Addiction crosses so many lines affecting people from all walks of life. It’s not a new thing, but perhaps awareness of it has grown. The opioid crisis that continues to raise overdose deaths to levels unseen has many people’s attention. The epidemic is so urgent that President Donald Trump in 2017 officially declared it a public health emergency.
It is estimated that about 20.1 million U.S. adults aged 12 and older have substance use disorders (SUDs). With those statistics, it is likely that you or someone you know either is struggling or has struggled with SUD or addiction. Still, while that is true for many people, how likely do they really know what addiction is or understand how it begins? Below is a quick overview to understanding addiction and what to do to get help.
What is Addiction?
There may be hesitation on the part of some people to think of addiction as a complex brain disease, but that’s exactly the perspective many scientists and healthcare professionals have. When using addictive substances takes priority in one’s life, even to the extent of impairing one’s health and jeopardizing one’s relationships and income, one likely has an addiction.
The National Institute on Drug Abuse (NIDA) tells us that addiction is “A chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long-lasting and can lead to many harmful, often self-destructive, behaviors.”
The institute also writes, “Addiction occurs when a person cannot control the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction.”
Many people do not take addictive substances with the intention to use them to the point where they can’t stop using them ever again. People commonly start their drug and alcohol use because they want to:
- Feel good (get “high”)
- Feel better (relieve tension, anxiety, or stress of any kind)
- Improve their performance
- Satisfy their curiosity about a substance
People can become addicted to:
- Opioid pain relievers
As NIDA notes, many people are exercising a free choice the first time they use drugs. However, when the brain has changed as a result of using addictive substances, pursuing and using drugs takes on a different meaning. Many people who are in active addiction find it difficult to resist the urge to stop using, even when they want to. Some have even made great efforts to stop but can’t seem to stick with it or commit to it.
Is a Substance Use Disorder the Same as an Addiction?
Addiction is referred to as a substance use disorder (SUD) in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the manual published by the American Psychiatric Association (APA). The manual categorizes SUDs as mild, moderate, or severe.
It’s important to note that the association no longer uses the terms “substance abuse” or “substance dependence” to define problematic behaviors related to substance use. Certain diagnostic criteria must be present before it is determined which category best fits an individual’s condition or situation.
According to the American Psychiatric Association (APA), symptoms of substance use disorder can be grouped into four categories. They are:
- Impaired control. This involves strong cravings or urges to use substances. It also involves desire or failed attempts to reduce or control substance use.
- Social problems. Social difficulties involve how substance use affects work, school, or home activities as well as ones of leisure.
- Risky use. High-risk involves using substances in high-risk settings and continuing to use despite knowing what problems are caused by substance use.
- Drug effects. Needing larger amounts of a substance to feel the same highs that were initially felt when use started is known as tolerance, and this indicates a dependence on a substance. If withdrawal signs and symptoms are experienced when substance use is reduced or stopped, this is also another sign that dependence is underway.
How Addiction Develops
People take different paths before they find themselves grappling with an addiction. One person may become hooked right away, depending on the substance, while others may develop a dependence over time. There is no set time length on how long it takes before someone is in active addiction.
Addiction And The Brain
Everything starts with the brain, a vital organ that plays an important part in understanding how and why addiction happens. As NIDA explains, drugs affect and change the brain once they enter the body. Addictive substances affect how the brain works and in some cases, even how it is physically structured.
According to NIDA, drugs affect three areas of the brain. They are:
- The brainstem. This is the part of the brain that keeps bodily functions working, such as breathing, blood circulation, and food digestion. The brainstem connects the brain to the spinal cord, which is responsible for moving muscles and limbs.
- The limbic system. This part of the human brain affects our emotional responses or the good feelings that cause users to repeat behaviors that result in pleasurable feelings.
- The cerebral cortex. The cerebral cortex is the outer region of the brain known as gray matter. It is made of four areas that collectively control functions such as thinking and problem-solving and processing data collected from our senses.
Repeated use of harmful chemicals interferes with the system the brain uses to communicate. NIDA notes that drugs affect the brain by either imitating the organ’s natural chemical messengers, known as neurotransmitters or overstimulating the brain’s “reward circuit,” which is a part of the brain’s limbic system.
Chronic use of an addictive substance will force the brain to adjust to high amounts of dopamine. As a result, the brain will produce less dopamine and wait for it to come from an outside source, and the toxicity of some drugs will kill neurons. The result is that users who go through this may feel reduced pleasure, which causes them to use drugs so they can “feel good” again.
Distorted thinking, impaired judgment, and loss of memory and behavior control are all signs of a person with an addiction. Studies of the human brain show that chronic use of harmful substances can affect the areas that control these behaviors.
Physical Addiction Vs. Psychological Addiction
According to some sources, there are two kinds of addiction: Physical addiction and psychological addiction. There may not seem like there’s much difference between the two, but they are not the same. NIDA outlines the difference between the two: “Addiction—or compulsive drug use despite harmful consequences—is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal.”
It refers to “physical addiction” as a “physical dependence,” and defines it as when “the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal).”
It writes that a physical dependence can happen when many drugs are chronically used, including prescription drugs that are taken as directed. “Thus, physical dependence in and of itself does not constitute addiction, but it often accompanies addiction,” it writes.
“This distinction can be difficult to discern, particularly with prescribed pain medications, for which the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.”
So, from that, we learn that when physical addiction, or dependence, has developed, it means the body’s cells don’t work properly without the substances being in the user’s system.
When reduced amounts of the substance are in the body, withdrawal symptoms start, making the user feel ill or uncomfortable.
This is why many addicted users continue to take substances.
They are trying to avoid withdrawal symptoms. These actions keep them in the hard-to-break cycle of physical addiction.
Symptoms commonly associated with physical addiction, or physical dependence, include:
- Having a high tolerance for a substance. When larger amounts of a substance are needed to feel the same highs that were initially felt when use started, that is known as tolerance, and this indicates a dependence on a substance.
- Physical withdrawal symptoms. If withdrawal signs and symptoms are experienced when substance use is reduced or stopped, this is a sign that dependence is underway.
Psychological addiction (also known as an emotional addiction), on the other hand, is about compulsion or feeling the need to use an addictive substance. It is possible that people with psychological addictions are physically dependent, or physically addicted to a substance because their bodies are affected by their use of potent substances that are addictive. But there also are cases in which people are not physically dependent, but they feel like they are, and so they use. An example is when a marijuana user feels they need to use the drug to feel calmer, but they are not going through any physical withdrawals as a result of not using.
Symptoms that are commonly associated with psychological dependence include:
- Being preoccupied with obtaining the substance of choice
- Self-medicating, or using the substance to get high or relieve tension, stress
- Strong cravings for drugs, alcohol, or other substances
- Appetite loss or increased appetite that occurs after use has stopped
- Anxiety and/or depression that comes after attempts to stop using
- Agitation, irritability, or restlessness that results from attempting to stop using
- Sleep disturbances that follow when use has stopped or attempts to not use
There is a perspective that the body and mind are connected, therefore abusing substances brings on addictive behaviors and effects that combine the physical and the mental, or psychological. Many would agree that it is difficult to separate the two.
Key Risk Factors In Addiction Development
Several factors can influence and play a role in who becomes addicted to substances. It is not easy to name one specific factor that causes addiction as it could be a combination of things. Not all recreational users will chronically use drugs or alcohol or other mood-altering, mind-altering substances. But for many people, recreational use can become something more serious. However, for other people, addiction may start with occasional use or recreational use. Common addiction risk factors include:
According to the Genetic Science Learning Center, scientists are looking for biological differences that may make a person more or less susceptible to addiction when they look for “addiction genes.” These genes may make it more difficult for someone to quit using or make withdrawal worse when a person tries to quit, the center explains. However, there is no single gene that makes someone more or less likely to use substances. There is research to support that people who have a history of substance abuse and addiction in the family are at greater risk of developing an addiction. As the center notes, though, “susceptibility does not mean inevitability.”
People may turn to substance use because of the environment they spent a great deal of time in. This could be where they grew up or a place they are familiar with. Someone may start to do drugs or drink because it helps them fit in with the people around them. An environment that provides access to an addictive substance or exposure to popular culture references that encourage substance use, such as those in the media) are also environmental influences.
Psychology, or the study of human behavior, cannot be overlooked or discounted when it comes to understanding why addiction happens. Mental health plays an important role in addiction. Unhealthy behaviors follow unhealthy coping practices and strategies that are used to deal with the life’s challenges, which happen to just about everyone. Anxiety, depression, and stress all can influence someone’s decisions to pick up substance use, personality traits such as high impulsivity or risk-seeking, eating disorders, and other psychiatric disorders can make someone susceptible to addiction.
Early Substance Use/Abuse
Starting drug or alcohol use during the adolescent or teen years (or even earlier) can put someone on the path of battle with addiction.
The National Center on Addiction and Substance Abuse (CASA) reports that psychological and environmental factors appear to be more influential in determining if someone starts to use substances. Biological or genetic factors appear to influence which people move from substance use to addiction, it says.
The more risk factors that are present, the greater the risk of developing an addiction. Still, if all of these factors are present, it doesn’t mean one will become an addict.
Signs of Addiction
Determining when an addiction is happening can be difficult. But there are warning signs that signal danger is ahead. These questions are all red flags that you or your loved one is struggling with compulsive substance use. In these cases, you should ask the following questions:
- Are frequent or intense cravings for the drug present?
- Have spending habits changed to support buying drugs or alcohol?
- Is the substance used after attempts were made to not use it?
- Is the substance used longer or more often than intended?
- Does recovery from using take a great deal of time? Does the recovery period last for an extensive amount of time, such as days or weeks?
- Is the person unable to stop using the substance despite wanting to?
- Has a high tolerance to the substance developed with regular, prolonged use of the substance? Is more of the substance needed to achieve a high?
- Have efforts to obtain the substance increased? Are those efforts illegal or reckless or moving in that direction?
- Are withdrawal symptoms experienced when drug or alcohol use is stopped or scaled back?
- Is the person continuing to use harmful substances despite adverse effects on daily routines, health, work, interpersonal, and work relationships?
Other warning signs that can help you figure out if treatment is needed include:
- Unexplained physical changes (bloodshot eyes, needle marks, yellowed teeth, nose bleeds)
- Sudden weight gain, weight loss
- Withdrawing from normal social activities
- Withdrawing from friends, family
- Showing lack of interest in activities, hobbies
- Financial problems
- Job loss
- A sudden change in mood
- Unusual sleep patterns
- Legal problems
Addiction Treatment: How Does It Work?
Once it has been determined that an addiction is present and the decision has been made to get help for it, the next step is to start the addiction treatment process. To help treatment centers meet the needs of a client based and follow NIDA’s principles of effective treatment, The American Society of Addiction Medicine has outlined the general progression treatment should take called the continuum of care.
When you plan to enter an addiction treatment program, clinicians will help determine where your needs would place you on this continuum. As you progress, your doctors and therapists will lower the intensiveness of your treatment and increase your independence, while continuing to offer you the support you need.
Here are the different levels of care that constitute addiction treatment:
A medical detoxification (detox for short) is the highest level of care for people in addiction recovery. It is designed for people with medical needs and those who enter into treatment in active addiction. Detox involves 24-7 medical management from healthcare professionals who specialize in addiction treatment in recovery.
Inpatient treatment, which is also known as residential treatment, requires clients to live on-site at a facility while recovering from addiction. This setting is structured and monitored 24-7 to ensure all recovery needs are met, including medical needs. Inpatient treatment allows them to start addiction treatment while they continue to receive any needed medical support.
Intensive outpatient treatment, or IOP, involves at least nine or more hours of clinical services every week. Clients who choose this arrangement are allowed to live on their own either at home or in a transitional housing arrangement, they receive intensive addiction treatment are responsible for attending all appointments.
Outpatient treatment services offer fewer than nine hours of clinical services and provide support for people transitioning from more intensive treatment to live on their own.
Clients who have completed detox and treatment, which NIDA recommends lasts for at least three months, or 90 days, can then receive aftercare. Aftercare programs, which are available at many treatment facilities, continue support for clients’ new lives by connecting them to like-minded people with similar journeys and goals in alumni groups, 12-step groups, transitional housing services, employment programs, and other needs.
What Makes Treatment Effective?
The National Institute on Drug Abuse gives guidelines about how to find an effective program for your needs or the needs of your loved one. It cautions that there is no one treatment that works for everyone and that treatment varies according to the kind of drug used and the characteristics that are unique to each client. Treatment also doesn’t have to be voluntary to be effective. Drug treatment interventions can be successful. This includes programs that are ordered by a court, a job, or as a final appeal from a person’s loved ones.
“Matching treatment settings, interventions, and services to an individual’s particular problems and needs are critical to their ultimate success in returning to productive functioning in the family, workplace, and society,” it writes. Here are the 13 factors the institute highlights what makes addiction treatment effective:
- Addiction is a complex, but treatable disease that affects brain function and behavior.
- No single treatment is appropriate for everyone.
- Treatment needs to be readily available.
- Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
- Remaining in treatment for an adequate period of time is critical.
- Counseling— individual and/or group —and other behavioral therapies are the most commonly used forms of drug abuse treatment.
- Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
- An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure it meets his or her changing needs.
- Many drug-addicted individuals also have other mental disorders.
- Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
- Treatment does not need to be voluntary to be effective.
- Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
- Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.