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What is addiction ?

Addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences. Despite the involvement of a number of psychosocial factors, a biological process – one which is induced by repeated exposure to an addictive stimulus – is the core pathology that drives the development and maintenance of an addiction. 

The two properties that characterize all addictive stimuli are that they are reinforcing (i.e., they increase the likelihood that a person will seek repeated exposure to them) and intrinsically rewarding (i.e., they are perceived as being inherently positive, desirable, and pleasurable).


Addiction is a disorder of the brain’s reward system which arises through transcriptional and epigenetic mechanisms and develops over time from chronically high levels of exposure to an addictive stimulus (e.g., eating food, the use of cocaine, engagement in sexual activity, participation in high-thrill cultural activities such as gambling, etc 

Wikipedia

Causes of Addiction

Because addiction is a multi-faceted condition, arising from the confluence of many elements—including, of course, exposure to an addictive agent—it is more productive, and more accurate, to think of risk factors for the development of substance abuse disorders, rather than causes. And just as there are risk factors, so are there factors that protect individuals against addiction. Research makes it clear: There is no way to predict who will develop compulsive substance use or gambling behavior.

Among the factors that contribute to risk are these:

Biological factors

  • Genes. Estimates vary but scientists find that genetic factors contribute about half the risk for developing a substance use disorder. For example, one factor linked to vulnerability is variation in a gene that determines the makeup of brain receptors for the neurotransmitter dopamine. Another factor appears to be the nature of the body’s hormonal response to stress.
  • Physiological factors. Variations in liver enzymes that metabolize substances are known to influence risk of alcohol use disorder.
  • Gender. Males are more likely to develop substance use disorder than females, although the so-called gender gap may be narrowing for alcohol use disorder and females are more subject to intoxication effects at lower doses of alcohol.

Psychological Factors

  • Personality factors. Both impulsivity and sensation seeking have been linked to substance use and gambling disorders. Impulsivity may be particularly related to the risk of relapse.
  • Trauma and abuse. Perhaps by sensitizing brain pathways of alarm/distress, perhaps by adding to the burden of stress, early exposure to significant adverse experience can contribute to the development of substance use disorder by overwhelming the coping ability of an individual.
  • Mental health factors. Conditions such as depression, anxiety, attention deficit disorder, and post-traumatic stress disorder (PTSD) increase the risk of addiction. Difficulties managing strong emotions are also linked to substance use.

Environmental Factors

  • Family factors. While strong family relationships have been shown to protect against substance use disorders, several aspects of family functioning or circumstances can contribute to addiction risk. Having a parent or sibling with an addictive disorder raises the risk, as does lack of parental supervision or support. Poor-quality or troubled parent-child relations and family disruptions such as divorce add to risk. Sexual, physical, or emotional abuse also increases risk. Research shows that marriage and taking on child-raising responsibilities mitigate the risk of addiction.
  • Accessibility factors. Easy availability of alcohol or other substances in one’s home, at school or work, or in one’s community increases the risk of repeated use.
  • Peer group. As profoundly social animals, people are strongly influenced by their peers and, in generally seeking to be liked by them, adopt many of their behaviors, particularly during the adolescent years. Positive social relationships are known to strongly protect against substance use.
  • Employment status. Having a job, and developing the skills for employment, exerts pressure for stability and provides financial and psychological rewards that mitigate addiction risk.

Observations of recovery

There is scientific evidence that the addictive substances and behaviors share a key neurobiological feature—they intensely activate brain pathways of reward and reinforcement, many of which involve the neurotransmitter dopamine.

Both substance use disorders and gambling behaviors have an increased likelihood of being accompanied by mental health conditions such as depression and anxiety or other pre-existing problems. Substance use and gambling disorders not only engage many of the same brain mechanisms of compulsivity, they respond to many of the same approaches to treatment.

Complex conditions that affect reward, reinforcement, motivation, and memory systems of the brain, substance use and gambling disorders are characterized by impaired control over usage; social impairment, involving disruption of everyday activities and relationships; and may involve craving. Continuing use is typically harmful to relationships and work or school obligations. Another distinguishing feature is that individuals may continue the activity despite physical or psychological harm incurred or exacerbated by use. And typically, tolerance to the substance increases, as the body adapts to its presence.

Because addiction affects the brain’s executive functions, individuals who develop an addiction may not be aware that their behavior is causing problems for themselves and others. Over time, pursuit of the pleasurable effects of the substance or behavior may dominate an individual’s activities.

Although all addictions have the capacity to induce a sense of hopelessness and feelings of failure, as well as shame and guilt, research documents that recovery is the rule rather than the exception, and that there are many routes to recovery. Individuals can achieve improved physical, psychological, and social functioning on their own—so-called natural recovery. Others prefer the support of community or peer-based networks. Still others opt for clinical-based recovery through the services of credentialed professionals.

The road to recovery is seldom straight: Relapse, or recurrence of substance use, is common—but definitely not the end of the road. For those who achieve remission of the disorder for five years, scientists report, the likelihood of relapse is no greater than that among the general population.

Health direct

 

The Science of Addiction

There are plenty of myths and misconceptions about addiction, but in reality, the processes that give rise to addictive behavior resist a simplistic explanation. There is not just one cause: Although genetic or other biological factors contribute to a person’s vulnerability to the condition, many social, psychological, and environmental factors have a powerful influence on substance use. Some characteristics, such as a lack of ability to tolerate distress or other strong feelings, have been associated with addiction, but there is no one “addictive personality” type that clearly predicts whether a person will face problems with addiction.

 

Substance Use Disorders

The medical world currently views substance use disorders according to the class of drug that is used. As a result, it defines 10 separate substance use disorders. All of the disorders share the defining features of addiction—they directly and intensely involve reward and reinforcement systems of the brain, stimulating compulsive use that typically leads to the neglect of normal activities and negative consequences. With some variation, they also share common symptoms, although withdrawal symptoms differ significantly among them and do not occur for some classes of drug (hallucinogens and inhalants).

  • Alcohol Use Disorder: Alcohol is a brain depressant and alcohol use disorder is common, more so among adult men (12.4 percent) than among women (4.9 percent), although it is on the rise among women. It affects men and women differently; women seem to be more susceptible to some of the detrimental effects of alcohol, researchers find. Most commonly, the disorder develops well before age 40.
  • Caffeine Intoxication: The consequence of very high doses of caffeine consumption, caffeine intoxication is marked by symptoms including restlessness, nervousness, insomnia, flushed face, gastrointestinal disturbance, muscle twitching, rambling thoughts and speech, cardiac rhythm disturbances, periods of inexhaustibility, and psychomotor agitation.
  • Cannabis Use Disorder: Cannabis use disorder is highest among 18- to 29-year-olds (4.8 percent) and prevalence of the disorder decreases with age.
  • Phencyclidine and Other Hallucinogen Use Disorder: These substances alter perception. Phencyclidine is commonly called “angel dust” or PCP and produces feelings of separation of mind from body.
  • Inhalant Use Disorder: Inhalant substances are volatile hydrocarbons, toxic gases that are released from glues, fuels, paints, and other volatile compounds and have psychoactive effects. The disorder occurs primarily among those ages 12 to 17.
  • Opioid Use Disorder: Opioid drugs include the illicit drug heroin and prescription pain-relievers such as oxycodone, codeine, morphine, and fentanyl, among others. According to the American Society of Addiction Medicine, in 2015, 2 million people had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin. Opioid-related overdoses are now the leading cause of death in Americans under 50 years of age. Prescribed opioids are the “overwhelming initial source” of addiction.
  • Sedative, Hypnotic, or Anxiolytic Use Disorder: Addiction to sleeping pills and anti-anxiety medications falls into this category. Like alcohol, these agents are brain depressants. Rates of the disorder are highest among 18- to 29-year-olds.
  • Stimulant Use Disorder: Substances in this group include amphetamines; methylphenidate, best known as the prescription drug Ritalin; and cocaine. Stimulant drugs are commonly prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. In the U.S., cocaine use is highest among those aged 18 to 25.
  • Tobacco Use Disorder: The nicotine in tobacco acts as a central nervous system stimulant. Studies show that 68 percent of adult smokers want to quit, and 50 percent of smokers have made attempts to quit.
  • Other (or Unknown) Substance Use Disorder: Substances ranging from antihistamines, betel nut, and cortisol to steroids may also have effects on the central nervous system that lead to compulsive use causing serious problems.
 
 

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The road to recovery is seldom straight: Relapse, or recurrence of substance use, is common—but definitely not the end of the road

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