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What is Addiction?

A person with addiction uses a substance or engages in a certain behavior frequently and repeatedly; the rewarding effects are compelling enough for them to pursue the drug or activity even after there are detrimental consequences. It is marked by an inability to control the behavior or substance use despite problems with school or work, and negative changes in relationships with family and friends, and disruptions of everyday activities.

Addiction is a condition that affects the reward and reinforcement centers of the brain, as well as the motivation and memory systems. Humans are biologically motivated to seek rewards, which trigger the release of dopamine—a neurotransmitter involved in helping us feel pleasure. The smell of cookies baking in the oven or hugging a loved one can trigger dopamine release, and we begin to associate the activity with the good feeling.

Substances (such as alcohol, nicotine or opioids) and certain behaviors (such as sex or gambling) can also trigger the release of dopamine, and a cycle begins where they continue to seek out the substance or activity because of the rewarding effects. The continued use of the substance can affect the brain’s executive functions in the prefrontal cortex, making it so the pursuit of the activity or the drug begins to consume the person’s thoughts and interest.

Addiction is a complex phenomenon with many theories, and several factors that may contribute to its development. It has recently been defined by some healthcare professionals as a progressive disease, in order to help reduce the stigma (the belief that addiction is a problem with morality or willpower) that is often associated with addiction.

Other professionals assert that addiction is not so simple or straightforward, and that the causes are not just biological, but also cultural, social, and psychological. They support the idea that addiction is a deeply entrenched and self-perpetuating habit, and that changes to the brain such as rewired brain circuits can eventually be reversed.

In either case, addiction is a multi-faceted condition. People of any age, sex or economic status can become addicted to a substance. However, there are several risk factors that can influence one’s likelihood of developing an addiction.

Biological Factors

  • Genetic factors such as a family history of drug or alcohol addiction, the way one’s hormones in the body respond to stress, or a variation in the makeup of dopamine receptors in the brain could predispose an individual to addiction.
  • Gender may also play a role. Compared to women, men are more likely to develop substance use. Women tend to experience greater problems due to addiction and have more health-related consequences. Recent research indicates that the substance abuse patterns of men and women have become more similar.
  • Early use of drugs or alcohol can increase the likelihood of a progression to addiction, since the part of the brain that controls executive function is not fully developed.

Psychological Factors

  • Mental health disorders such as anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) increase the risk of addiction. Substance abuse can be a way for these individuals to cope with painful feelings, while exacerbating their condition.
  • Sustained trauma and abuse in childhood can dysregulate the normal stress response and shift the course of brain development, which in turn, can impair emotional regulation and sensitize the stress response situation. This leads to an abnormally strong reaction to perceived threats, making an individual feel easily overwhelmed by the usual struggles of life.

Environmental Factors

  • Lack of family involvement or parental supervision, troubled relationships with parents or siblings, and family disruptions such as divorce can contribute to the risk of addiction.
  • Particularly during adolescence, when the desire to be liked by one’s peers is strong, peer pressure is a factor influencing substance use and abuse.

A feature of addiction is that a person will continue taking the substance or engaging in the behavior even after repeated use causes them physical and psychological harm. Since the body can build up a tolerance to substances, the individual may need larger and larger doses in order to reach a high. They may keep trying to recapture the original feeling, which becomes more difficult as their brain adapts to the use of the drug.

Addiction is marked by continued use despite deleterious effects to one’s self, relationships, finances, and performance at school or work, as well as an inability to control use of the substance. Due to its effect on executive function, individuals may not be aware of the consequences to themselves or their relationships.

The initial step towards recognition of a problem may come through an intervention from family or other loved ones. Diagnosis of a substance disorder usually includes assessment by a psychiatrist, psychologist, or licensed drug counselor. Most of these professionals use criteria defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make a diagnosis, or in the case of an individual with a mental health condition, a dual diagnosis.

At a Glance

Dr. Paul Poulakos

  • Attending Psychiatrist at Mount Sinai Beth Israel Medical Center
  • Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai
  • Past Clinical Assistant Professor of NYU Langone Medical Center
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