Addiction: The Medical and Mental Health Perspective

What is "addiction"? The word has many definitions and triggers different emotions, experiences and conditions. Learn more about how physicians and substance abuse counselors categorize different types of addiction and how you can recognize it in a loved one.

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How to Recognize a Secret Addiction (2:21)

Addiction is a deadly disease. The American Society of Addiction Medicine defines addiction as “a primary, chronic, neurobiologic disease, with genetic, psychosocial and environmental factors influencing its development and manifestations.” Those who are addicted to a substance (like alcohol, prescription drugs or street drugs) or to an activity (like gambling or shopping) tend to partake in neurologically programmed behaviors that demonstrate a lack of control, constant cravings, and continued use despite dire consequences.

Some addictions are more deadly than others. While one may be addicted to the caffeine in a cup of coffee, another may be addicted to potentially dangerous substances like alcohol or heroin.

Addiction is more common than you think: 8% of all adults in the US have had some form of substance use disorder or addiction in the past 12 months.

Substance Use Disorders (SUDs)

While the word addiction is commonly used, many physicians and counselors prefer to avoid using this word, as it may have negative connotations for their patients. Instead, many say “substance use disorder” (SUD), which includes both “substance abuse” and “substance dependence.” Both substance abuse and dependence have specific criteria for diagnosis.

To have substance abuse, one must:

  • Consistently fail to fulfill major duties at work or school because of intoxication from the substance (not showing up or performing very poorly)
  • Use and reuse the substance in potentially hazardous situations (drinking and driving)
  • Get into recurring legal troubles (arrests or jail time)
  • Or continue using the substance despite recurring conflicts with family or friends.

Many consider substance dependence to be a step up from substance abuse. Most develop some form of physical tolerance, which means he or she needs higher and higher doses of the drug or substance in order to reach the same levels of intoxication or euphoria. Most also develop withdrawal symptoms if taken away from their desired substance or activity for too long.

While physicians try to catch these problems in patients as early as possible, it’s often hard to detect until it’s too late.  It’s very common for one to deny using addictive substances like alcohol, heroin or cocaine or to deny having a problem at all. This is why it’s important for family members and close friends to observe signs of addiction and get that person help as soon as possible.

Who Is More at Risk?

It’s important to note that substance use disorders are prevalent among all races, ethnicities, age groups, and socioeconomic statuses. However, some populations have higher rates of SUDs than others. 

Those who have substance abusers in their family are at increased risk of becoming abusers themselves. Researchers have found both environmental and genetic links. Compared to the general population, children of alcoholics are 3 to 4 times more likely to become alcoholics themselves.

Substance abuse is twice as prevalent among those with mental health issues, particularly those who are depressed, overly anxious, or bipolar.

Health-care workers, surprisingly, are at greater risk of developing an SUD. This could be because of the increased access to addictive drugs, like painkillers. Many also feel that the high-stress lifestyle that comes with being a health-care worker may also be a factor.

The Neurobiology of Addiction: What’s Going on Upstairs?

As neuroscientists study animal models of addiction, they found evidence that developing an addiction alters some of the pathways in your brain, perhaps permanently. At least three brain circuits have been identified that are important to understanding the neurobiological changes associated with developing an addiction.

One pathway in particular travels from the ventral tegmental area (VTA) to the nucleus accumbens. This dopamine-driven pathway drives reward and pleasure-seeking. This pathway normally allows one to feel pleasure when eating, nurturing or having sex.

Many drugs like cocaine, heroin or alcohol also activate this pathway. Some drugs directly increase the amount of dopamine in this pathway – causing instant pleasurable feelings. However, with too much use, the pathway changes and becomes more dependent on the increased levels of dopamine in order to maintain rewarding feelings. Eventually, the person is unable to feel positive reinforcement or pleasurable feelings from natural rewards, like food or sex. The person is only able to feel pleasure from the chosen drug.

As a result, the user shows signs of substance dependence. Withdrawal of the drug causes extreme distress, depression or physical pain. He or she goes out of his or her way to get the desired drug, even at the expense of work or social obligations.

Learn more about these pathways from the National Institute on Drug Abuse.

Rehab: A Long Road to Recovery

Because addiction is often hardwired into one’s brain, recovery is extremely difficult. Spending a few days away from a drug simply does not solve the problem. Many consider addiction recovery to be a lifelong journey filled with ups and downs. Relapsing into old habits is exceedingly common among recovering addicts.

To achieve full recovery, substance abusers typically require long-term comprehensive treatment. The usual goals of treatment include successful cessation of drug use, reestablishing broken family and career ties, and generating sources for psychosocial support through support groups or mentors. Various approaches to treatment have been tested, each with varying levels of success.

Rehab, or rehabilitation, typically refers to intensive, comprehensive methods of treatment for substance abusers who have become dangerously dependent on drugs. Some check into rehab facilities on their own or are ordered into rehab by the legal system. They usually receive some form of psychotherapy, in which one learns coping strategies for dealing with cravings. Some may also receive medications that could help with cravings (like methadone for heroin cravings) or craving-associated anxiety.

Various 12-step programs, like Alcoholics Anonymous, also exist and help provide long-term support for addicts and help prevent relapse. Learn more about methods of treatment for addiction from the National Institute of Drug Abuse.