Addiction Psychology Explained
Addiction is fundamentally a brain disorder – and although its core pathology is a biological process, a significant number of psychological and psychosocial factors are also involved in the development, and maintenance, of addiction.
What is the Psychology of Addiction?
A great deal of study and research have gone into the psychological basis of addiction – and not all experts are in complete agreement about the precise degree to which psychology, rather than biology, drives the condition, nor about how it manifests psychologically once it has developed. However, while it is clear that some aspects of what is commonly known as “addiction” are more physiological than psychological in nature and that the core mechanism underpinning the vast majority of behavioural and drug addictions is a biological one, it is accepted that psychology does play key roles in how and why certain individuals become, and potentially remain, addicted.
Addiction psychology is the psychological study of addiction, its causes, effects and possible approaches to treatment. A wide range of different perspectives on the condition of addiction can be found within the psychology community, and a great variety of therapeutic models have been developed and refined for use in the treatment of the condition, some of which are typically employed alongside the provision of certain medications. A psychological approach, including psychotherapy, lies at the heart of almost all modern addiction treatment.
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How Can a Habit Become an Addiction?
When an individual engages in a specific behaviour, whatever it may be, their brain may respond to the stimulus represented by that behaviour by judging it to be “rewarding”: their brain’s reward system will create the impulse to repeat that behaviour – either because it is intrinsically pleasurable or because it is extrinsically rewarding – via the production of chemicals such as dopamine which drive what is known as motivational salience.
The more someone engages in a rewarding behaviour, the more they become conditioned to want to repeat it in order to achieve and sustain the positive feelings created by dopamine and other chemicals – and to avoid the negative feelings which result from a lowered level of dopamine in the absence of the behaviour in question. In this way, what may begin as something merely habitual (behaviourally routine) can transform into an addiction, as the affected individual’s reward system becomes disordered and they are compelled to repeat the addictive behaviour, until and unless they can achieve a neurochemical rebalancing.
The Disease Model of Addiction versus The Choice Model of Addiction
Psychologists investigating addiction have traditionally fallen into one of two camps: those supporting the disease model, and choice model, of addiction respectively.
The disease model of addiction sees addiction as being a disease, with potential biological, genetic and/or environmental origins. This model attributes addiction to developments in the brain – in particular, in the mesolimbic pathway – which may or may not result from any conscious choices the affected individual may make. Because of the neurological basis of the disease model of addiction, those espousing it may believe that a pharmaceutical – or even surgical – cure for addiction itself might be found which could “heal” the affected areas of the brain and remove the compulsion to engage in addictive behaviour.
On the other hand, the choice model of addiction places the responsibility for the development of the condition on the shoulders of the addict themselves. According to this model, it is the conscious choice to engage repeatedly in addictive behaviour, despite the awareness of any negative consequences of doing so, which leads to addiction. Supporters of this model typically believe that no pharmaceutical or surgical cure for addiction is possible and that the addict must work to change their behaviour in order to achieve and sustain abstinence through conscious decision-making.
Individual Differences and Susceptibility to Addiction
Not everyone is equally susceptible to addiction; indeed, scientists are not yet fully in agreement as to why one person may develop an addiction while another may not. However, a number of factors which can contribute to the condition have been identified.
Addiction is known to be a heritable condition: a family history of addiction is one of the most prominent risk factors for the emergence of the condition in an individual. Moreover, the genetic basis of addiction is increasingly well understood: an overexpression of DeltaFosB in the mesolimbic pathway is associated with nearly all cases of addiction.
Various personality disorders – disorders causing significant impairments to personal and interpersonal functioning which do not result from a medical disorder – are associated with an increased likelihood of addiction, especially substance addiction, perhaps as affected individuals seek to ease the psychological burden of their conditions, or to relieve feelings of worthlessness or social incompetence.
Psychological coping strategies
Many individuals suffering from stress or the effects of trauma turn to substance abuse or other superficially rewarding behaviours as a coping mechanism. These behaviours can become addictive, often very quickly, as the individuals in question engage in them even more frequently, and perhaps to a greater extent than is commonplace as they seek distraction or escapism from their troubles.
Mental disorders and addiction
Mental disorders and addiction are often closely related. Some mental disorders drive compulsive behaviour directly, which becomes addictive almost by definition. Other disorders can drive addictive behaviour (especially substance abuse) as a means of self-medication or escapism, and can also result from addiction itself.
Dual diagnosis and addiction
When a substance use disorder co-occurs alongside another mental health disorder, the condition is known as dual diagnosis. Dual diagnosis is extremely common in cases of addiction and typically makes treatment significantly more complicated (as both disorders need to be treated simultaneously, and the treatment of one can often interfere with that of the other).
Psychological Mechanisms of Addiction
Numerous psychological mechanisms associated with the development of addiction have been identified.
The rebound effect is the emergence, or re-emergence, of symptoms which may have been suppressed or controlled while an individual was taking a medication or consuming a substance of abuse, after cessation of use. The symptoms in question may reoccur in a more severe manner than was initially the case. For example, someone taking medication to deal with insomnia may experience even worse episodes of insomnia once they come off the medication in question. The rebound effect drives addiction as affected individuals feel compelled to keep consuming a drug, regardless of any negative consequences, in order to stave off unpleasant symptoms; rebound can also occur as a symptom of withdrawal.
In behavioural psychology, “reinforcement” refers to the strengthening of a behavioural response over time when preceded by a specific stimulus. Reinforcement may be positive or negative and both can contribute to the development of addiction, though typically positive reinforcement is more common, in the form of the positive feelings and experiences which result from, for example, the consumption of substances of abuse and which are subsequently sought out by individuals, thus riving the repeated engagement in substance abuse.
The reward system is the name for the parts of the brain responsible for motivation, desire and cravings which drive the impulse to engage in (or avoid engaging in) particular behaviours. The brain’s reward system comprises all or part of a large number of different areas and structures, connected by neurons of various types, and abnormal behaviour in any of these areas of the brain can drive the compulsion to engage in addictive behaviour. Addiction is fundamentally a disorder of the reward system, though scientists and psychologists are not yet fully in agreement as to specifically how this disorder develops.
Sensitisation is a process by which the repeated exposure to a particular stimulus results in the amplification over time of the response to that stimulus. For example, someone gambling for the first time may experience a pleasurable response to that experience; however, if they continue to gamble they may become sensitised to that behaviour: they may experience an increasingly intense response to the act of gambling. Sensitisation can also occur in cases of substance abuse: drug sensitisation involves the experience of increasingly enhanced effects following repeated consumption.
Brain Structures, Hormones and Addiction
A number of different parts of the brain, and hormones acting within and upon them, are fundamental to addiction.
Dopamine and addiction
Dopamine is a hormone and neurotransmitter which plays a number of important roles in the human body, including driving motivational salience (the compulsion to engage in or avoid particular behaviour). Dopamine is often described as a “pleasure chemical”, though it is more accurately thought of as causing feelings to reward rather than pleasure specifically. Anticipating reward increases the level of dopamine in the system, thus creating the desire for that reward; meanwhile, many addictive substances of abuse either increase dopamine release or inhibit its reuptake into the system. A deficiency of dopamine creates unpleasant sensations and emotions, the avoidance of which further drives addictive behaviour.
The nucleus accumbens is a region of the basal forebrain (towards the front and base of the brain) which together with the olfactory tubercle forms the ventral striatum. The nucleus accumbens is a key area associated with motivation and reward, and therefore related to the experience of pleasure; it is an endpoint of the mesolimbic pathway down which dopaminergic neurons (transmitting dopamine) project, and an overexpression of the gene transcription factor DeltaFosB in the nucleus accumbens is now thought to be the primary mechanism as a result of which addiction (behavioural and substance-related) develops.
Serotonin is a neurotransmitter commonly thought of as contributing to feelings of happiness, wellbeing and pleasure, though its true function is significantly more complex, relating to reward, memory, cognition and learning as well as a number of physiological processes including the regulation of appetite, mood and sleep. Many substances of abuse, including a number of psychedelic hallucinogens, increase the production of serotonin, as do certain antidepressants. The desire to experience the positive feelings associated with serotonin production can drive addictive behaviour, as can the compulsion to avoid the negative feelings resulting from serotonin depletion, especially in the aftermath of substance abuse.
Neuroplasticity is the ability of the brain to change over the course of a person’s life: for example, the proportion of grey matter in the brain may change, as can the strength of certain neural networks. The regular engagement in addictive behaviour can lead to a restructuring of key parts of the brain which can reinforce addiction and make it significantly more difficult for an affected individual to overcome the condition. Likewise, certain forms of substance abuse can drive aspects of neuroplasticity which can cause the reinforcement of addiction as well as negative long-term effects such as cognitive impairment.
Addiction Psychology and Dependence
Psychological dependence is a condition of reliance upon a particular substance or behaviour for normal psychological functioning, which results in the manifestation of psychological withdrawal symptoms upon the cessation of the substance use or behaviour in question. Psychological dependence develops over time as a person repeatedly engages in a particular behaviour and adjusts psychologically to the repeated experience of the effects of that behaviour (including substance abuse).
Psychological dependence is distinct from, though closely related to, the phenomenon of addiction itself: it can often contribute to addiction as affected individuals feel compelled to engage in repeated substance abuse or other addictive behaviours in order to avoid or dispel the unpleasant psychological symptoms of withdrawal which they experience when they stop using a given substance or engaging in a given behaviour. Psychological dependence is differentiated from physical dependence by the nature of the symptoms of withdrawal associated with each condition (though they often co-occur, and some cases of psychological dependence involve physical symptoms manifesting psychosomatically).
Psychological dependence is typically treated through detoxification and subsequent psychotherapy; long-term pharmaceutical management of withdrawal symptoms may be required.
Modalities of Treatment for Addiction
Because addiction – especially addiction to alcohol and other drugs – affects many millions of people worldwide it is now considered a serious public health issue, and the treatment of addiction is now a highly sophisticated field, with a huge amount of research ongoing into various aspects of the phenomenon. Many different approaches to treatment, from numerous different philosophical perspectives, are applied. With treatment provided around the world by public, private and third-sector organisations.
Most modern approaches to treatment are based on a combination of detoxification and psychotherapy, with medication also often provided. There is a general consensus that the most effective form of addiction treatment is residential rehabilitation, with addicts staying onsite to receive treatment in a dedicated facility, though various other formats are also known to be successful in many cases.
Recovery from addiction is typically considered a long-term, even lifelong, process continuing long after the completion of any addiction treatment programme in which an addict may engage, and numerous organisations exist worldwide providing support to recovering addicts outside the confines of a treatment environment.
- Detoxification and Medically Managed Withdrawal
- Long-Term Residential
- Short-Term Residential
- Outpatient Treatment Programmes
- Individualised Drug Counselling
- Group Counselling
- Intensive Outpatient Program (IOP)
Benefits of Addiction Treatment and Rehab Centres
Residential rehabilitation (“rehab”) is commonly considered to be the most effective form of addiction treatment. In rehab, addicts stay onsite (typically for between 30 and 90 days, though the duration of treatment varies considerably from one case to the next) to receive treatment in a secure, confidential, peaceful and substance-free environment designed with healing and thoughtfulness in mind. Addicts in rehab benefit from the 24/7 presence of medical professionals highly experienced in the treatment of addiction, and from the presence of fellow recovering addicts who can provide much-needed support, advice and simple companionship.
Rehabs typically divide treatment into a detoxification phase and a subsequent rehabilitation phase with therapy at its heart; they will typically also provide up to a year’s free aftercare for clients who have been through treatment to ensure the best possible foundations for recovery.
Addiction Psychology and Counselling
Counselling is often invaluable during both the treatment of addiction and the subsequent recovery phase. Counsellors address and advise on specific issues and many addicts find counselling to be literally life-saving, especially early on in treatment when they may be struggling with the overwhelming psychological impact of their addictions.
Counselling is almost always provided in rehab alongside psychotherapy; addiction counsellors can also be found operating independently outside a rehab environment, and many recovering addicts continue to engage in counselling long after they leave a clinic in order to support them as they move through recovery.
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