teaches and build upon necessary cognitive skills required to manage living with an addiction.

Co-Occurring Disorders: Mental Health Issues & Addiction

Comorbidity refers to the fact that two conditions can exist at the same time, whilst avoiding pointing to either one specifically as the cause of the other. The relationship between mental health and substance abuse is complicated and interlinked. Use of substances can lead to an exacerbation of mental health symptoms, for instance use of cannabis can be linked with symptoms of psychosis (the experience of hallucinations or delusions) (5).

In addition some people experiencing symptoms of a mental health disorder may use substances to “self-medicate” (manage their negative psychological states through the use of substances such as drugs or alcohol) which may in turn may increase symptoms of poor mental health. This is known to be particularly relevant to people suffering from trauma, for instance from childhood abuse or post-traumatic stress disorder. There is some evidence that addiction and mental health issues may originate from the same root causes, such as genetic predisposition or childhood trauma (5).

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How Substance Abuse Impacts Your Mood

One of the trickier aspects of a substance abuse disorder is the way that it restructures your brain. Once the addiction has taken hold, the person has to contend with the mood effects that take place as a result of the substance itself, such as the highs and lows of ‘coming up’ and ‘coming down’ from drugs, aggression or depression from alcohol use, psychosis and paranoia from cannabis, etc. There is then the withdrawal effects – i.e. the physiological and psychological effects of not being on the substance. A person suffering withdrawal may appear very agitated or even aggressive, and may seem preoccupied and unhappy. Finally, the changes in the brain structure mean that everyday life feels less enjoyable, meaning that daily activities can feel ‘pointless’, unimportant and difficult to attend to.

Signs and Symptoms of Addiction

The main indication that someone has developed an addiction is evidence that they are regularly using a particular substance or engaging in a particular behaviour on a regular basis despite the fact that doing so is causing some kind of impairment, be it physiological, psychological or detrimental to the person’s life in some way. Generally when an addiction is diagnosed, at least two of the following signs and symptoms are required to be present in addition to the main, most obvious sign that there is the recurrent usage of the substance or behaviour:

  • The use of the substance continues in larger amounts or over a longer duration that was originally intended
  • The individual expresses a wish to reduce or stop engaging with the substance or behaviour but feels unable to do so
  • The use of the substance or activity, or recovering from using it, starts to take up a significant amount of the person’s time
  • The person is struggling with a very strong desire or craving to use the substance or behaviour
  • Using the substance or engaging in the activity is disrupting the person’s obligations at home, work or school
  • Despite the fact that the substance or activity is causing the person problems, the person continues to engage with it
  • The person is disengaging with social activities, work or recreation that were once important to them
  • The person is putting themselves at risk by engaging with the substance or behaviour
  • The person may be fully aware that the problem is causing physical or psychological problems but feel unable to stop
  • The person has developed tolerance to the substance or behaviour, meaning that the amount that they had been using no longer achieves the required effect, causing an urge to increase the amount used
  • The person starts to experience withdrawal symptoms, meaning that they experience physical or psychological negative effects when they do not use the substance or engage in the behaviour

The severity of the person’s addiction can be broadly categorised by how many of the above symptoms are present. Generally two to three symptoms represents a mild condition; for to five symptoms indicates a moderate addiction disorder, and the presence of six or more of the above symptoms would suggest that the addiction should be considered to be severe (4).

Diagnosis of Addiction

A diagnosis of an addiction requires a mental health professional, this is not something that you should determine on your own for yourself or someone you care about. The diagnosis is complex and may require collaboration between GP, psychologists and psychiatrists and a comprehensive assessment of the individual’s present difficulties as well as their family and personal history. It is important for mental health professionals to be able to assess the person so that they can rule out any comorbid diagnoses. Comorbid refers to the fact that two different presenting issues can exist at the same time and can make diagnosing and formulating about the condition more complicated. For instance, someone might present with substance misuse, however in the assessment with a psychologist it may be found that the substance misuse is connected with other mental health issues. This would be called ‘dual diagnosis’ and may be treated and managed in different ways than if the problem had been found to be substance misuse alone. This is why it is essential that the person undergoes a full assessment from a mental health practitioner.

Consequences of Addiction 

Addiction can have catastrophic effects on a person’s emotional and physical wellbeing. Each different type of addiction will present with different kinds of risks to someone’s health or the quality of their life. For instance, drug abuse brings about risks to the person’s mental health, physical health, to their ability to manage their life moving forward and to maintain the things that are most important to them such as their jobs and families. Sexual addiction, on the other hand, presents with completely different kinds of risks, such as the risk of catching STDs or the risk of hurting loved ones through impulsive sexual behaviours.

Gambling, on the other hand, presents a financial risk which can be catastrophic to the life of the person and anyone whose finances are connected with them.
What all addictions hold in common however is the risk that the addiction ‘takes over’ This means that as the structure of the brain changes, the object of the addiction becomes more important to that person than anything else. Normal life activities lose their pleasure and meaning to the person, as a result of decreased dopamine levels and decreased dopamine receptors. Soon the individual can only get pleasure from their addictive substance or behaviour, and things that were once important to them no longer seem to matter. When this happens, it can be hard for the person to hold onto their priorities or maintain ‘perspective’. Things that seem commonsense to those of us not afflicted with addiction, such as holding onto a job to pay your mortgage, working on a relationship to keep your marriage working, even caring for children, can easily slip into the background for someone whose brain has adapted to substance dependency.

Dangers of Multi-substance Addiction 

Multi-substance addiction presents its own unique challenge due to the risks involved with using multiple substances at one time. The risks of any illicit substance are increased when combined with another substance. Studies have shown that use of multiple substances causes damage to the brain and can seriously impact on memory and ability to learn new information (6)

Living With & Managing Life with Addiction 

Addiction can cause permanent negative consequences to the lives of the person living with it and the people closest to them. Because of the changes addiction makes to the structure and function of the brain, it can be incredibly difficult to manage on your own. It is advisable to speak to a GP, or to speak to a GP on your loved one’s behalf, to start seeking support in managing this complex condition. 

Helping Someone with Addiction

Approaching someone who is struggling with this condition can be complex and emotionally challenging. Some treatment centres offer support with the initial intervention to provide emotional guidance and expertise. It is advisable for people caring for or living with people who struggle with addiction to seek support for themselves as well. Please speak to your GP or see the resources provided at the end of this article for ideas of organisations that may be able to provide additional support for relatives and friends of those struggling with addiction.

Top Risk Factors for Addiction

Addiction is an incredibly complex and multi-faceted condition that comes about for a wide variety of reasons. It cannot be located to a single cause, however there may be certain risk factors which make some people at higher risk of developing an addiction than another. These can be broadly categorised under the brackets of genetic, environmental and epigenetic factors.

Genetic factors

It is estimated that genes can account for approximately half of the risk of developing a substance disorder (4). One genetic issue that may account for some elements of addiction is a gene which is responsible for the the way the brain receptors receive dopamine. This may make someone more susceptible to the dopamine high that leads to addiction. Another genetic factor may be the way that the body responds to stress. Someone who has greater resilience may be less prone to developing a substance disorder.

Environmental factors

Certain elements of family life can influence a person’s susceptibility to substance misuse disorders. The risk is raised by growing up with a deficit in parental support (4) and having relatives with substance misuse issues. Emotional, physical or sexual abuse increase the risk of a person having issues with substance misuse, as does poor quality of relationship between child and parent. Another environmental factor is the ease of accessibility. Having easy access to substances, for instance alcohol, increases the risk of someone developing a habitual relationship with alcohol which could turn into an addiction. People are strongly influenced by their social circles and being around ‘bad influence’ peers who misuse substances increases the risk of developing an addiction. Finally, social class, perceived social mobility and having a stable job and career prospects is a protective factor against substance misuse.

Epigenetic factors

Epigenetics refers to the ways in which our environment and upbringing may influence the way that our genes are ‘expressed’, that is how they manifest in actual behaviour and outcomes. It may be that two people have the exact same gene, but in one that gene manifests in a particular quality, such as developing an addiction, whilst in another it doesn’t. Scientists call this field of research epigenetics and there has been a lot of interest in recent years in how the study of epigenetics can improve our understanding of addiction (7). Fascinatingly, some research has shown that epigenetics can even be passed down to offspring, influencing the behaviour of our children. This shows how fundamental the study of epigenetics is to our understanding of human behaviour and specifically addiction.

Psychology often looks to ‘twin studies’ to understand the role of genetics in understanding a particular trait or behaviour. This is because identical twins carry the same DNA, but may be exposed to different environmental factors, say for instance if they were separated at birth, and studying this can allow psychologists to draw conclusions about the ways that the same gene can be expressed differently, or how different environmental factors can act upon genetic information. In the field of addiction, epigenetic scientists have found that substance misuse can actually change the individual’s DNA.

One study showed that heavy cocaine use shaped the DNA of how the brain’s reward centre worked (6). An important study from McGill University and Bar Ilan University found that it may be possible to alter these epigenetic changes through medication. Whilst DNA itself cannot be changed – DNA is inherited from your parents and will be passed on to your children – epigenetics refers to the ways in which the genes are ‘switched on and off’. They found that they could use epigenetic treatments to reverse the changes that took place as a result of heavy cocaine use, in effect returning the brain to the state it was in before heavy cocaine use had altered it (8) This presents a radical shift in the way that we think about addiction treatment and poses some interesting areas for development in the future.

How to Prevent Addiction

At this point, compulsion takes over. The person no longer gets the same sense of pleasure from the substance or behaviour that they were used to. However they continue to crave the pleasure which the brain now associates with that particular substance or activity. The person’s behaviour may become increasingly reckless as they take more and more of the substance, or engage more and more with the activity that produced the original ‘high’, desperately trying to get back to the feeling that they had when they first started. This will never be possible however, because the brain has changed it’s structure to cope with the dopamine differently. As a result, the individual may start to experiment with different substances, or different behaviours, trying to attain that same state of pleasure as before.

Cost of Addiction to Families and Society

The costs of addiction are numerous and complex. On a financial level the costs can accumulate in a number of ways. The costs of maintaining a habit can be limitless, and as the person becomes more entrenched in the addiction, their values change to accommodate the addiction so that savings and other priorities no longer feel as important as satisfying the cravings. In addition an addiction can overrule someone’s life so much that they are unable to hold onto their job, causing further financial strain.

On an emotional level, the addiction can cost the person their relationship with their family, who can struggle to manage the emotional toll that addiction takes. Children who grow up with parents who struggle with addiction are more likely to suffer themselves. Society suffers when drug addiction uses up valuable government resources, when crime is increased in connection with addictions and when people are experiencing mental health difficulties connected with their addictions.

Types of Addiction Treatment

  • Addiction withdrawal and detox – specialist support to manage the early stage of terminating substance use, when cravings will be strongest. Detox provides medicalised support to manage the physical and psychological impact of withdrawal symptoms.
  • Treatment and Rehab – the detox process is primarily about managing the physical symptoms of withdrawal. The next stage of the process involves psychological support and teaching skills to manage the addiction long term.
  • Medications used in addiction treatment – benzodiapines, antidepressants and specific medications to manage opiate withdrawal may be used
  • Behavioral therapy for Addiction – behavioural therapy may include teaching skills to learn to manage cravings, to manage stress and difficult feelings and to rebuild your life after a period of addiction

Addiction Support Groups in the UK

There are a wide range of support groups available all over the country which cater for specific addictions and needs. There are groups which are available for people who are suffering with addiction themselves, such as Alcoholics Anonymous and Narcotics Anonymous. There are also a wide range of groups available for family members and those close to the person struggling, for instance UKAT offer support groups specifically for family members https://www.ukat.co.uk/family-support-programme/.

Addiction Statistics

  • Genetic factors account to approximately 40-60% of the risk of a person become addicted to a substance
  • Research shows that age at which someone first drinks alcohol has an influence on addiction. 16% of alcoholics began drinking before the age of 12
  • The National Bureau of Economic Research found that there is a “definite connection between mental illness and the use of addictive substances”  with people with mental health difficulties also having difficulties with the following areas: 38% with alcohol, 44% with cocaine, and 40% with cigarettes

Related FAQ’s

What Is Addiction?
Addiction is a process of becoming dependent on a substance or activity and feeling unable to control cravings or stop doing or using it 
How Is Addiction Treated?
Addiction is best treated at specialist rehabilitation centres where medical and psychological support can be provided to manage the wide range of symptoms and difficulties that occur during withdrawal and long-term
How do you become an addict?
Most people start using a substance or engaging in an activity with no idea that they will become addicted to it. The addiction takes place once a habit for using the substance or engaging with it sets in and the person starts to become tolerant to the substance and then dependent on it
What happens to the brain when a person takes drugs?
The brain becomes overwhelmed by a release of dopamine, which floods the reward centre of the brain. To protect itself from this, the brain reduces the amount of dopamine released, or the numbers of dopamine receptors, causing the person to require more and more of the substance to achieve the required effect. The person starts to experience withdrawal symptoms when they don’t have it, this is known as dependence.
What is the Difference between Drug or Alcohol Abuse and Addiction?
Substance abuse becomes an addiction when the brain starts to protect itself from it by reducing dopamine and/or dopamine receptors, so that the person feels an urge to take more and more of the substance, and they suffer negative effects when they are not taking the substance.  
Why do some people become addicted to drugs while others don’t?
There are a number of risk factors that can make one person more likely than another to develop an addiction. This can include hereditary factors and environmental factors such as growing up in a challenging or abusive background, poverty, difficult family relationships, isolation. 
Can addiction be cured?
Most treatments for addiction focus on learning how to manage the symptoms of addiction on a long-term basis. Many people learn to cope with their addiction so well that they no longer struggle with cravings and can return to normal functioning. 
How Long Should You Expect Withdrawal Symptoms to Last?
In general the most severe withdrawal effects last 48 hours, and can continue for as long as 1-2 weeks 

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