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What Is Addiction?

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Addiction is defined as a chronic, yet treatable medical disease that’s characterized by the repeated, uncontrollable use of substances. When a person has an addiction, they continue using alcohol, medications, or illicit drugs regardless of the consequences.1

While addiction is a chronic illness, like diabetes or cancer, there are various evidence-based treatment approaches that are generally just as successful as treatments for other chronic medical conditions that affect both the body and behavior, such as hypertension, asthma, or diabetes.1,11

If you or a loved one are struggling with substance use and want more information about what addiction looks like, this article will help you understand what addiction is, how it may be caused, how to identify it, and how it is treated.

What Are the Different Types of Addiction?

Addiction is most commonly associated with substance use disorders (SUDs), which is the compulsive and problematic use of substances like drugs and alcohol. These fall under the larger class of substance-related disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5).3,13

The DSM-5 separates substance-related addictions into 10 classes of drugs and provides diagnostic criteria, which medical professionals use to determine appropriate care plans. The following SUDs are defined in the DSM-5: 3,13

  • Caffeine
  • Alcohol
  • Cannabis
  • Phencyclidine and other hallucinogens
  • Inhalants
  • Opioids
  • Sedatives, hypnotics, or anxiolytic
  • Stimulants
  • Tobacco
  • Other considerations

When it comes to non-substance related addictions, there continues to be discussion in the scientific community about whether or not other behaviors should be formally classified as addictions or impulse control disorders.2

Currently, the DSM-5 only classifies pathological gambling as a non-substance related disorder, or behavioral addiction, however there are other repetitive and compulsive behaviors, such as sex, exercising, and shopping that are outlined in a chapter of the DSM-5 titled “Conditions for Further Study.”3

What Is the Definition of Addiction?

Addiction can be defined as both a brain disorder and a mental illness. It’s characterized by the compulsive desire to seek out and use a substance despite the potentially harmful consequences including long-lasting changes in the brain.4

The DSM-5 is published by the American Psychiatric Association and contains descriptions and symptoms of all diagnosable mental health disorders. It is used by clinicians to diagnose SUDs and help direct appropriate care, but it does not officially use the word “addiction” in diagnostic criteria. The 10 or 11 general criteria (depending on the substance) in the DSM-5 used to help diagnose a potential SUD include:3, 4

  • Taking more of a substance than originally was intended or taking it for a longer period of time than intended.
  • Unsuccessful attempts to cut back or stop using a substance.
  • Spending a lot of time finding a substance, using it, and recovering from use.
  • Cravings or strong urges to use a substance.
  • Inability to fulfill one’s roles in the family, or at work or school due to substance use.
  • Increased interpersonal issues due to substance use.
  • Giving up things that used to be important or enjoyable and using a substance instead.
  • Using a substance in a high-risk situation, such as driving.
  • Using a substance despite knowing that it will worsen physical or emotional disorders.
  • Tolerance, which means your body becomes used to a substance and needs more of it to feel its effects.
  • Physical withdrawal and other symptoms in response to the substance being taken away or significantly reducing use, which may occur with certain substances.

Substance use disorders are sub-classified as mild, moderate, or severe based on how many of these criteria a person may be exhibiting.4

Diagnosing an SUD can only be done by a medical professional who will assess whether or not a person meets the diagnostic criteria for an SUD. If you or a loved feel you’ve experienced more than 2 of these criteria in the past 12 months, it may be a good time to talk with a medical professional or explore treatment options.

Signs of Addiction

When a person has a substance use disorder, their behavior may appear different than before they began using substances. The repeated use of substances can lead to changes in a person’s brain functioning, which could potentially impact their judgment, cognitive abilities, decision making, and other behaviors.5

In general, people who have a substance use disorder struggle with the following:5

  • Impaired control, which means that while they want to cut back, or try to cut back, their cravings for a substance are so strong that they find abstinence impossible.
  • Social problems, including failing at school, getting poor reviews at work, or being fired from work, and interpersonal issues, such as relationship problems.
  • Giving up on other things that interfere with using a substance.
  • Risky use, which means using even when it’s dangerous to do so, such as driving under the influence or drinking even though it can make your liver problems worse.

Other potentially harmful behaviors associated with addiction may include:6

  • Lying or being secretive about using a substance.
  • Stealing money or other items to pay for your substance use.
  • Changes in friends and/or adjustments to how you spend your free time.
  • Engaging in risky sexual encounters.
  • Neglecting parental duties.

Though the potential outward physical effects of drug abuse may vary from one substance to the next, some general physical symptoms may include:3,6

  • Gaining or losing a lot of weight.
  • Sleeping far more or less than normal.
  • Bad breath or bad teeth.
  • Shaking or tremors from using.
  • Bloodshot eyes.
  • Developing withdrawal symptoms, such as chills or vomiting, during a period of abstinence from the substance.

Emotional signs of addiction may include:6

  • Frequently seeming worried without a specific reason.
  • Tiredness and feeling unmotivated.
  • Rapid changes in mood, energy, or attitude.
  • Unusual amount of energy, nervousness, or irritability.

What Are the Causes of Addiction?

There is no single cause of an addiction. Addictions involve complex interactions among brain circuits, genetics, the environment, and a person’s life experiences.1 Researchers have identified a number of potential risk factors that may contribute to a person developing an addiction to drugs or alcohol. These factors may stem from various areas, including a person’s biology, environment, and development.7 These risk factors include:7

  • Gender.
  • Socioeconomic background.
  • Presence of a co-occurring mental health disorder.
  • Friend groups.
  • Family life.
  • Traumatic experiences.

There isn’t one specific risk factor that can predict whether or not someone gets addicted to a substance.7 Addiction is often associated with a combination of these factors. The more risk factors a person has, the greater the chance that taking drugs could lead to addiction.7

Some common motivations for use and/or misuse of substances can include:5

  • Trying to feel better—using substances to improve mood or soothe pain.
  • To perform better—using some substances may make people feel like they can focus better at work or in school.

Curiosity—some people may want to experiment or feel pressured by others.

How Do Drugs Affect the Brain?

Most drugs affect the brain’s reward system, generating a series of reactions that can lead to larger-than-normal releases of the neurotransmitter dopamine.4 As a result, people may experience a flood of pleasurable feelings (i.e., euphoria). Dopamine normally helps motivate positive behaviors such as eating and spending time with friends and family. When there are surges of dopamine associated with drug use, however, it instead can motivate unhealthy behaviors, which may lead a person to keep using the drug over and over.3

With repeated use of certain drugs, the brain adapts to the presence of the drug over time. This could lead a person to use more of the drug to achieve the same feelings that it gave before.4 This effect is known as “tolerance.” For example, 2 drinks may initially be all a person needs to have to feel the pleasant effects of alcohol. But after repeated, regular use, it may take 3 drinks to feel the same way.4 This can lead to a person increasing their use of a substance as tolerance increases.

Dependence often accompanies tolerance. Dependence develops from the body’s adaptation to repeated exposure of a drug, such as daily or near-daily use of a substance.4 A telltale sign of dependence is the presence of withdrawal symptoms and cravings when you stop using or significantly reduce your use of a substance. It’s important to note that tolerance and dependence can still occur even when taking certain substances as they are prescribed, such as opioid painkillers, and isn’t always the result of misuse.4

The combination of tolerance and dependence may potentially contribute to a person developing an addiction. As a person becomes accustomed to a substance (i.e., tolerance), they may continue to chase the dopamine rush by increasing their intake. Should they decide to stop, or have trouble accessing a substance, they find they begin to experience the uncomfortable side effects associated with withdrawal (i.e., dependence). It’s only by using the substance again that helps the person feel relief. As this cycle continues, drug-seeking could become compulsive and be challenging to stop without professional help.4

Long-term use of drugs or alcohol can cause additional changes in the brain that affects:7

  • Learning.
  • Judgment.
  • Decision-making.
  • Stress.
  • Memory.
  • Behavior.

Getting Treatment for Addiction

People struggling with substance use should know that it is treatable and there are numerous options for substance use treatment. Effective treatment is characterized by individualized care that addresses the whole person including physical, medical, social, psychological, and legal considerations.10 Treatment options may include:8

  • Outpatient treatment. Outpatient programs can vary in their offerings, but typically cost less and are less structured than inpatient treatment.8 Some forms of outpatient treatment may meet 2 to 3 times per week for 2 to 3 hours at a time. More intensive programs often meet daily.8 The outpatient approach allows people to keep working or going to school while getting treatment because they do not stay at the treatment center overnight, nor do they receive around-the-clock care.
  • Inpatient treatment. With inpatient treatment, a person resides in the treatment facility 24/7 to focus on their recovery. They also receive constant supervision and highly structured care to address their substance misuse. Depending on the level of care needed, inpatient care may be high- or low-intensity, and/or population specific (e.g., gender or substance-specific).14,15 Intensive inpatient care may be medically monitored to help manage withdrawal and/or for those who have more acute emotional, behavioral, or cognitive problems.15
  • Residential treatment. This can be short-term or long-term depending on the person’s needs. Short-term residential treatment can last from 3 to 6 weeks. Long-term residential treatment can last between 6 and 12 months depending on the type of program.

Depending on the substances a person is being treated for, how long they’ve been abusing them, and other factors, treatment may involve a combination of behavioral methods, medication, treatment for co-occurring mental health or medical disorders, and aftercare.9 It’s important that a person’s treatment be continually assessed to ensure that their needs are being attended to, as they may change over the course of treatment.10

Types of Behavioral Treatment for Addiction

Behavioral therapy is often used to treat people struggling with addiction. This type of therapy helps people abstain from using a substance by changing their thoughts, behaviors, and attitudes towards substance use. This can help them manage situations that could trigger cravings and/or use.15 The following are behavioral therapies that may be used in addiction treatment:15

  • Cognitive Behavioral Therapy (CBT). Addresses thinking patterns around substance use and help a person learn effective ways to cope with the triggers that in the past has led to substance use.
    Cognitive-behavioral therapy can also introduce skills and coping strategies to deal with cravings and/or
    high-risk situations.
  • Motivational Enhancement Therapy/ Motivational Interviewing. This method is aimed at enhancing a person’s motivation to get into treatment and to stay in treatment. It starts with an initial assessment followed by additional individual treatment sessions with a therapist to engage in conversation and build a plan for change. Effectiveness may depend on the type of substance a person used.
  • Contingency Management (CM). An approach that uses various forms of positive reinforcement to help keep people abstinent from substances.
  • Family Behavioral Therapy (FBT). This type of therapy helps the whole family address substance use disorder and co-occurring problems such as family conflict, conduct disorders, and mistreatment. Therapists encourage families to apply the behavioral strategies they learn in session to help improve the home environment.

Medications Used in Drug Addiction Treatment

Medications can be effective in helping to manage withdrawal symptoms during detox from certain substances, reduce cravings, prevent relapse, and address co-occurring disorders.9 While medication can be helpful in certain circumstances, it’s not designed to be the only treatment. It’s common for people who simply detox to return to their drug use.9

For alcohol use disorders (AUDs), medications may include disulfiram, acamprosate, and naltrexone.9 Disulfiram, also known as Antabuse, causes an unpleasant reaction when people drink that may help people who are highly motivated to quit drinking. Acamprosate may help people stop drinking and ease withdrawal symptoms—it may be more effective in people with severe AUDs. Naltrexone blocks opioid receptors to prevent the rewarding effects associated with drinking and alcohol cravings.

For people with opioid use disorder (OUD), medications such as methadone and buprenorphine are effective in reducing withdrawal symptoms as well as helping to control drug cravings. They have both been shown to be effective at reducing relapse. Naltrexone can also help with opioid use disorder by blocking the effects of opioids. Unlike methadone and buprenorphine, naltrexone can be used only after the person is fully detoxed from opioids.9

It’s important to remember that no one type of treatment works for everyone. Treatment is most effective when it is tailored to an individual’s unique needs.10 Discussing treatment options with a knowledgeable treatment provider can help you or a loved one find the type of treatment that meets your needs.8

Treatment for substance use can be effective, but it’s important that a person’s progress during treatment be continually evaluated to provide the appropriate level of care and ensure the patient’s needs are being met.10,14 While relapse can be common, it’s estimated that about 40% to 60% of people with a SUD relapse, rates that are lower or similar to other chronic illnesses. Relapse does not indicate failure but may signify a need to reevaluate the treatment approach.11

If you or your loved one is struggling with substance misuse, American Addiction Centers can help. Our caring and compassionate admissions navigators are ready to help you find a treatment program that fits your needs and start the journey toward recovery today. Call for free at . You can also check your insurance coverage online now.

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Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series of in-depth articles on Community Paramedicine programs across the country that go beyond transporting patients to emergency rooms and connects specific patients, such as repeat system users, the homeless and others with behavioral health issues and substance use disorders, to definitive long-term care and treatment. In his current capacity as Medical Editor for American Addiction Centers, Ryan works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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