What is Addiction?

Addiction is a complex, chronic condition characterized by the compulsive seeking and use of substances or engagement in activities despite harmful consequences. Addiction is a brain disorder, not a result of a lack of willpower. It affects the brain's reward, motivation, and memory systems, which can lead to compulsive behaviors or substance use despite negative consequences. This disorder impairs judgment, behavior, and decision-making, requiring comprehensive treatment and support for recovery.¹

This page will delve into various types of addiction, identify substances and behaviors prone to disordered use, and review the signs, symptoms, and contributing factors to addiction. Additionally, we will explore effective treatment options and offer tips for supporting someone living with addiction.

Types of Addiction

Anything that can serve as a stimulant to an individual can be addictive. When the desire or habit for stimulation becomes an obligation, it can be considered an addiction. There are two main forms of addition:²

• Substance addictions, or substance use disorder (SUD)
• Non-substance addictions, or behavioral addictions, also called process addictions

It's not uncommon for individuals with SUDs to also have other mental health conditions, including behavioral addictions.^2,3

Substance Addictions

According to the Substance Abuse and Mental Health Services Administration about 48.7 million people, more than 1 in 6 people, aged 12 or older had a substance use disorder in 2022.⁴ Substance use disorders (SUD) are conditions that occur when someone’s drug or alcohol use causes problems at work or school, in their relationships, and are potentially hazardous to their physical health. They are characterized by the persistent use of the substance even when the consequences are problematic.5 People who are in what’s often called “active addiction” are preoccupied with obtaining and using that substance, even to the detriment of their own health, relationships, and other important areas of their life.

Substance use disorder can involve substances that are prescribed medications or non-medical drugs. Some of the most commonly used substances include⁵:

• Alcohol
• Opioids, including prescription medications and heroin
• Cocaine and methamphetamine as well as prescribed stimulant medications
• Marijuana
• Sedatives, tranquilizers, and anxiety drugs such as sleeping pills, barbiturates, and benzodiazepines
• Hallucinogens, including PCP and LSD
• Tobacco

Non-Substance Addictions or Behavioral Addictions

The key characteristic of behavioral addictions is the inability to resist an impulse, drive or temptation to perform an act that is harmful to an individual or to others. As with substance use disorders, individuals with behavioral addictions repeatedly engage in these behaviors so much that it interferes with other areas of their lives.^3,5

Currently, gambling disorder is the only diagnosable behavioral addiction recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the guide used by healthcare professionals to diagnose behavioral health conditions.5 However, several other behavioral addictions are becoming commonly discussed. These behaviors, if compulsively repeated, can negatively impact a person’s ability to function in daily life.²

• Gambling
• Sex
• Viewing pornography
• Shopping or compulsive buying
• Shoplifting or kleptomania
• Video/computer gaming
• Using the Internet or social media

The Signs of Addiction

There are several elements of diagnostic criteria healthcare providers use to determine the presence and severity of addiction. This diagnostic criteria for substance use disorders is integral to determining whether someone is misusing substances or experiencing a mild to severe form of a substance use disorder.⁶

People who are experiencing an addiction to a substance or behavior may have the following general symptoms:

• Preoccupation with the substance or activity: They spend a significant amount of time or resources craving, obtaining and thinking of the substance or activity. They may engage in important activities less frequently or not at all because of the intense focus on the subject of the addiction.
• Failure to stop: Despite wanting to control or stop use of the substance or behavior, they cannot, even knowing that it causes negative physical or emotional consequences.
• Challenges in other areas of life: Addiction may cause recurring problems such as conflicts with others, withdrawal from social activities, and performance issues at work or at school.
• Increased tolerance: Eventually, they may need more of the substance or the behavior over time to achieve the same euphoric or pleasurable effect. In the case of substances, this can lead to physical dependency.
• Withdrawal: When people with addiction stop using the substance or engaging in the behavior that is the subject of the addiction, they may experience negative physical and emotional symptoms of withdrawal. Withdrawal from substances can be extremely uncomfortable, painful, or even deadly. With behavioral addictions, withdrawal can be characterized by feelings of dysphoria.6

Risk Factors for Addiction

The development of substance use disorders and behavioral addictions is complicated. There is no one single cause, and everyone’s experience is unique. Factors that can influence a person’s likelihood of developing an addiction exist at personal, relational and sociocultural levels.¹

Individual Risk Factors include:³

• Mental health issues, such as depression or anxiety
• Physical health problems, such as chronic pain
• Poor self-esteem
• Low impulse control
• Genetic predisposition and family history of addiction
• Physical and emotional trauma
• Stressful or traumatic events during childhood, called Adverse Childhood Experiences (ACEs)

Relational Risk Factors include:⁷

• Significant conflict, strain, or tension with family
• Bullying, mistreatment, or abuse from others
• Exposure to others in a person’s family or peer group using substances

Sociocultural Risk Factors include:⁷

• Lack of economic and educational opportunities
• Poverty and violence
• Lack of access to medical and mental health care
• Access to alcohol or drugs at home or school

Addiction Treatment

Recognizing addiction as a brain disease emphasizes the importance of empathy and effective intervention. Due to the nature of this complex disease, many people who want to stop using substances or stop problematic behaviors need treatment and support to do so.6 Cravings are powerful drivers of using the addictive substance or engaging in the addictive behavior. Cravings can occur physically, emotionally, and psychologically, often all at the same time. Cravings are triggered by the complex way a person’s brain chemistry is impacted by the disease.

Mental health or healthcare providers can help individuals in their recovery journey. These professionals can recommend treatment approaches that account for an individual’s unique situation as well as any medical, psychological or social challenges that person might have.⁸

Since addiction impacts many areas of a person’s life, multiple types of treatment are often recommended. For most people living with addiction, a combination of medication and individual or group therapy is most effective. Treatment for addiction might include:⁸

• Medications to control substance cravings and relieve severe symptoms associated with withdrawal
• Therapy to help individuals living with addiction understand the motivations behind their behavior and the impacts of their behavior on themselves and others. Therapy can help people develop higher self-esteem, cope with stress, and address other mental health issues.
• Therapeutic communities that offer highly controlled, substance-free environments, such as sober living homes or halfway houses.
• Rehabilitation services to equip people to manage addiction long-term with counseling, education, and support.
• Hospitalization to monitor the potentially dangerous symptoms of substance withdrawal.
• Peer support groups for individuals and their families can be useful. Groups like Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, and Nar-Anon are particularly well-known.

How to Help Someone with an Addiction

Treating a substance use disorder or behavioral addiction and maintaining recovery are challenging for anyone. The journey from initial use to misuse can significantly alter an individual's relationship with the substance or behavior. Throughout this journey, the nature of this relationship evolves, often leading to profound changes in the person's interactions and experiences.⁹

Here are some tips to help you best support someone who is struggling with addiction.

• Educate yourself: Learn about problem use, tolerance, dependence, withdrawal symptoms, and cravings. Each of these has a powerful effect on the person who has addiction and affects how that person thinks, feels, and interacts with others.
• Start the conversation: Reaching out and showing meaningful support can make a world of difference. Be sure to start from a place of honesty and genuine concern, use active listening, and respond in a way that is kind and without judgment.^1,9,11
• Be prepared to help: Are you ready to help them seek support or treatment? Do you have a list of resources? Do you have the time to make the call with them to a support hotline or facilitate a referral to treatment services? Are you ready to support them for the long run as they work toward recovery? ¹
• Maintain boundaries: Be supportive and offer reasonable, practical help. It's also important to remember that an individual’s treatment and recovery is their responsibility. It's not possible to recover for someone else. It also doesn't help to punish or reject someone when he or she struggles.¹¹
• Honor their treatment choices: There are many ways to stop using a substance or treat a behavioral addiction. Friends and family members may not always understand or agree with all treatment options, but a person's own choice for their treatment typically gives that person the best odds for long-term success.
• Be patient: Treatment does not end when the person stops using the substance or engaging in the behavior, that's usually just the beginning. Starting treatment can be difficult because people are making major physical and behavioral changes. The more patience you can offer, the more they can focus on the challenges of treatment and meaningful change.⁸
• Be supportive: People with strong support networks experience a greater chance for meaningful change. Friends and family may experience some of the same challenges as the person in treatment, but a strong support network is essential when treatment gets hard.¹⁰
• Don’t neglect your own support needs: Just as your loved one needs support because of the challenges experienced in treatment and recovery, friends and family also benefit from support. It can be really helpful to connect with other people in your situation, to get support during this challenging time.⁸

Summary

Addiction is a multifaceted brain disorder that significantly impacts various aspects of an individual's life. Whether it's substance use or behavioral addiction, recognizing the signs such as preoccupation, inability to stop, and withdrawal symptoms is critical. Understanding the complexity of addiction and its influence on behavior and decision-making can help in providing effective support. Treatment typically involves a blend of medication and therapy, with a strong emphasis on building a supportive environment. By educating ourselves and offering compassionate support, we can better assist individuals on their path to recovery.