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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
If you’ve ever found yourself unable to stop doing something you know is harming you, no matter how hard you try, you’re not alone.
Substance use disorders (SUD) affect over 20 million Americans aged 12 and over (Bustamante, 2021). Addictions can also include alcohol use disorders and other harmful behaviors that a person has difficulty controlling.
While there are many different types of addictions, they share similar causes and treatments. Recovery from any form of addiction is a long road, but it is possible with support.
What is addiction?
The American Society of Addiction Medicine (ASAM) defines addiction as follows (ASAM Board of Directors, 2019):
“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”
There’s a lot of stigma around addiction, but it doesn’t have to be that way. As the ASAM makes clear, addiction is a chronic illness, much like heart disease or asthma. And just like other chronic diseases, people with addictions can be successful in preventing, treating, and managing their illnesses (ASAM, 2019).
Different types of addiction
There are two main categories of addiction. Substance addiction centers on the repeated desire to take a substance continuously despite the negative consequences. Behavioral addiction does not involve a substance but includes similar harmful behaviors (Fluyau, 2020).
Common substance addictions include:
- Illicit drugs, such as heroin, cocaine, or methamphetamines
- Prescription drugs, such as opioid painkillers or benzodiazepines
Alcoholism: signs, causes, and treatments
The central feature of behavioral addictions is the failure to resist an impulse to act in a way that is causing harm to the person or others. Some of the more common behavioral addictions include (Grant, 2010):
While you might think substance addictions and behavioral addictions are totally separate entities, they have similar roots and often go hand-in-hand. For example, gambling addiction—the most studied behavioral abuse condition—often goes along with substance abuse, particularly alcohol abuse (Grant, 2010). That means if you have one type of addiction, it’s important to watch out for other addictions, as well.
What causes addiction?
Addiction is caused by a complex interaction between neurobiology, genetics, and a person’s environment (Fluyau, 2020).
Our brains play a significant role in developing addictions. We have a dopamine reward system that works closely with the hippocampus’s learning and memory centers and the emotional regulation centers in the amygdala. Those systems converge to wire our brains for addiction, assuming other factors are in place (Fluyau, 2020).
One factor that kicks up those responses is actually using a highly addictive substance. After multiple uses of an addictive substance, a chemical called Delta-FosB builds up in the brain. Studies have found a similar build-up of Delta-FosB in the brain after compulsive running. This suggests Delta-FosB may be associated with many compulsive or addictive behaviors (Fluyau, 2020).
Environmental and social risk factors that can contribute to addiction include (Fluyau, 2020):
- Prolonged stress or trauma, particularly in early childhood
- Inadequate parental supervision
- Peers who abuse substances
Research has shown that early childhood abuse or mistreatment creates notable changes in the brain’s stress response pathways. The body’s normally balanced processes become dysregulated, making a person more vulnerable to drug abuse and possibly addiction (Fluyau, 2020).
The signs of addiction
So, how do you know if you or a loved one has an addiction vs. just really enjoying a particular substance or behavior?
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), published by the American Psychiatric Association (APA), is considered the gold standard for diagnostic criteria for behavioral health issues. It lists the following criteria for determining if someone has a substance abuse disorder. The signs for non-substance addictions would be similar (McLellan, 2017).
- Using larger amounts or for longer than intended
- Wanting to cut down or stop but being unable
- Spending a lot of time to get/use/recover from use
- Being unable to manage commitments due to use
- Continuing to use even though it causes problems in your life
- Giving up important activities due to the use
- Continuing to use, even when it puts you in danger
- Continuing to use, even if it is making your physical or psychological problems worse
- Increasing tolerance
- Withdrawal symptoms
If you are experiencing two or more of these symptoms, it may be a sign that you have an addictive disorder (McLellan, 2017).
Consult a medical or behavioral healthcare provider for help with cutting down or stopping use.
How do you treat addiction?
Addiction is often a chronic illness requiring long-term treatment. Individuals recovering from addiction often experience periods of relapse. Recovery should be considered a process rather than a one-time event (Guenzel, 2020).
Several types of addiction treatment have shown effectiveness in assisting with recovery and preventing relapse (Guenzel, 2020).
Several forms of individual therapy have been used to help people struggling with addiction. A combination of various approaches tailored to an individual’s needs is often the most effective (Guenzel, 2020).
Cognitive-behavioral therapy (CBT) is the most widely used approach. CBT helps participants identify and modify thought patterns that are negatively affecting the person’s life. The therapist can employ various skills based on the individual. One skill with a growing body of scientific support is mindfulness (Guenzel, 2020).
Other types of therapy include motivational interviewing, in which a clinician seeks to increase an individual’s readiness for change, and acceptance and commitment therapy, which helps the person change the relationship that they have with addictive substances (Guenzel, 2020).
EMDR therapy for anxiety, grief, and PTSD
Peer support groups
Over the years, various peer support groups have allowed individuals in more advanced stages of recovery to offer assistance to those in the earlier stages (Guenzel, 2020).
Peer support groups emphasize the need for frequent meetings, working through a specified program (steps), and guidance from a mentor (often called a sponsor). The most well-known of these are Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Self-Management And Recovery Training (SMART) (Guenzel, 2020).
There is limited evidence that peer support groups effectively reduce rates of relapsing. Researchers have noted that designing studies to measure this accurately is challenging. One small study did find that AA may help participants accept and remain in treatment (Guenzel, 2020).
A variety of medications can help individuals in the process of substance abuse recovery, both during the initial detoxification from a substance and while maintaining sobriety (Guenzel, 2020).
Bupropion (brand name Wellbutrin; see Important Safety Information) has been shown to be effective for relapse prevention in nicotine use for up to 12 months after nicotine cessation. There is insufficient evidence on the effects of nicotine replacement (including e-cigarettes) and varenicline on relapse prevention (Guenzel, 2020).
Disulfiram, naltrexone, and acamprosate have all shown effectiveness in preventing or delaying relapses in alcohol use (Guenzel, 2020).
Both methadone and buprenorphine have been shown to be effective in reducing the risk of relapse on opioids. Methadone has been shown to be slightly more effective but has a greater potential for abuse (Guenzel, 2020).
Drug addiction and abuse: challenges and solutions
Many different medications have been studied to assist with relapse prevention for cannabis and methamphetamines. Still, none have shown clear signs of effectiveness to date (Guenzel, 2020).
Resources for additional support
If you, a family member, or a loved one is dealing with mental health, alcohol abuse, or drug addiction issues, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a national helpline.
The helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service available in English and Spanish.
- ASAM Board of Directors (2019). ASAM definition of addiction. American Society of Addiction Medicine. Retrieved from https://www.asam.org/Quality-Science/definition-of-addiction
- Bustamante, J. (2021). Substance abuse and addiction statistics . National Center for Drug Abuse Statistics. Retrieved from https://drugabusestatistics.org/
- Fluyau D, Charlton TE. (2020). Addiction. [Updated 2020 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK549783/
- Grant, J. E., Potenza, M. N., Weinstein, A., & Gorelick, D. A. (2010). Introduction to behavioral addictions. The American Journal of Drug and Alcohol Abuse, 36(5), 233–241. doi: 10.3109/00952990.2010.491884. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164585/
- Guenzel N, McChargue D. (2020). Addiction relapse prevention. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK551500/
- McLellan A. T. (2017). Substance misuse and substance use disorders: why do they matter in healthcare?. Transactions of the American Clinical and Climatological Association, 128, 112–130. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525418/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.