What is addiction?

The Costs of Addiction

According to the National Institute on Drug Abuse, the societal cost of drug and alcohol addiction, in terms of lost productivity, crime, and health-care associated costs, is more than $600 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 set of 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 an diagnostic criteria 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). Additional criteria for substance dependence include 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 also is 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, 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 addicting 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 researcher 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.

Bibliography

DiClemente, Carlo C. Addiction and Change: How Addictions Develop and Addicted People Recover. New York: Guilford, 2006. Print.

Granfield, Robert, and Craig Reinarman, eds. Expanding Addiction: Critical Essays. New York: Routledge, 2015. Print.

Hart, Carl L., and Charles Ksir. Drugs, Society, and Human Behavior. 16th ed. New York: McGraw-Hill, 2014. Print.

Julien, Robert M., Claire D. Advokat, and Joseph E. Comaty. A Primer of Drug Action. 13th ed. New York: Worth, 2014. Print.

Koob, George F., Michael A. ARends, and Michel le Moal. Drugs, Addiction, and the Brain. Boston: Academic, 2014. Print.

Miller, Peter M. Biological Research on Addiction. Amsterdam: Elsevier, 2013. Print.

Nutt, David J., and Liam J. Nestor. Addiction. Oxford: Oxford UP, 2013. Print.

Rosenberg, Kenneth Paul, and Laura Curtiss Feder. Behavioral Addictions: Criteria, Evidence, and Treatment. Boston: Academic, 2014. Print.

Rosner, Richard. Clinical Handbook of Adolescent Addiction. Chichester: Wiley-Blackwell, 2013. Print.

Sheff, David, Clean: Overcoming Addiction and Ending America's Greatest Tragedy. Boston: Houghton Mifflin Harcourt, 2013. Print.

Volkow, Nora. "Teacher's Guide: The Essence of Drug Addiction." The Brain: Understanding Neurobiology Through the Study of Addiction. Natl Inst of Health, 2010. Web. 8 Sept. 2014.