What is addiction?
Traditionally, the term addiction has been used to identify self-destructive behaviors that include a pharmacological component.
However, within the last 20 years the scope of the term addiction has expanded to include any substance use or reinforcing behavior that has an appetitive nature, has a compulsive and repetitive quality, is self-destructive, and is experienced as difficult to modify or stop (Orford, 1985)
Addiction is a physical and psychological dependence and compulsive engagement of a substance or behavior that creates disorder and chaos in one’s life, and the lives of those connected to the individual. Addictive behavior patterns are repeated and become predictable in their regularity and excess.
According to the American Society of Addiction Medicine (ASAM), the definition of addiction is the following:
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. “
Types of Addiction
Addiction has a larger spectrum than most people realize. There are substances and behavioral addictions
| Substance Addiction | Behavioral Addictions |
| 1. Alcohol 2. Tobacco (smoking cigarettes or using chewing tobacco) 3. Opioids 4. Other prescription drugs including; hypnotics, anxiolytics, sleeping pills, tranquilizers, and sedatives. 5. Cocaine 6. Cannabis 7. Meth and other amphetamines 8. Hallucinogens 9. Inhalants 10. PCP or Angel Dust (Phencyclidine) | 1.Sex and Pornography 2. Internet 3. Video Game 4. Gambling 5. Eating disorders which can include bulimia or overeating 6. Seeking out pain 7. Shopping 8. Spiritual obsession 9. Exercise 10. Work (being a workaholic) |
1. Substance Addiction
Substance addiction is a disease that affects a person’s brain and behavior and leads to an inability to control the use of a legal or illegal drug or medication. Substances such as alcohol, marijuana and nicotine also are considered drugs. When one is addicted, they may continue using the drug despite the harm it causes.
Drug addiction can start with experimental use of a recreational drug in social situations, and, for some people, the drug use becomes more frequent. For others, particularly with opioids, drug addiction begins with exposure to prescribed medications, or receiving medications from a friend or relative who has been prescribed the medication.
The risk of addiction and how fast one can become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others.
As time passes, there is a need of larger doses of the drug to get high and may need the drug just to feel good. As drug use increases there is an increasing difficulty to go without the drug.
Attempts to stop drug use may cause intense cravings and make individual feel physically ill (withdrawal symptoms).
2. Behavioral Addictions
Similar to substance-related addiction, behavioral addiction is a disorder that affects the neural circuitry of the brain’s reward system. It is typically characterized by the compulsive, repetitive involvement in a rewarding non-substance-related behavior, despite consistent adverse consequences.
Thus, the individual becomes pathologically focused on pursuing reward from engaging in the behavior and/or achieving relief from distress through the behavior. The individual will struggle with refraining from the behavior, experience intense cravings and have difficulty resisting, and will have limited awareness of the problems that have emerged as a result of their behavioral addiction. There has been some suggestion that addiction can develop with any activity, behavior, substance, or object that provides the individual with reward through sensations of pleasure.
Prevalence of Addiction
Global statistics on substance addiction
An estimated 4.9% of the world’s adult population (240 million people) suffer from alcohol use disorder (7.8% of men and 1.5% of women), with alcohol causing an estimated 257 disability‐adjusted life years lost per 100 000 population.
An estimated 22.5% of adults in the world (1 billion people) smoke tobacco products (32.0% of men and 7.0% of women). It is estimated that 11% of deaths in males and 6% of deaths in females each year are due to tobacco.
Of ‘unsanctioned psychoactive drugs’, cannabis is the most prevalent at 3.5% globally, with each of the others at < 1%; 0.3% of the world’s adult population (15 million people) inject drugs. Use of unsanctioned psychoactive drugs accounts for an estimated 83 disability‐adjusted life years lost per 100 000 population.
World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC)
Statistical data on Behavioral Addiction
1. Pornography addiction: A study found that of 10,131 women surveyed, 0.5% of women agreed with the statement that they were “addicted” to pornography; 1.2% (of 4,218 who viewed) when limited to women who say they viewed sex films.
The comparable figure limiting to men who view sex films was 4.4%.
Another study of a convenience sample of 9,265 people found that 1% of Internet users have concerns about their Internet use and 17% of users meet criteria for problematic sexual compulsivity
2. Internet Addiction: According to one of the Meta analysis study there is a 6 percent addiction rate for the internet. Some research suggests that 1.4 percent to 17.9 percent of adolescents are addicted to the Internet.
3. Video game: Worldwide, the rate of gaming addiction ranges from 7% to 11%. Studies generally agree that males report more problems related to video gaming compared to females
4. Gambling: Not enough data was available to determine global rates of problem gambling; however, researchers found a prevalence rate of 1.5% in countries with data on this addiction.
The critical dimensions for an addiction
(1) The development of a solidly established, problematic pattern of an appetitive—that is, pleasurable and reinforcing—behavior,
(2) The presence of physiological and psychological components of the behavior pattern that create dependence, and
(3) The interaction of these components in the life of the individual that make the behavior resistant to change.
Brain and Addiction
Most drugs affect the brain’s “reward circuit,” causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.
As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.
Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include:
- learning
- judgment
- decision-making
- stress
- memory
- behavior
Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.
Similarities between Behavioral Addictions & Drug Addictions
There are a number of common characteristics between behavioral and substance use addictions
- Most significantly, they share the same general definition of becoming obsessively preoccupied with an activity, object, or substance, and will go to great lengths to avoid feelings of discomfort as the result of withdrawal from the substance, removal of the object, or cessation of the activity.
- Individuals suffering from any type of addiction will exhibit signs of being unable to control their own behavior, are unable to refrain from their addictive behavior even though they want to, and deny the presence of any difficulties as the result of their behavior or use of the substance
- Individuals with addiction will continue to engage in the behavior or use the substance, even though it results in a continued accumulation of problems and negative outcomes
In general, any activity that has become the primary focus of an individual’s daily life to the exclusion of other activities or that has begun to cause the individual harm (either psychological, physical, or social) can be considered an addiction.
Reward and related brain pathways in behavioral addictions is still in its early stages. More research is needed to determine the overlapping and distinct characteristics, including more clearly delineate genetic contributions between behavioral addictions and substance-related addictions.
Who are susceptible to Addiction
Addiction can develop in anyone and at any time, regardless of age, socioeconomic status or cultural background. The line between things that are habitual and those which are addictive is the fact that habits are those actions done out of choice and a person could successfully stop those behaviors at any time. On the other hand, addictive behavior can develop in anyone and is a repetitive process that is used to distract us from feeling deeper discomfort, pain and trauma. Whether it is through a substance, thoughts or activities, addictive behaviors is to distract someone from actual pain they may experience.
Those actions–whether negative (such as substance abuse) or positive (such as exercise)–release powerful chemicals called endorphins in the brain which allows people to feel pleasure. The release of these chemicals reinforces the behavior and the addict will constantly engage in those behaviors that will help them feel good and becomes reinforced by repeating those actions; however, the real source of their stress and anxiety is not being addressed. People will continue to engage in those behaviors that are pleasing while the real source of their problems will continue to grow worse over time. As a result, those who are addicted are not aware of the damage their behavior is creating in their environment.
Why are Youth more Susceptible to Addiction?
Teens and young adults are more inclined than adults to take risks, including smoking, drinking or using other drugs. Use of any addictive substance while the brain is still developing increases the chances of future use of that and other addictive substances.
At this development stage the brain is still in a process to develop there is a change in the dopamine system of adolescents. Dopamine is a chemical, it’s a neurotransmitter that’s part of the system of reward in the brain. Dopamine levels at baseline are lower and the dopamine release amounts are higher (in adolescents). This helps in explaining that some of the boredom of adolescents and the drive toward doing things that secrete dopamine. One of the things that secretes dopamine that’s a good thing is novelty, trying new things. And that can explain the risk-taking behavior. But this dopamine shift, unfortunately, makes it so that the adolescent is at risk of anything that could be addictive, because addiction involves the release and then the entrainment of the dopamine system. This explains the finding that if you’re going to get addicted to something, it’s most likely to happen during adolescence.
Prevention Measures
Many prevention approaches, such as selective prevention strategies, focus on helping individuals develop the knowledge, attitudes, and skills they need to make good choices or change harmful behaviors.
Universal prevention approaches include the use of environmental prevention strategies, which are tailored to local community characteristics and address the root causes of risky behaviors by creating environments that make it easier to act in healthy ways.
The successful execution of these strategies often involves lawmakers, local officials, and community leaders, as well as the acceptance and active involvement of members from various sectors of the community (such as business, faith, schools, and health).
Environmental change strategies have specific advantages over strategies that focus exclusively on the individual. Because they target a much broader audience, they have the potential to produce widespread changes in behavior at the population level. Further, when implemented effectively, they can create shifts in both individual attitudes and community norms that can have long-term, substantial effects.
Strategies that target the environment should include Communication and education and Enforcement
To overcome the addictions Rehabilitation is required which involves getting to the core issues that fuel your addiction through therapy.
Dr. Azra Fatima
Consultant Clinical Psychologist
Islaah Center for Psychological Wellness (Adivision of LEARN Maximum)