What is Addiction?

Content provided by Elizabeth Eidson and Katharine Cammack, Ph.D., The University of the South.

Addiction is characterized by intense cravings, an inability to limit or control drug use, a preoccupation with the drug, and continued use despite negative consequences. Although these consequences can be quite serious (e.g., being arrested, losing a job), people struggling with addiction often continue to take drugs despite causing harm to themselves or their loved ones. People can become addicted to alcohol, tobacco, opioid painkillers, illicit drugs (cocaine, heroin, methamphetamine), food, sex, or gambling.[1][2][3]

Addition is a brain disease, not a moral failing. Your brain can change as a result of being exposed to many kinds of drugs. However, drugs that can lead to addiction almost always alter a specific set of pathways in the brain. These pathways, or brain circuits, send and receive information that help you make decisions, regulate your emotions, and process rewards. After repeated drug use, these circuits can stop working properly. It can take months or even years for some of those brain circuits to function normally again. This is why seeking treatment and support throughout your recovery is so important.

It is also important to note that addiction is different than physical dependence. When someone is physically dependent on a drug, they may experience withdrawal symptoms when they stop the drug. These symptoms are the body’s response to no longer having the drug. This does not mean that they crave the drug or cannot control how much drug they take. For instance, many people with chronic pain take opioid painkillers (e.g., oxycodone) to manage their pain. Taking medications as prescribed does not lead to addiction, but it can lead to physical dependence. You can also be addicted without being physically dependent. Unlike opioid painkillers, cocaine does not cause many noticeable withdrawal symptoms, but cocaine addiction can be very serious.

“That’s Right, Addiction is a Disease”: https://www.youtube.com/watch?v=P–6LEbksds
“Everything you think you know about addiction is wrong”: https://www.youtube.com/watch?v=PY9DcIMGxMs

[1] Kalat, James (2016) Biological Psychology, 12th edition
[2] https://www.centeronaddiction.org/what-addiction/addiction-disease
[3] https://www.drugabuse.gov/related-topics/addiction-science

Who can develop an addiction?

Anyone can develop an addiction, but there are certain risk factors that make a person more likely to struggle with addiction. One major set of risk factors is your biology. For instance, you are born with genes (DNA) that may make you respond differently to certain drugs and thus more likely to develop addiction. If you have a history of addiction in your family, that may indicate that your family shares genes that make them more vulnerable to addiction. Another major set of factors is your environment. Examples include if you have friends who abuse drugs, or if you have experienced toxic stress or trauma in your life.

It is important to note that not all people who try a drug will become addicted, and no single factor is guaranteed to cause addiction.[4] The influence of many different factors makes addiction difficult to predict and to treat, but it also means that there are many approaches that might help your recovery.

https://www.youtube.com/watch?v=SY2luGTX7Dk&feature=youtu.be

Is addiction a choice?

No. Often, your first experiences with drugs or alcohol are choices. Over time, your brain can change and adapt to the drug so that the person must continue taking the drug in order to feel “normal.” Your genes also play an important role in how vulnerable (or resilient) you are to addiction. For instance, genes can influence how your body processes the drug, and how your brain responds to the drug. However, many other factors contribute to drug-taking behaviors, such as your friends, psychological wellbeing, and stress level (i.e., if you like to “take the edge off” after getting home from a long day at work).

A chronic disease is the result of a combination of genetics and behaviors that cannot always be cured, but can be treated and maintained.[5] In this way, addiction is similar to other chronic health conditions (heart disease, diabetes, cancer) that are often influenced by health choices like diet, exercise or sun exposure, but also have a strong genetic component.[6]

https://youtu.be/zV6zKmt7S5E

[4] https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction
[5] https://www.centeronaddiction.org/what-addiction/addiction-disease

How do drugs affect the brain?

Our brain contains billions of cells called neurons. These neurons communicate with each other like how cell phones communicate. One neuron sends a chemical signal to its neighbor, and the second neuron receives the signal. In other words, one phone places a call, and a second phone answers the call.

Drugs mimic the natural chemical signals, but the calls they make are much stronger, more frequent, or longer lasting than normal signals. Over time, the receiving neurons become overstimulated and stop responding to the signal. In the phone example, the phone volume might be really loud or many calls might be made in a row, so the receiving phone may just stop answering the calls. This process is called tolerance.

When tolerance occurs, more drug is needed to stimulate that neuron in the same way. Your brain gets used to the drug and adapts, so increasing amounts of drug are needed to cause the same effect. Tolerance can continue to build, until a person is consuming way more drug than they intended or planned. In the phone example, now five phones might need to call repeatedly to get the message through to the receiving phone, instead of just one. In response to this barrage of calls, the receiving phone may be put on mute or turned off completely.

It takes time and energy to return the brain back to its normal state. The brain may be able to send normal signals again after weeks, months or even years. During this time, it is critical to remain drug-free, so that the brain can heal itself.

Different drugs act like different chemical signals in the brain. A drug will act on every single brain cell that can receive/process its signal. As the brain contains ~100 billion neurons, that could mean a lot of neurons! For instance, a drug like alcohol affects very common chemical signals and could thus affect billions of brain cells at once.

While the brain sends lots of different types of chemical signals, one of the most important – and well studied – is dopamine. Dopamine signals help the brain identify things that are rewarding. Every time something positive or rewarding happens in your life, dopamine signals are released to tell you that this is something that it wants to happen again and is therefore worth pursuing. This can be anything from a good grade on a test to your first kiss to scoring a touchdown. Drugs increase dopamine signals in the brain, telling the brain that the drug is rewarding and should be pursued.

Tolerance builds in the dopamine system, too, so after frequent drug use, the neurons receiving the dopamine signals can adapt and become less responsive to the drug. This has two negative consequences. First, more drug is needed to cause the same original rewarding/euphoric effect, so the user takes more drug to try to achieve the original effect. Second, the brain has trouble recognizing normal dopamine signals anymore – it just recognizes stronger, more frequent signals caused by drugs. This means that other things that you used to enjoy doing (eating a good meal, playing football) aren’t as rewarding anymore. This can lead to depression and lead to further drug use to alleviate these negative feelings.

“Why do our brains get addicted?” by Nora Volkow, Director of the National Institute on Drug Abuse: http://www.tedmed.com/talks/show?id=309096

Which drugs can lead to addiction?

Many drugs can lead to addiction. Different drugs act on different receptors in the brain, but virtually every abused drug affects dopamine signaling (see “How do drugs affect the brain,” above).

Click on each drug to learn more.[7]

Alcohol
Tobacco
Prescription Drugs
- Opioid painkillers (e.g., oxycodone, Percoset)
- Stimulants: https://www.addictioncenter.com/stimulants/adderall/
Illegal Drugs

[7] https://easyread.drugabuse.gov/

How do I know if I am or someone I know is addicted?

If you or someone you know is experiencing significant distress due to their drug use, or is continuing to use drugs despite negative consequences, you may want to consult with a health care or treatment professional.

ADDICTION SYMPTOMS CHECKLIST[8]

You may wish to consult with a health care provider if you have experienced two or more of the following symptoms in the last year:

Often taking more of the substance for a longer period than intended
Ongoing desire or unsuccessful efforts to reduce use
Great deal of time spent to obtain, use or recover from substance
Craving the substance
Failing to fulfill obligations at work, home or school as a result of continued use
Continued use despite ongoing social or relationship problems caused or worsened by use
Giving up or reducing social, occupational or recreational activities because of use
Repeated use in physically dangerous situations (e.g., drinking or using other drugs while driving)
Continued use despite ongoing physical or mental health problems caused or worsened by use
Developing tolerance (feeling less effect from the substance with continued use)
Experiencing withdrawal symptoms after reducing use (note: not all drugs produce withdrawal symptoms, e.g., inhalants, hallucinogens)

DSM-5; https://www.centeronaddiction.org/addiction-treatment/signs-of-addiction

How do I get help?

The most important aspect of getting help with addiction is to not be ashamed. Understand that addiction is a brain disorder that can affect one’s ability to make healthy decisions, regulate emotions, and process rewards. If you or someone you love is struggling with addiction, please ask for help – there are many local resources available to help you. It can also be difficult and frustrating to support a friend or family member struggling with addiction. Remember that their brain might be working in slightly different ways as a result of their drug use. Don’t hesitate to reach out a local resource to help support and guide you.

Recovery from addiction can be a long-term process. Avoiding triggers is important. Triggers can be anything in a person’s life that might remind them of the drug. Research suggests that being exposed to a trigger (e.g., needles, burners) causes strong cravings and increases the likelihood that someone will relapse. Over time, the association between these triggers and the drug will fade, as the brain rewires itself, but this process cannot occur overnight. Trying to minimize your exposure to triggers, and finding ways to distract yourself if you are exposed to a trigger, will help protect your brain as it heals.

How can I prevent my child from using drugs?

Childrens’ brains continue to develop through their early 20s. This means that early exposures to drugs and alcohol can affect normal brain development.

Work to be an involved, positive role model in childrens’ lives. Set the right example by using alcohol responsibly and refraining from drug use. A child with involved parents is less likely to use drugs than a child without involved parents, and children who have activities after school and hobbies which keep them focused and busy are less likely to use drugs. [9]

Links:

http://www.addictionbrainstory.org/

https://www.slideshare.net/centeronaddiction/how-to-raise-a-drug-free-kid?from_action=save

https://www.centeronaddiction.org/addiction-prevention/teenage-addiction

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What is Addiction?

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