What is Addiction? Definition, Causes, Signs & Treatment

Addiction is a chronic disorder that causes brain changes. People with an addiction continue to take or do something to the point that it becomes a harmful habit. ^{1, 2, 3}

Addiction is usually associated with alcohol and drugs. But it can also involve potentially addictive activities or behaviors.

Common Addictive Substances

Addictive substances directly activate the brain’s reward system, producing a high feeling. Here are the 10 classes of addictive substances:^{4, 5, 6}

1. Alcohol 
2. Caffeine
3. Cannabis and synthetic cannabinoids 
4. Hallucinogens (including LSD, mescaline, phencyclidine, and psilocybin)
5. Inhalants (including paint thinner and certain glues)
6. Opioids (including fentanyl, morphine, and oxycodone)
7. Sedatives, hypnotics, and anxiolytics (including benzodiazepines and barbiturates)
8. Stimulants (including cocaine and amphetamine-type substances) 
9. Tobacco 
10. Other or unknown substances (including anabolic steroids)

Common Addictive Habits and Behaviors

Some behaviors or activities that can turn into addiction include:^{6, 7, 8, 9}

• Gambling
• Eating
• Sex
• Work
• Shopping
• Watching pornography
• Social media
• Video or internet gaming 
• Watching television

Signs and Symptoms of Addiction

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the leading source for understanding addiction. The American Psychiatric Association (APA) publishes it. 

The DSM’s latest version—the DSM-5—lists 11 criteria for diagnosing substance use disorder (SUD) within a 12-month period:^{6, 9, 10}

1. Strong cravings or urges to use the substance
2. Continued substance use that leads to hazardous situations (like drunk driving)
3. Continued substance use even though it causes or worsens social or interpersonal problems
4. Continued substance use that leads to neglect of work, school, or home obligations
5. Withdrawal (manifested as either withdrawal symptoms or using the substance to avoid or relieve withdrawal symptoms)
6. Tolerance (increasing the substance’s amount to get the desired effects or diminishing effects with the same amount)
7. Repeated, unsuccessful attempts to quit substance use
8. Using the substance in larger quantities or over an extended period
9. Significant time spent using or obtaining the substance or recovering from its effects
10. Continued substance use even though it causes or worsens physical or psychological problems
11. Giving up important activities because of substance use

A person with two or more criteria can be diagnosed with substance use disorder. This is the DSM-5 term for substance addiction. The level of addiction is classified based on the number of met criteria:^{6, 10}

• Two or three: Mild
• Four or five: Moderate
• Six or more: Severe

The DSM-5 does not recognize certain addictions, like technology, sex, and work.⁹ These are diagnosed with different criteria.

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Difference Between Substance Misuse, Abuse, and Dependence 

People loosely use and sometimes interchange the substance-related terms misuse, abuse, dependence, and addiction. Generally, their definitions are:^{9, 10}

• Misuse: Using a substance that’s inconsistent with legal or medical guidelines
• Abuse: Using a substance for illegal or non-medical purposes
• Dependence: Usually characterized by withdrawal and tolerance  

Take oxycodone as an example. It’s an opioid that’s prescribed as a painkiller. Oxycodone is misused if taken at a higher dose for stronger pain relief. It’s abused for the high feeling it provides. People are oxycodone-dependent if they experience withdrawal after suddenly quitting. 

The previous DSM version—the DSM-4—defined substance abuse and substance dependence as separate disorders. The DSM-5 replaced these terms with substance use disorder in 2013. This is now the medical term for substance addiction.⁹

Causes of Addiction

The chances of developing an addiction depend on the person. Generally, having more risk factors means more chances of developing an addiction.  

Addiction risk factors include:^{2, 3, 11}

• Genetic predisposition to addiction
• Environmental factors that influence addiction
• Parents, family members, and peers who have struggled or who struggle with substance abuse
• Lack of parental supervision in early years
• School struggles
• Poor social skills
• Low self-control
• Substance availability
• Low substance cost
• Aggressive behavior during childhood
• Unemployment
• Poverty
• Presence of mental disorders (like social anxiety and depression) 
• Stress
• History of trauma
• Extreme professional pressure
• Early drug use
• Method of drug use (smoking and injection methods increase a drug’s addictive potential)

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Stages of Addiction

The four stages of addiction are:¹²

1. Experimentation: People use drugs or drink alcohol out of curiosity. This stage typically involves peer pressure.
2. Social or regular use: Substance use has a problematic pattern. People miss more school or work. They may begin to avoid friends and family or change friend groups to include regular substance users.
3. Problematic or risky use: People show significant behavioral changes. They no longer care about school, work, family, or relationships. They may also start switching to more potent drugs.
4. Dependency or addiction: People’s bodies and minds become dependent on drugs or alcohol. Their physical conditions, financial situations, and legal problems worsen. They lose control and may become suicidal. 

Complications of Addiction

Short-Term Complications

Some immediate complications of alcohol and drug addiction include:^{12, 13} 

• Intoxication
• Overdose
• Withdrawal
• Risk of falls and accidents

Long-Term Complications

Some harmful consequences of alcohol and drug addiction occur in the long-term. They include:^{3, 14}

• Physical conditions (lung or heart disease, cancer, risk of contracting HIV and hepatitis C)
• Mental disorders (anxiety, depression, schizophrenia)
• Behavioral and emotional complications (stress, blaming others)
• Social consequences (jail, damaged relationships)
• Economic consequences (work problems, bankruptcy, debt)

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Addiction Treatment Options

Addiction is a treatable condition. No single treatment is the best option for everyone. Ask a medical professional to determine the best treatment approach(es) for you. 

Examples include: 

Inpatient/Residential Treatment

In this treatment, people stay in a rehab facility 24/7. It’s usually for people with severe addiction. 

Inpatient treatment is categorized into:^{15, 16, 17}

• Therapeutic communities (TC): Lasts for 6 to 12 months. Both residents and staff are essential in changing residents' attitudes, understandings of addiction, and behaviors.
• Shorter-term residential treatment: Shorter but more intensive than TC. It starts with 3 to 6 weeks of detox, followed by a modified 12-step program. 
• Recovery housing: Supervised, short-term housing that starts after other inpatient treatments. It helps residents transition smoothly to independent living. 

Outpatient Treatment 

This approach is cheaper and less structured than inpatient treatment. People don’t need to stay 24/7 in a rehab facility. They can go home after their treatment.^{15, 18}

Outpatient treatment programs are classified into:^{15, 16}

• Low- or moderate-intensity outpatient program: Requires less than 9 hours of weekly sessions for adults (less than 6 hours for teenagers). 
• Intensive outpatient program (IOP): Requires 9 hours or more of weekly sessions for adults (6 hours or more for teenagers). 

Partial Hospitalization Programs (PHPs)

PHPs are suitable for people with unstable medical and psychiatric conditions. 

Compared to outpatient treatment, a PHP requires 20 hours or more of weekly sessions. Compared to inpatient treatment, it doesn’t require 24/7 care.¹⁶

Medication-Assisted Treatment (MAT)

Some medications are used to:^{15, 17, 19}

• Treat withdrawal symptoms
• Decrease cravings
• Prevent relapse

Here are the FDA-approved medications:^{15, 19}

• For opioid use disorder (OUD): Methadone, buprenorphine, lofexidine, and naltrexone
• For nicotine addiction: Bupropion and varenicline
• For alcohol use disorder (AUD): Acamprosate, disulfiram, and naltrexone

Behavioral Treatment

Some behavioral therapies that are effective against substance use disorders include:^{15, 17, 19}

• Cognitive behavioral therapy (CBT): Helps people develop coping skills to enhance self-control and reframe negative thoughts.
• Contingency management (CM): Uses rewards or privileges to motivate people to stay drug-free, attend counseling sessions, or take medications.
• Motivational enhancement therapy (MET): Focuses on people's readiness to change their behavior and enter treatment.
• Group therapy: Provides social reinforcement through peer discussion. 
• Family therapy: Helps people (especially young people) with drug use problems, addresses their drug influences, and improves their family situations.
• Twelve-step facilitation (TSF): An individual therapy setting delivered in 12 weekly sessions. This prepares people to engage in 12-step mutual support programs (like Alcoholics Anonymous (AA)). 

When is it Time to Seek Treatment?

You will know it’s time to seek addiction treatment if you:  

• Cause harm to yourself and/or others due to your substance use
• Cannot quit using substance(s) on your own.
• Notice that addiction severely affects many areas of your life
• Cannot live without drugs, alcohol, gambling, or other activities 
• Hide and act secretive about your addictive behavior
• Use drugs or alcohol to self-medicate

Many people seek help only after their addiction has already caused major problems. Always seek help proactively, even if you are not completely sure you have a serious problem.

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