Understanding Addiction and Recovery

Addiction covers a variety of substances and behaviors. The causes of addiction are individual and often interconnected, and the effects of addiction vary as widely as the causes. This makes the nature of addiction both complex and deeply personal.
In this article: 

What Is Addiction?

Addiction, or substance use disorder (SUD), is the continued use of a substance that produces intense activation of the brain reward system (e.g., alcohol) despite significant substance-related problems, which may affect any area of life (e.g., interpersonal relationships or financial stability). The diagnosis of an SUD is based on the criteria of a pattern of behaviors related to use of the substance, divided into the following three categories:1

  1. Impaired control—Manifests as more severe over time, with an individual:
    1. Using larger amounts of the substance than they intend
    2. Unsuccessfully attempting to stop using the substance or expressing a repeated desire to stop using the substance
    3. Spending increasing amounts of time obtaining, using, or recovering from use of the substance
    4. Developing strong cravings or urges to use the substance
  2. Social impairment—Affects an individual’s ability to fulfill major role obligations at home, school, or work. They may stop or avoid activities they once enjoyed or felt a responsibility to perform in order to use the substance.
  3. Risky use—Represents a knowledge of physical hazards related to continued use of the substance. It is important to note that the criterion of “risky use” is not the existence of substance use, but rather the fact that the individual does not stop using the substance despite having persistent or recurrent physical or psychological issues likely related to substance use.

When evaluating SUD, a clinician may also consider pharmacological criteria, specifically: 1

  • Tolerance, which consists of requiring more of the substance over time to achieve the effects. Tolerance can also be observed in how an individual’s body adapts to handle the side effects of the substance while using it, such as compensating for the respiratory depression and sedation caused by alcohol. Tolerance is distinctly different than individual differences in sensitivity to substances.
  • Withdrawal symptoms differ based on the type of substance in use, how heavily it has been used, and for how long. Withdrawal syndrome occurs when the levels of the substance in an individual’s blood and tissues decrease to a significant enough degree to produce symptoms.

However, the existence of pharmacological criteria is not necessary for a clinical diagnosis of SUD. 1

There are three levels of SUD severity: mild, moderate, and severe. The more severe the addiction, the more likely the individual is to experience more intense versions of the diagnostic criteria, as well as develop signs of tolerance and withdrawal.1

For example, someone with a mild alcohol use disorder (AUD) may fulfill work and family responsibilities, not suffer visible health effects, and not have any financial impact from purchasing alcohol. At the same time, they might use alcohol every night as a sleep aid, use a larger amount than intended, and have had one or more unsuccessful attempts at reducing the amount of alcohol they use.

Someone with severe AUD may spend a noticeable amount of time acquiring and using alcohol—so much time that they are not able to fulfill major responsibilities. They might continue to purchase alcohol despite the cost negatively impacting their finances, have strong cravings for the substance, drive while intoxicated, and continue to use alcohol even though they have a known health condition exacerbated by it.

Why and How Does Addiction Happen?

There is no simple, universal reason why or how addiction occurs. Addiction results from a combination of biological and environmental factors. The greater the number of risk factors a person has in their life, the more vulnerable they may be to substance misuse.2

Some risk factors for developing an addiction are:3

  • Family history of addiction
  • Lack of impulse control, which may indicate a co-occurring impulse control disorder (ICD) 4
  • Childhood trauma
  • Interpersonal challenges in your family of origin
  • Significant stress
  • Lack of healthy coping strategies

Addiction can begin with engaging in a behavior or using a substance as a coping mechanism. For some people, this substance use develops into an addiction.

Notably, behavioral addictions such as gambling, sex, and video games share many features with substance use addictions. These shared features are:5

  • Lack of impulse control
  • Typical appearance in late teens to early 20s
  • A pattern of lapses and recoveries
  • Higher risk of developing in someone who experienced childhood trauma
  • Involvement of brain mechanisms that reinforce immediate gratification
  • Lack of social supports or significant interpersonal problems

“Addictive personality” is a term used in popular culture to describe someone at higher risk of developing an addiction. However, this is an over-simplified, inaccurate misnomer because it implies that risk of addiction is something inherent to who someone is—part of their personality. The presence of risk factors does not predict or guarantee the development of an addiction.

Alcohol Addiction

Alcohol is one of the most used mind-altering substances. How alcohol affects you depends on factors such as how much you drink, how often you drink, your gender, your age, your overall health, and your family history. Alcohol reaches the brain quickly and can significantly affect decision-making ability, motor control, and reaction time. Long-term alcohol use can lead to the development of mental health complications and long-term problems with thinking and planning abilities.1

AUD symptoms are similar to those of addiction to other SUDs, such as drinking in larger amounts than intended, having unsuccessful efforts at reducing or stopping use, drinking in hazardous situations (e.g., drinking while driving), tolerance, and withdrawal.1

Alcohol, because it is legal, is highly available and may be used due to its accessibility, including when another substance becomes difficult to obtain. Alcohol is also often used with drugs, which can amplify the effects of each substance and increase associated risks. Using alcohol with other substances can be hazardous, even when they are over-the-counter drugs or your own prescription medications. For example, mixing alcohol with benzodiazepines—prescription drugs typically used to treat anxiety—has a high risk of overdose due to the fact that both substances are central nervous system depressants and can affect your ability to breathe normally when combined.12

Short-Term Effects of Addiction

The short-term effects of substances depend on the type of substance and amount used in one sitting or on one occasion. In general, how the substances affect the brain and body include:1

  • Alcohol: slurred speech, incoordination, memory impairment
  • Hallucinogens: dilated pupils, rapid heartbeat, sweating, tremors, blurred vision
  • Opioids: drowsiness, slurred speech, significant mood and behavioral changes
  • Cannabis (marijuana): increased appetite, dry mouth, rapid heartbeat

If a substance is used in large amounts over a relatively short amount of time, there is a high risk for overdose. Symptoms of overdose depend on the drug and how much the person used, but general symptoms may include:6

  • Confusion or disorientation
  • Loss of consciousness
  • Vomiting or diarrhea
  • Seizures
  • Severe stomach cramps
  • Limp body
  • Difficulty breathing
  • Pale or clammy face
  • Blue fingernails or lips

If you or someone you know experiences any of these signs of overdose, get immediate medical attention.

Long-Term Effects of Addiction

Chronic, long-term use of substances can lead to physical dependence and neurological changes. These changes can last after there is no more of the substance left in the body. This can partly explain relapse and cravings.7

Physical dependence occurs when your body becomes so accustomed to the activated feeling the substance provides that you become dependent on the substance to function normally. People who have developed a physical dependence may have trouble focusing, sleeping, or managing anxiety without substance use.

In addition to physical dependence, you may develop long-term neurological effects. For example, alcohol affects the part of the brain that increases alcohol-seeking behavior.8 Other long-term effects of substances can include:7

Physical dependence is seperate from tolerance. However, developing a tolerance can contribute to the development of physical dependence. Someone who has developed a tolerance will need to use more of the substance to achieve the same effects. With the development of physical dependence comes an increased risk of uncomfortable, painful, or potentially harmful withdrawal symptoms if you suddenly stop using the substance.

Withdrawal symptoms can include:1

  • Anxiety
  • Fatigue
  • Sweating
  • Vomiting
  • Depression
  • Seizures
  • Muscle aches

If you are experiencing withdrawal or see that someone else is, get medical attention right away.

If you are physically dependent on a substance, the first important step toward recovery is detoxification. During detox, the substance is safely removed from your body with the supervision of medical professionals. They often do this by administering a medication similar to the substance of use and then slowly reducing the dose over time. This way, your body can slowly adjust to the absence of the substance and avoid the painful experience of withdrawal.

Addiction Treatment

Steps in a treatment process for SUD typically include:9

  1. Intake—You meet with a therapist who specializes in substance use issues. During this appointment, the therapist will gather information about your background, mental health history, and your substance use.
  2. Treatment recommendation—The therapist will present treatment recommendations for you based on your needs.
  3. Detoxification—If you have a physical dependency on the substance, you will first need a detox. This typically happens during a 5-7 day hospital stay with the supervision of medical professionals. If you enter treatment due to a medical emergency, the detox process may happen before intake.
  4. Referral—After detox, you may be referred to a treatment program depending on the severity of your addiction. Most treatment programs include both individual and group therapy. There are several types:
    1. Inpatient hospitalization and may be indicated if you use multiple substances, have significant health problems, or also have a co-occurring mental health disorder.
    2. Residential rehabilitation (rehab) is where you live at the facility; this would be appropriate if you have struggled with substance use over a long period of time or lack a strong social support system.
    3. Outpatient treatment is where you would meet with a therapist as part of a structured program, but continue to live at home. This would be appropriate if you are meeting most of your personal obligations and have a strong social network.
  5. Aftercare—After you complete an inpatient or rehabilitation program, you will be referred to outpatient therapy to sustain progress and help prevent relapse. It is usually recommended that you do therapy at this stage for at least one year. Your program may recommend additional supports, such as peer support groups like Alcoholics Anonymous (AA).

If you are concerned about your drug or alcohol use or that of a loved one, please call 800-839-1686Who Answers? for 24/7 help.

Resources

  1. Substance-related and addictive disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders (5th ed).
  2. Szalavitz, M. (2015). No more addictive personality. Nature, 522, 48-49.
  3. Sinha, R. (2008). Chronic stress, drug use, and vulnerability to addiction. Ann NY Acad Sci, 1141, 105-130.
  4. Schreiber, L., Odlaug, B. L., & Grant, J. E. (2011). Impulse control disorders: updated review of clinical characteristics and pharmacological management. Frontiers in Psychiatry, 2, 
  5. Kim, H.S. & Hodgins, D.C. (2018). Component model of addiction treatment: A pragmatic transdiagnostic treatment model of behavioral and substance addictions. Frontiers in Psychiatry, 9.
  6. Better Health Channel (2020). Symptoms of overdose.
  7. Sweis, B.M., Thomas,M.J., & Redish, A.D. (2018). Beyond simple tests of value: measuring addiction as a heterogeneous disease of computation-specific valuation processes. Learning and Memory, 25, 501-512.
  8. Abrahao, K.P., Salinas, A.G., & Lovinger, D.M. (2017). Alcohol and the brain: Neuronal molecular targets, synapses and circuits. Neuron Review, 96, 1223-1238.
  9. Center for Substance Abuse Treatment. (2014) What is substance abuse treatment? A booklet for families

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