Updated: Feb 7, 2021
Source: American Psychiatric Association 01/2017 (https://www.psychiatry.org/patients-families/addiction/what-is-addiction)
What Is Addiction?
Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems. Yet a number of effective treatments are available and people can recover from addiction and lead normal, productive lives.
People can develop an addiction to:
PCP, LSD and other hallucinogensInhalants, such as, paint thinners and glue
Opioid pain killers, such as codeine and oxycodone, heroin
Sedatives, hypnotics and anxiolytics (medicines for anxiety such as tranquilizers)
Cocaine, methamphetamine and other stimulants
Non-Tangible items such as gambling, social media, pornography, video games, etc
People with a substance use disorder have distorted thinking, behavior and body functions. Changes in the brain’s wiring are what cause people to have intense cravings for the drug and make it hard to stop using the drug. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory and behavior control.
These substances can cause harmful changes in how the brain functions. These changes can last long after the immediate effects of the drug — the intoxication. Intoxication is the intense pleasure, calm, increased senses or a high caused by the drug. Intoxication symptoms are different for each substance.
Over time people with addiction build up a tolerance, meaning they need larger amounts to feel the effects.
According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including:
to feel good — feeling of pleasure, “high”
to feel better — e.g., relieve stress
to do better — improve performance
curiosity and peer pressure
People with addictive disorders may be aware of their problem, but be unable to stop it even if they want to. The addiction may cause health problems as well as problems at work and with family members and friends. The misuse of drugs and alcohol is the leading cause of preventable illnesses and premature death.
Symptoms of substance use disorder are grouped into four categories:
Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use.
Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use.
Risky use: substance is used in risky settings; continued use despite known problems.
Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance).
Many people experience both mental illness and addiction. The mental illness may be present before the addiction. Or the addiction may trigger or make a mental disorder worse.
How Is Addiction Treated?
Effective treatments for addiction are available.
The first step on the road to recovery is recognition of the problem. The recovery process can be hindered when a person denies having a problem and lacks understanding about substance misuse and addiction. The intervention of concerned friends and family often prompts treatment.
A health professional can conduct a formal assessment of symptoms to see if a substance use disorder exists. Even if the problem seems severe, most people with a substance use disorder can benefit from treatment. Unfortunately, many people who could benefit from treatment don’t receive help.
Because addiction affects many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s situation and any co-occurring medical, psychiatric and social problems can lead to sustained recovery.
Medications are used to control drug cravings and relieve severe symptoms of withdrawal. Therapy can help addicted individuals understand their behavior and motivations, develop higher self-esteem, cope with stress and address other mental health problems.
Treatment may also include:
Therapeutic communities (highly controlled, drug-free environments) or sober houses
Many people find self-help groups for individuals (Alcoholics Anonymous, Narcotics Anonymous) as well as their family members (Al-Anon or Nar-Anon Family Groups) useful.
Opioids produce high levels of positive reinforcement, increasing the odds that people will continue using them despite negative resulting consequences. Opioid use disorder is a chronic lifelong disorder, with serious potential consequences including disability, relapses, and death. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition describes opioid use disorder as a problematic pattern of opioid use leading to problems or distress.
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gambling disorder is included in a new category on behavioral addictions. This reflects research findings that gambling disorder is similar to substance-related disorders in many ways. Recognizing these similarities will help people with gambling disorder get needed treatment and services, and may help others better understand the challenges.
Internet gaming disorder is included in DSM-5 in the section of disorders requiring further research. This reflects the scientific literature showing that persistent and recurrent use of Internet games, and a preoccupation with them, can result in clinically significant impairment or distress. The condition criteria do not include general use of the Internet or social media.
Caffeine Intoxication and Withdrawal
Caffeine intoxication and caffeine withdrawal are included in DSM-5. Caffeine use disorder, however, is in the section of DSM-5 for conditions requiring further research. While there is evidence to support this as a disorder, experts conclude it is not yet clear to what extent it is a clinically significant disorder.