The definition of addiction is a chronic brain disease that manifests itself as a dependency on a substance or behaviour. This mental illness is characterised by engaging in a compulsive behaviour, despite negative consequences, combined with preoccupation and cravings. However, it is important to try to understand what addiction is, because without treatment, it can be highly detrimental to the mental and physical wellbeing of the person affected and those around them.
An addictive substance has the characteristics of being rewarding and reinforcing. Addiction itself combines both dependence and abuse. Substance abuse by itself does not necessarily mean addiction. Dependence refers to being psychologically and/or physically dependent on a substance/behaviour, and exhibiting withdrawal symptoms if the substance/behaviour is taken away. In the case of drug addiction, abuse can refer to misusing a substance, taking much more of it than recommended, or repeatedly engaging in the activity despite notable harm.
Addiction can be to a substance, such as alcohol or drugs, or a process/behaviour, such as gambling or sex. All types of addictions affect a person’s brain function and behaviour, taking control of their day-to-day life. Although addiction is a chronic mental illness, it is possible to recover from it.
Types of Addiction
Physical vs. Psychological Addiction
A person can have a psychological addiction, physical addiction, or both. A psychological addiction means that the brain has become dependent on the substance/behaviour, and a person will exhibit mental symptoms, such as depression, anxiety or psychosis, upon cessation. A physical addiction means that the body has become dependent, and a person will exhibit physiological withdrawal symptoms upon cessation of use, such as nausea, headaches, seizures. It is also possible to be both psychologically and physically addicted.
A person can develop a psychological addiction without a physical addiction, even with drugs. The same is true in reverse. Some people may also never develop an addiction, but that doesn’t mean they are immune to it.
What is an addiction to drugs?
A drug addiction is a mental and/or physical dependency on a natural or synthetic chemical substance. Drugs are considered any psychoactive substance that creates temporary changes to the body or brain. They can be either legal or illegal. Caffeine, nicotine, meth, cocaine, and even prescription medicines and alcohol, are drugs. All drugs have the potential to be addictive.
What is an addiction to alcohol?
An alcohol addiction is a dependency on alcohol, and can exhibit itself in several ways. While some people drink in a responsible fashion, others start doing so in an abusive manner. Occasional binge drinking, excessive drinking, or a general inability to control one’s drinking are all signs of an alcohol addiction. Just like other drugs, an alcohol dependency can result in both psychological and physical withdrawal symptoms.
What is a behavioural/process addiction?
A behavioural (or process) addiction is a dependency on and abuse of a certain behaviour, instead of a substance. Some examples are sex addiction, food addiction, gambling, gaming addiction, and shopping addiction. A behavioural addiction affects the brain just like a drug or alcohol addiction, and can cause psychological withdrawal symptoms. Although no physical substances are involved, this type of addiction can be just as dangerous to the person and those around them.
Causes of Addiction
Addiction is a complex topic to comprehend, with various biological and psychosocial aspects behind it. Addiction actually affects the brain, altering reward pathways and parts responsible for self-control. Addiction is also influenced by a number of factors such as genetics, environment and general state of mental health.
Genetics are believed to play a key role in addiction. While there are studies about “addiction genes”, there are also genes that control impulsivity and inhibition, that can influence dependence. For example, it has been noted alcohol addiction is about 40-60% determined by a person’s DNA. Likewise, the chance of a person developing a drug addiction is about 50% higher if they have a direct relative with the same problem.
Social environment also influences people’s behaviours. Peer pressure is a powerful thing. Living in a stressful environment can lead a person to search for an escape from their day-to-day situation. Or they may look for ways to improve their image. For example, a college student may start to take amphetamines to improve their grades. Some people may be just simply bored of their lives, and try to seek out a “new high”.
With both genetics and environment, addiction falls under the debate of nature vs. nurture. Just because a person has no genetic predisposition, doesn’t mean they can’t get addicted. Alternatively, just because a person is predisposed to becoming addicted, doesn’t mean they will have a problem in the long-run.
According to the National Bureau of Economic Research, there is a clear connection between addiction and mental illness. In fact, one disorder appears to trigger the other.
People with underlying mental health problems, such as PTSD or a personality disorder, are already prone to depression, anxiety and paranoia. Addiction can not only exacerbate them, but makes the mental issue itself worse. Negative emotional states that accompany most people with mental health problems, put them at greater risk for addiction.
For some people, self-medication with drugs or pleasurable activities act as an escape from their day-to-day struggles. Having an addiction alongside a psychological disorder is referred to as dual-diagnosis.
Going back to genetics, some disorders, such as manic depressive disease, or schizophrenia, have specific genetic factors that also make it easy to become addicted.
The Science Behind Addiction
The brain functions with the aid of neurotransmitters, which act like messengers, travelling from one part of the brain to the next, in order to fulfil a purpose. It’s something like a game of “pass the baton”. A neurotransmitter travels through a neuron, binds to a receptor on the next neuron, signalling the neurotransmitter of the next neuron to do the same.
Dopamine is the neurotransmitter associated with the internal reward system, and is one of the biological factors responsible for addiction. When a person engages in a “rewarding” behaviour or consumes a drug, their brain gets far more dopamine than normal. risking dependency and addiction.
Although dopamine is the main neurotransmitter associated with the brain’s reward system, other ones, such as serotonin, endorphins, GABA, and norepinephrine can be affected by addiction.
In the case of drugs, a substance can mimic a neurotransmitter, trigger production of more neurotransmitters, or block the reuptake of a neurotransmitter. Cocaine, for example, hijacks dopamine pathways by blocking dopamine reuptake. No matter what happens on the cellular level, the brain essentially becomes flooded with dopamine.
Although there are no extra substances involved, behavioural addictions affect the reward system in a similar manner.
Drugs, alcohol and/or behaviours trigger the brain’s reward pathways, prompting a feel-good state of being. Over time, the person will associate that substance or behaviour with happiness, which will influence them to repeat that behaviour again and again. With repeated stimulation, dependence and addition become more and more likely.
Stages of Addiction
There are multiple stages of [drug] use and addiction. Although one develops an addiction usually by going through the steps in order, it is possible to go back and forth on the list.
This is the first stage. A person may simply be curious and want to try a specific drug. Some people move on from the experimental phase quickly. They sample a drug, decide they don’t like it, and never use it again. Alternatively, with some drugs, a person can get hooked right away. It is possible to become addicted after one use.
2. Recreational Use
After experimentation, some people may find that they enjoy the experience, and decide to continue using “for fun” on an occasional basis. For example, Jack may try cocaine once and start regularly using it on the weekends, only when out with friends. Then, after the weekend, Jack goes back to his normal life.
With repeated recreational use, a person can start to develop a dependency. This is the turning point where a person begins to lose control and is reluctant to stop. Continuing the previous example, Jack may find that he only enjoys the weekends he uses cocaine, and start to use it on his own, or more often than before. Dependency usually results in tolerance and an eventually heavy use of their drug of choice.
After a person develops a dependency, they can easily become addicted. Although they are reluctant to stop, they may try, but find that they no longer have control over their brain or body. They can experience unpleasant withdrawal symptoms, which prompts them to use again.
Addiction is an illness that is also characterised by relapse. While relapse is not necessarily inevitable, if it does happen, it should be recognised as another stage of the illness that is wholly treatable. It is also an event from which valuable lessons can be learned.
Signs of Addiction
Watching out for warning signs, both in yourself and those you care about, can be beneficial in treating addiction before it becomes too severe. A person with an addiction may not be aware they have a problem, or may be in complete denial.
People should also look for signs of addictions in themselves. Having even one or two symptoms can signal a potential problem.
An addiction-focused website by the NSE lists some of the key behaviours to watch out for in your loved ones that signal they may be developing a problem. Some of these signs are:
- Preoccupation with the substance/behaviour
- Secrecy or lying
- Change is social circles
- Change in hobbies or interests
- Acting more withdrawn
- Neglecting basic needs (self-care, family, work/school, daily duties)
- Financial problems
- Anxiety or unease [when without substance]
- Putting considerable effort into acquiring substance/performing a behaviour
- Repeated failed attempts at quitting
- Continuing their actions despite consequences
- Mood swings
- Change in appetite/weight/sleep
There are also signs of addiction that are specific to the substance or behaviour. For example, a person with a heroin or steroid addiction may have track marks from injections. Those who drink a lot may often go on binge-drinking streaks, or have regular blackouts. Amphetamine users can appear jittery and hyperactive.
Effects of Addiction
Addiction can affect the life and wellbeing of the person and those around them. Some addictions may appear harmless, but they can have many negative consequences in the long run.
Drug and alcohol addiction can wreak havoc on the body, both in the short and long-term. Organ damage (or failure) and other permanent damage is not uncommon with substance abuse. For example, prescription painkillers and alcohol often cause liver damage.
Drugs also cause damage to the brain, either directly or by continuously overloading the reward system. Over time, the brain cannot metabolise glucose as well as before. Since the brain needs glucose to function, its activity is slowly reduced.
A person with an addiction will become preoccupied with their substance or behaviour, which may cause them to neglect other aspects of their lives, such as self-care, family, work, school or social life.
This and other consequences of addiction can result in depression, anxiety, or paranoia. Depression and anxiety can come as a result of withdrawal symptoms or being unable to get their drug of choice. Paranoia can come from changes to the brain after long-term drug use. It can also stem from a person being secretive about their addiction, either to avoid stigma or other troubles.
Cross-addiction refers to a person having two addictions at the same time, or trading one addiction in for another. It is a common phenomenon. For example, a person with a gambling problem may also develop an alcohol problem. Or, a person who quits cocaine may turn to methamphetamine instead as a substitute.
Addiction in Specific Groups
Some people may be more prone to addiction, or have a harder time overcoming addiction. Specific groups such as women, young people, physically disabled, elderly, or those in the military (or veterans), have additional factors in their lives that can increase their chances of becoming addicted.
Women, for example, tend to have more psychological and physical damage from alcohol and/or drug use. For example, their organs are more sensitive to the detrimental effects from too much alcohol, hence liver and brain damage develops faster in women than men. Emotional consequences such as depression, trauma, stigma and abuse, are common amongst women with addictions. They are also more susceptible to relapse.
Young people are also at a higher risk for a number of factors. One being that their brains, especially the prefrontal cortex that controls impulses and decision-making, is not fully developed. So they may end up taking more risks than a full-grown adult. Young people are also more likely to use social media, which not only exposes them to peer influence, but is also a widely used tool for drug dealers in the modern age.
Addiction can be addressed in a number of ways. There is no “one-size-fits-all” recovery programme. Every person needs a personalised treatment plan. Some people may be able to begin recovery at an outpatient clinic, while others need the support and supervision of an inpatient setting.
Many people start with joining a 12-step fellowship such as Alcoholics Anonymous, Narcotics Anonymous or Cocaine Anonymous. Others go to an outpatient clinic for individual and group therapy. Health Service Executive (HSE) offers a directory that can help people find addiction treatment services in Ireland. However, a residential rehabilitation clinic is considered the best course of action when it comes to treating addiction. At a residential rehab, a normal treatment programme last about 4-6 weeks.
Assessment and Admission
Upon entering a treatment programme, a patient should be assessed for their current state of mental and physical wellbeing. Prior to admission, a patient should be checked for any underlying mental health issues, any physical health problems, and potential damage that has resulted from their addiction.
Every patient entering treatment will need to begin with a detoxification period. It is not only for drug addiction, it applies to behavioural addictions as well. This usually means stopping their drug or activity completely and going through a withdrawal period. However, with some drugs and sometimes alcohol, going “cold turkey” is risky. In this case, detox has to be done gradually, or with the aid of a substitute. In all cases, it is best to complete detoxification with medical supervision, as withdrawal symptoms can be dangerous.
Detox is not enough to recover from addiction. Therapy is the most important step, but it will not have the same effect until a person has detoxed from their drug or behaviour. Addiction is often treated by behavioural therapy, such as CBT (cognitive behavioural therapy) or DBT (dialectical behavioural therapy).
Alternative, complementary therapies are implemented as well. Some popular ones are equine-assisted psychotherapy, art therapy, or relaxation therapy. Many patients find complementary therapies to be very helpful and fun as well.
Continuing care is critical in assuring a lasting recovery. A proper treatment programme should involve an aftercare aspect. Even after completing detox and therapy, a person can still relapse. Aftercare reduces the risk of this.
As part of continuing care, a patient will be motivated to continue attending therapy, even after they finish their treatment. Attending 12-step groups is often recommended to patients after they leave a rehabilitation programme.
The staff at Smarmore Clinic are here to answer your questions about treatment and the admissions process at any time. Please contact: email@example.com or +353 41 214 5111
Last updated on clinically assessed 28 June, 2021