Addiction
Addiction is recognized as a chronic brain disease characterized by compulsive behavior related to substance use, classified as substance use disorder by the American Psychiatric Association. It significantly impacts individuals and society, with costs exceeding $3.73 trillion annually in lost productivity, healthcare, and crime. The effects of addiction are profound, often extending to loved ones and communities, leading to impaired relationships and responsibilities. The brain's dopamine receptors are notably affected, diminishing the ability to experience pleasure over time, which contributes to the escalation of substance use despite negative consequences.
Addiction manifests through maladaptive behaviors, including the failure to fulfill obligations, risky behavior, and an inability to control substance use. The DSM-5 has expanded the concept of addiction to include non-substance-related disorders, like gambling, while common societal views also recognize behaviors such as workaholism and compulsive shopping. Understanding addiction involves various models, including neurobiological, psychological, and genetic perspectives, illustrating the complexity of this condition. Efforts to treat and manage addiction can be challenging, with relapses being common, underscoring the need for continued research and improved therapeutic approaches.
Addiction
- DEFINITION: Addiction is a chronic brain disease and is identified as substance use disorder by the American Psychiatric Association in their most recent publication of the Diagnostic and Statistical Manual of Mental Disorders (2013), the DSM-5, which is compiled to describe and diagnose all currently identified mental health problems that may receive a formal medical diagnosis in the United States.
The Costs of Addiction
According to the Recovery Centers of America in 2019, the societal cost of drug and alcohol addiction, in terms of lost productivity, crime, and health-care associated costs, is more than $3.73 trillion billion per year. Perhaps an even greater cost, but one that is far more difficult to calculate, is the harm of addiction to those addicted and the “collateral damage” that often occurs to the loved ones of the addicted individual.
Most people can think of someone in their lives—a friend, partner, parent, or child—who is affected by addiction. Addiction is far too common, and its effects can be devastating. Researchers are making considerable progress in understanding the illness, and with greater understanding should come better treatment and more reason for hope.
Diagnostic Categories Related to Addiction
Substance use disorder involves a set of maladaptive behaviors associated with the taking of substances, including drugs and alcohol, that lead to significant impairment or distress. Maladaptive behaviors include the failure to fulfill one’s responsibilities at work, school, or home; engaging in risky or dangerous situations while using substances (such as driving while intoxicated or operating machinery while under the influence of drugs); or continuing to use substances despite recurrent negative consequences (such as losing one’s job or arguments or physical altercations with others).
Tolerance of a substance is also a diagnostic criterion of addiction and substance use disorder. Tolerance is the need for increased amounts of a substance to achieve the desired effect or to reach intoxication. Tolerance is also marked by noticeably diminished effects despite continued use of the same amount of the substance. Other criteria include withdrawal (unpleasant symptoms associated with drug removal); the tendency to escalate drug use; taking the drug more frequently, in greater doses, or for longer periods of time; loss of control over drug use; and an inability to limit one’s use.
The term “addiction” has been expanded in the DSM-5 to include excessive, compulsive, or destructive habits that have nothing to do with drugs or alcohol, such as gambling disorder. Although several societal addictions have not been formally recognized in the DSM-5, two terms, workaholics and shopaholics, are commonly used by individuals to reflect society’s belief that a person can be addicted to working or to shopping. The concept of addiction is also commonly applied to cigarette smoking, internet use, overeating, and sexual behavior, though not formally recognized in the DSM-5.
General Features of Addiction
Addictions occur with behavioral rewards. Behavioral rewards include experiences that a person wants and experiences for which a person is willing to behave in a particular way. In short, the objects of addictions always feel good, at least in the beginning. While certain potentially addictive drugs and behaviors may indeed be harmful in all circumstances, this is not true across the board. There is nothing inherently unhealthy in things that feel good, or in the tendency to engage in certain behaviors to obtain those things. These behaviors have evolved, and they are tendencies that have served well for human survival.
The problem with addiction is that the effect of the behavioral reward changes in particular ways. With time and repeated exposure, a person’s reaction to the behavioral reward changes in three observable ways. First, the person may develop a tolerance and then experience withdrawal. More and more of the behavioral reward will be needed to get the same amount of pleasure (tolerance), and the behavior may need to continue to keep feeling pleasure (withdrawal).
The presence of tolerance and withdrawal has been used as the primary indicator of addiction in years past. However, a person can vary in the extent to which he or she experiences tolerance and, especially, withdrawal, in his or her addiction, even with drugs such as alcohol, which produce symptoms of physical dependence.
In addition, other changes in a person’s reaction to behavioral rewards also typically accompany the development of addictions. For example, the value of the addictive behavior, relative to other possible behaviors, changes. The person’s behavioral repertoire shifts from one in which variable behaviors and responses occur to a far narrower focus, in which behaviors associated with the addiction come to predominate. Finally, the person seems to lose control of the addiction. Once he or she gets started with the behavior in question, they “overdo it” in ways that they did not intend and that they frequently regret. Efforts to permanently curtail or eliminate the addiction are extraordinarily difficult. Relapse, or returning to the behavior after successfully staying away from it for a time, is a common problem.
Models of Addiction
Many different models, from widely diverse theoretical orientations within the field of psychology and medicine, have been proposed to account for addiction. Advances in brain imaging, however, have allowed scientists and researchers to see inside the brain of addicted individuals and study the areas of the brain that are affected by drugs and alcohol. Research has found that addiction is a brain disease because alcohol and drugs change the structure and function of the brain itself. Although many outside the scientific and research communities still consider addiction to be learned behavior, research is proving otherwise.
Other experts have sought to explain addiction in terms of personality variables, emphasizing the role of inner conflict or inadequate psychological coping mechanisms. Finally, numerous biological models search for the root of addictive behaviors in genetics and neurochemistry. It seems likely that a complete understanding of addiction may ultimately require a synthesis of several, if not all, of these approaches.
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