What Is Addiction? Causes, Symptoms, Types, and Treatment

What Is Addiction?

Addiction is a chronic but treatable medical condition, characterized by the continued use of a substance or activity despite it causing clinically significant distress and impairment in one’s life.¹

This page will discuss addiction, and the risk and protective factors and treatment options for substance use disorder.

What Are Substance Use Disorders?

Substance use disorder (SUD) is the clinical term for an addiction to drugs or alcohol. It is defined as the continued use of substances even though use leads to significant problems in a person’s life.¹

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) places substance disorders into classes based on the classification of the drug. Specific types of substance use disorders in the DSM-5 include:¹

• Alcohol use disorder (AUD).
• Cannabis/marijuana use disorder.
• Stimulant use disorder. This includes prescription drugs like Ritalin or Adderall as well as illicit substances like cocaine and methamphetamine.
• Hypnotic/sedative use disorder. These drugs include benzodiazepines, barbiturates, and others.
• Inhalant use disorder. This includes addiction to huffing nitrous oxide gas, paint, and other household items that elicit a high when their fumes are inhaled.
• Opioid use disorder. Opioids include painkillers like Vicodin and Oxycodone as well as street drugs like heroin.
• Hallucinogen use disorder. This includes addiction to drugs such as MDMA (ecstasy), peyote, LSD, mushrooms, and mescaline.
• Phencyclidine (PCP) use disorder.

What Are Behavioral Addictions?

Behavioral addictions involve continued engagement in an activity even though it is harmful to the person or to others. They share attributes with substance addictions such as lack of emotion regulation and lack of control.^2,3 A common example of behavior addiction is gambling addiction, which can cause problems like psychological distress, severe financial trouble, and relationship issues.¹

Other behavioral addictions include:

• Internet addiction.³
• Video game addiction.²
• Hypersexual disorder.⁴
• Exercise addiction.⁵
• Food addiction.⁶

American Addiction Centers (AAC) facilities treat alcohol and drug addiction only, not behavioral addictions. The rest of this article will focus on substance use disorder and its treatment.

What Are the Signs of Substance Addiction?

The signs of substance addiction include physical, mental, and interpersonal problems as a result of compulsive use. The specific diagnostic criteria listed in the DSM-5 include:¹

1. Using increasingly higher amounts of a drug or alcohol or using a substance for longer than intended.
2. A persistent desire to quit using a drug or alcohol or making repeated failed attempts to do so.
3. Spending lots of time getting, using, or recovering from a drug or alcohol.
4. Craving, or a strong desire or urge to use a substance..
5. Failing to meet major obligations at work, home, or school due to recurrent substance use.
6. Continuing to use a drug or alcohol even when it causes or worsens persistent and recurrent social or interpersonal problems.
7. Giving up hobbies or  occupational or social  activities to use a substance.
8. Recurrent use of a drug or alcohol when it can be physically hazardous, such as prior to driving.
9. Continuing to use a substance knowing it has likely caused or worsened a persistent or recurrent physical or mental health problem.
10. Developing a tolerance to the substance, such that more is needed over time to feel the same effects, or diminished effects are felt when taking the same amount. This criterion does not apply to someone taking medication as prescribed.
11. Using substances to avoid withdrawal symptoms or experiencing withdrawal when use is ceased or significantly diminished. This criterion does not apply to someone taking medication as prescribed.

To be diagnosed with a substance use disorder, 2 of the above 11 criteria must be met over the previous 12 months.¹ The disorders can be mild, moderate, or severe depending on how many criteria are met. 2-3 is considered a mild SUD, 4-5 is considered moderate, and 6 or more is a severe substance use disorder.¹

How Are Addictions Diagnosed?

Substance use disorders are diagnosed by healthcare professionals like primary care providers, psychiatrists, psychologists, or drug and alcohol counselors.

They typically conduct a thorough medical history and assessment during which they gather information on the patient’s patterns of substance use and its impact on their life.

How Does Addiction Happen?

Addiction happens when a person cannot control their substance use, and they continue to use a drug or alcohol despite harmful consequences. Substance use disorders typically develop over time. Someone may start out using a substance for pleasure, curiosity, peer pressure, the desire to feel better or perform better, or to alleviate  physical or emotional pain.⁷ A person may feel they can control their use. But with continued use, a person’s ability to exert self-control can become impaired. Other normally pleasurable activities become less fun or fulfilling, and a person may prioritize drug seeking and use over everything else in their life.

Researchers believe that addiction is related to the action substances have on the brain chemical dopamine, which is involved in reinforcing or repeating pleasurable behaviors .⁸ The effect addictive drugs have on dopamine is far greater than other experiences that naturally bring people pleasure (e.g., having sex or eating their favorite food), powerfully reinforcing the connection between consumption of the substance, the resulting pleasure, and all the external cues linked to the experience. Over time, this effect on dopamine “teaches” the brain to prioritize drug use over other activities.⁸

What Factors Increase the Risk for Addiction?

Not everyone who uses drugs or drinks will become addicted, and no single factor determines whether a person will develop a substance use disorder. Research has identified several risk factors that increase someone’s vulnerability for developing a substance addiction.⁷

In general, the more risk factors a person has, the greater the likelihood that taking drugs will lead to continued drug use and an SUD.⁷

Biological Factors

Genetics play a powerful role in whether or not a person will develop an SUD. Scientists estimate that genes and epigenetics (the effect environmental factors have on someone’s gene expression) account for 40–60% of a person’s risk of addiction.⁷ 

Gender may also play a role in SUD development.⁷ Men are more likely than women to use almost all types of illegal drugs, and men have higher rates of dependence on illicit drugs and alcohol than do women. However, women are just as likely as men to develop an SUD once they start using drugs or alcohol.⁹

Ethnicity may also influence risk for drug use and addiction.

Contextual and Environmental Factors

A person’s environment and social context also play a role in the development of addiction. One such factor is the age when someone first uses drugs or alcohol.⁷ Taking drugs at any age can lead to addiction; however, those who begin use at an earlier age are more likely to develop significant problems. Scientists speculate that this is due to the effects of substances on brain development, which continues into young adulthood.⁷

Several familial factors can also influence addiction risk. For instance, someone who has a parent or older family members with an SUD is more likely to develop one themselves.⁷ 

Lack of parental supervision and adverse childhood experiences such as physical, emotional, or sexual abuse can increase chances of developing addiction.⁷

For adolescents and young adults, peer social context can also influence the chances of developing an SUD. These include peer pressure and the availability of drugs in school. In particular, there is a greater chance of teens using drugs if they do not have adequate skills to refuse them when offered. Having poor social skills or struggling in school can put a young person at further risk for using or becoming addicted to drugs. Lastly, sociocultural factors also play a role in the chances of someone developing addiction. For a person who grows up in an under-resourced community or a community where drugs are prevalent and available, there is a higher risk of developing an SUD.⁷

Psychosocial Factors

In addition to biological and environmental factors, research has found a link between certain personality traits and addiction, particularly impulsivity and sensation-seeking.¹⁰ In other words, someone who tends to act on impulse rather than making thought-out decisions is more likely to use a substance when it is offered or available. A person who is a thrill seeker may pursue drugs for the excitement.

It is also common for people with an SUD to have other mental health disorders like attention-deficit hyperactivity disorder (ADHD), schizophrenia, post-traumatic stress disorder (PTSD), depression, anxiety, and bipolar disorder.¹¹

What Factors Decrease the Risk of Addiction?

While there are various risk factors for developing an addiction, there are also protective factors or those that reduce the risk. These include:⁷

• Self-efficacy, or someone’s belief in their self-control.
• Neighborhood resources.
• Healthy, positive relationships.
• Anti-drug policies in schools.

In addition, parental monitoring and support can be  protective factors reducing the risk of addiction in their children. Supportive behaviors include  providing emotional support, assisting them with schoolwork, helping them to foster positive peer relationships and interpersonal communication, and connecting them with positive community groups like volunteer organizations.¹²

How Are Addictions Treated?

Effective treatment of substance use disorders often uses a combination of evidence-based treatment methods,  including behavioral therapies, medication, peer support groups, and more.

Behavioral therapies help people in addiction treatment to modify their behaviors and attitudes related to  substance use.¹³ These therapies can also help people remain in treatment longer, and also can enhance the effectiveness of medications. Common forms of behavioral therapy used in addiction treatment include:^13,14

• Cognitive behavioral therapy (CBT) seeks to help patients recognize, avoid, and cope with the situations in which they’re most likely to use drugs
• Contingency management (CM) involves providing rewards for positive behaviors such as achieving a treatment goal or abstaining from use.
• Motivational interviewing (MI) is an approach in which the therapist encourages the patient to discuss their substance use and make self-motivational statements to evoke internally motivated change.
• Family behavior therapy (FBT). FBT helps strengthen communication and bond between family members, addressing the issues that contribute to one member’s substance use.

Medications are a critical component in treating patients with opioid use disorder. There are also medications available to help treat alcohol use disorders. In addition, supportive medications may be given during treatment to reduce symptoms as a person is adjusting to living without a drug. Symptoms like restlessness or sleeplessness, as well as depression, anxiety, and other mental health conditions, can be managed with medication,, enabling patients to remain in treatment and continue to do the necessary work to remain in recovery.¹⁴

In addition to behavioral therapies and medication, peer support groups  (e.g, Smart Recovery and 12-Step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)can provide social and complementary support for  formal addiction treatment.¹⁴

When a person has a substance use disorder alongside another mental health disorder (i.e., co-occuring disorders), both disorders are treated concurrently.¹¹

Evidence-based treatment may be performed in a variety of levels of care. Common treatment levels include:¹⁵

• Medical detox. Medical detox is often a necessary first step for patients with a moderate to severe physiological dependency to certain substances (e.g., alcohol, opioids, benzodiazepines). The medically managed withdrawal process typically involves stabilizing the patient on medications to mitigate dangerous and uncomfortable withdrawal symptoms and monitoring their health. Detox alone is seldom effective in helping patients achieve long-term sobriety, so it is crucial that they enter some form of continued treatment afterward.
• Inpatient/residential treatment. Inpatient, or residential, treatment involves living at the treatment facility and receiving care 24/7 from a multidisciplinary team of providers.
• Outpatient. Outpatient services are available for those who need treatment but do not require round-the-clock care (i.e., someone who lives in a supportive, drug-free environment or needs to work or attend school while in treatment). The person can live at home and commute to the treatment facility for services from a multidisciplinary team. There are several levels of outpatient treatment, including partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and standard outpatient care. The primary difference between these levels of care are the required amount of time spent in treatment daily or weekly.

Finding Help for Addiction

If left untreated, addiction can be devastating. However, many people with addiction who go through treatment achieve recovery and lead fulfilling lives.

Please call to speak with an admissions navigator who can answer questions about addiction and treatment, verify your insurance, and help you begin the admissions process.

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