Addiction (a-DIK-shun) refers to the abuse of a substance, such as alcohol or another drug, to the point at which a person develops a physical or psychological * need for it. The term also may be used to describe a behavior that is out of control, such as gambling or spending too much time on the Internet.
When friends first told Josh that his drinking and drug use were out of control, he ignored them. He liked to party, he said, but he could stop anytime he wanted. He did not stop, though, no matter how much his grades fell and his soccer game suffered. He still did not stop even after he was kicked off the soccer team and lost many of his friends. Eventually, Josh had to admit that his use of alcohol and drugs had gotten out of control. He had developed an addiction, he now said, and he needed help to fight it.
People who have an addiction are commonly said to be “hooked” on a substance or behavior. It is an apt choice of word, since addicts often feel as if they are dangling like a fish on a hook and that they cannot break free. Fortunately, this is not true. Treatment can help people overcome addiction and regain control of their lives.
Some people feel as if they have lost control of their drinking or drug use, yet they do not show signs of tolerance * or withdrawal. While these people may not be physically hooked on a substance, they can still have a strong psychological dependence on it.
Psychological dependence is present when individuals are convinced they cannot manage or enjoy themselves without using. The substance, they believe, helps them cope. Like people with a physical dependence, these individuals feel an intense craving that leads them to believe that using is necessary.
Another sign of physical dependence is withdrawal, which means that people who are hooked on a substance can have physical symptoms, including feeling sick if they stop using it. The symptoms are so unpleasant that people may be driven to start using the substance again just so they can feel better in the present. Withdrawal discomfort explains why addicted individuals come back for more of a substance, even after they realize that they have a serious problem.
People who are dependent on alcohol or other drugs, either psychologically or physically, often spend much of their time finding ways of getting the substance, using it, hiding it, and recovering from its ill effects. Friendships, school, work, sports, and other activities are all negatively affected as a result. As the problems pile up, people may want desperately to give up the substance, yet they find it very hard to do so despite repeated efforts to kick the habit. Often, users will not see the connection between drug use and life problems. They think that the issues in their lives justify their drug and alcohol use, and deny that their substance abuse is the underlying problem causing those issues.
To understand how alcohol and drugs can gain such a strong hold on people, it helps to understand how these substances act inside the body. Once a substance is taken in through drinking, smoking, injecting, or inhaling, it travels through the bloodstream to the brain, which has its own built-in reward mechanism. When people engage in actions that are important for survival, such as eating, special nerve cells in the brain release chemicals that make people feel pleasure. In this way, the brain's response conditions people to want to repeat these actions in order to feel pleasure.
Substances that are addictive affect the brain's reward system. Instead of teaching people to repeat survival behaviors, they teach them to take more drugs. The way this pattern develops depends on the substance that is being used. Some drugs, such as heroin * * (a synthetic mood-altering drug used as a stimulant) also known as “speed.” At first, drug use may seem to be fun, because it leads to feelings of pleasure or relaxation. Over time, though, drug use gradually changes the brain so that people need to take drugs just to feel normal.
Addicts come in all shapes, sizes, and ages. The homeless man sleeping on the street may have an addiction, but so may the captain of the high school soccer team. Any person who abuses alcohol or other drugs is at risk of becoming addicted. For some people, the risk is especially high. For example, problems with drinking and drug use, just like heart disease or cancer, often run in families. Children whose parents are addicted to alcohol may be more likely than other people to have an alcohol or drug problem themselves.
People who have certain mental health disorders also have a higher than average risk of addiction. This statistic is not surprising, because it is thought that many mental health disorders are caused in part by an imbalance in the same kinds of brain chemicals that drugs affect. People who suffer from depression, for example, may find that a certain drug lifts their mood for a while. The self-medication theory of addiction asserts that people learn to cope with a particular mood by taking a drug in a misplaced effort to relieve their mental pain.
People can become addicted to a wide range of commonly abused street drugs and prescription drugs, including alcohol, amphetamines, cocaine, heroin, inhalants * , LSD, marijuana * , morphine * , tobacco, PCP, and sedatives * .
The street drug MDMA (also called Ecstasy) is a synthetic substance that combines the effects of amphetamines with those of hallucinogens. Otherwise known as Molly, this drug affects the brain's reward system. Studies show evidence of psychological dependence. Long-term users can experience symptoms of tolerance and withdrawal.
Not to be confused with the product that is added to bath water, bath salts are a substance made from stimulants such as mephedrone and methylone, drugs that are considered Schedule I controlled substances * . Those who use bath salts report a high similar to the effect experienced with the use of methamphetamine or cocaine, resulting in a high potential for abuse and addiction.
Methamphetamine is highly addictive and creates a dependence that can be relieved only by taking more of the drug. Because meth is concentrated, many users report immediate addiction after the first use. Methamphetamine is one of the hardest drug addictions to overcome because it is so highly addictive.
In 2015, 4.5 percent of U.S. high school seniors and 4.1 percent of U.S. 10th-grade students reported using methamphetamine at least once in their life.
Heroin is a highly addictive illegal drug. It is made from the resin of poppy plants, similar to that used to make opium and morphine. According to a 2012 National Survey on Drug Use and Health, the number of people in the United States dependent on and abusing heroin more than doubled between 2002 and 2012. Withdrawal from heroin in extremely painful and includes symptoms such as aches and pains in the bones, restlessness, severe discomfort, diarrhea, and vomiting.
Some people believe that marijuana use is relatively safe because it does not lead to addiction. However, regular marijuana users may become psychologically dependent on the drug. Some longtime heavy users can also experience mild signs of physical dependence, including tolerance and withdrawal. Some studies suggest that marijuana affects the brain's reward system in much the same way as other addictive drugs.
Alcoholism (AL-ko-hall-i-zm) is the common name for an addiction to alcohol. According to the U.S. National Institute of Drug Abuse and Alcoholism, almost 17 million Americans, ages 18 and older, have an alcohol use disorder (AUD), as do about 700,000 adolescents, ages 12 to 17. Three-fourths of all high school seniors report being drunk at least once. Adolescents who begin drinking before the age of 15 are four times more likely to become alcoholics than their peers who do not begin drinking until the age of 21. Some people with alcoholism develop a tolerance that allows them to drink large amounts of alcohol without seeming drunk or passing out. Others have severe withdrawal symptoms if they stop drinking. Delirium tremens (de-LEER-ee-um TRE-munz) is the name given to the most severe withdrawal symptoms seen in people who have alcoholism. These symptoms include confusion, disordered thoughts, and hallucinations * .
Cigarette smoking is a difficult habit to break because tobacco contains nicotine, a highly addictive substance. Smokers can build up a tolerance for nicotine, as shown by the fact that most smokers increase the number of cigarettes they smoke as they continue to use tobacco. They also go through withdrawal when they are unable to smoke, which explains why many smokers rush to light up as soon as they leave a place where smoking is not allowed.
Caffeine (ka-FEEN), a substance found in coffee, tea, colas, and many nonprescription medicines, is a widely used mind-altering chemical. It is no accident that coffee, a potent source of caffeine, is the favorite wake-up drink in so many homes. People often use caffeine for the temporary surge of energy it produces, much like the “buzz” that comes from some other drugs. Owing to tolerance, however, it eventually takes more and more caffeine to get this feeling. When daily coffee drinkers stop using caffeine, they may have withdrawal symptoms, such as headaches, fatigue, and irritability.
Experts disagree about whether this kind of out-of-control behavior should be termed an addiction. Many doctors prefer to call it an impulse control disorder. People with an impulse control disorder are unable to curb their urge to do something that is harmful to themselves or others, even though they may try to resist and feel guilty for failing to do so. In everyday conversation, people often refer to excessive gambling, promiscuous and risky sexual activity, and Internet use as addictions, because people with these problems act much like people who are addicted to alcohol or other drugs. Rather than responding to outside chemicals, however, these people may be responding in part to natural chemicals released inside the brain. Exciting activities, such as gambling and certain risky sexual behaviors, can trigger the release of brain chemicals that have an arousing effect. This mood alteration is similar to the effect that people get from taking cocaine or amphetamines.
Gambling addiction, also called pathological (pa-tha-LAH-ji-kal) gambling, refers to out-of-control gambling with harmful consequences. Like people addicted to substances, gambling addicts may need to risk ever-increasing amounts of money to feel the same excitement they got from gambling a small amount the first time. They may also become restless or cranky if they try to cut down on or stop gambling, which makes it hard for them to quit. The continued gambling causes trouble at home, school, or work. Yet gambling addicts use their habit as a way to escape problems, much the way someone else might use alcohol or drugs as a form of escape. They may find that much of their time is spent thinking about their next bet or scheming to get more money. They also may start lying to friends and family to hide how much they are gambling, or they may need to borrow money to cover their losses. As their financial situation gets worse, they may even turn to stealing. Despite increasing problems, such people find it nearly impossible to stop gambling.
Sexual feelings and desires are normal, but some people take these natural feelings to an unhealthy extreme, to the point where they are unable to control their sexual behavior. Some people might spend hour after hour looking at pornography * , whereas others might have casual sex with partner after partner. In either case, there can be serious negative consequences. People who spend too much time looking at sexual pictures or videos may lose friends or drop out of other activities. Those who have numerous sex partners risk an unwanted pregnancy or a sexually transmitted infection (an infection, such as herpes or HIV, which can be passed from person to person by sexual contact).
It is not easy to tell when friends or family members have an alcohol or drug addiction because addicted people work hard to hide the addiction. Addicts themselves may have difficulty recognizing the signs of their addiction. Nonetheless, certain signs do suggest that something is wrong. Typical warning signs in young people include the following:
People with an addictive disorder may act much like those with alcohol or drug addiction. Typical warning signs include the following:
An addiction is a tough problem to beat, but it can be done. The first step is to seek professional help. To make a diagnosis, a physician or mental health professional, such as a psychologist, psychiatric/mental health nurse practitioner, social worker, psychiatrist, or counselor, asks the addicted person about past and present alcohol and drug use. If possible, the doctor or mental health professional will talk to the person's family or friends. In addition, a physician can perform a full medical checkup and may order tests to check for diseases that are more common among addicts. For example, a person who injects drugs might be tested for HIV infection, which can be contracted by sharing needles with an infected person.
Once a diagnosis has been made, there are several treatment options. Medications can help control drug cravings and relieve withdrawal symptoms. These are not the same kinds of drugs that are involved in the addiction but rather medications that help lessen the addiction problem. Talk therapy can help people with addictions understand their own behavior, develop improved self-esteem, and cope better with stress. For most people, a combination of medication and talk therapy works best. Talk therapy can be done one-on-one with a therapist or in a group.
Some medications block the effects of addictive drugs and relieve withdrawal symptoms. For example, methadone (METH-a-don) is a medication used to treat heroin withdrawal, whereas naltrexone (nal-TREK-zone) blocks the effects of heroin and related drugs. Other medications discourage the use of addictive drugs. For example, disulfiram (dy-SUL-fi-ram) works against alcohol use by causing severe nausea and other unpleasant symptoms when a person who is taking it drinks alcohol.
Behavioral (bee-HAV-yor-al) therapy takes aim at negative forms ofbehavior, often by using a system of rewards and punishments to replace harmful behaviors with more positive ones. A teenager, for example, might get movie tickets for having a drug-free urine sample or lose the privilege of driving the car as a result of a relapse. Behavioral therapy may also focus on identifying behaviors that keep a drug or alcohol problem in place (such as going to bars for recreation or spending time with friends who drink) and choosing behaviors that help beat the problem (such as going to the gym instead of a bar).
Family therapy works on problems at home that may play a role in alcohol or drug abuse, such as conflict between family members. Family members may be taught to communicate better or to solve problems more effectively.
A partial list of self-help groups follows:
See also Alcoholism • Caffeine-Related Disorders • Fetal Alcohol Spectrum Disorders (FASD) • Hallucination • Hangover • Internet Addiction Disorder • Mushroom Poisoning • Psychopharmacology • Sexually Transmitted Infections (STIs): Overview • Substance Abuse • Tobacco-Related Diseases: Overview
Sheff, David. Clean: Overcoming Addiction and Ending America's Greatest Tragedy. New York: Eamon Dolan/Mariner Books, 2014.
Williams, Rebecca E., and Julie S. Kraft. The Mindfulness Workbook for Addiction: A Guide to Coping with the Grief, Stress, and Anger That Trigger Addictive Behaviors. Oakland, CA: New Harbinger Publications, 2012.
National Institute on Drug Abuse. “Drug Facts: Prescription Drugs.” http://teens.drugabuse.gov/drug-facts/prescription-drugs (accessed March 5, 2016).
National Institute on Drug Abuse. “Drug Facts: Understanding Drug Abuse and Addiction.” http://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction (accessed March 5, 2016).
Substance Abuse and Mental Health Services Administration. “Behavioral Health Treatment Services Locator.” https://findtreatment.samhsa.gov (accessed March 5, 2016).
National Council on Alcoholism and Drug Dependence. 217 Broadway, Suite 712, New York, NY 10007. Telephone: 212-269-7797. Website: http://www.ncadd.org (accessed March 5, 2016).
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National Institute on Drug Abuse. 6001 Executive Blvd., Room 5213, Bethesda, MD 20892-9561. Telephone: 301-443-1124. Website: http://www.drugabuse.gov (accessed March 5, 2016).
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* psychological (SI-ko-LOJ-i-kal) refers to mental processes, including thoughts, feelings, and emotions.
* tolerance (TALL-uh-runce) is a condition in which a person needs more of a drug to feel the original effects of the drug.
* heroin is a narcotic, an addictive painkiller that produces a high, or a euphoric effect. Euphoria (yoo-FOR-ee-a) is an abnormal, exaggerated feeling of well-being.
* amphetamine is a type of synthetic mood-altering drug used as a stimulant.
* inhalants (in-HAY-lunts) are substances that a person can sniff, or inhale, to get high.
* marijuana (mar-a-WA-na) is a mixture of dried, shredded flowers and leaves from the hemp plant that a person can smoke or eat to get high.
* morphine (MOR-feen) is a narcotic, an addictive painkiller that produces a high.
* sedatives (SAID-uh-tivs) are drugs that produce a calming effect or sleepiness.
* Schedule I controlled substances are substances, including drugs, classified by the United States Controlled Substances Act according to their potential for abuse. Substances classified as Schedule I controlled substances include those with a high potential for abuse and that have no currently acceptable medical use in the United States. In addition, Schedule I substances lack an accepted range of safety even when used under medical supervision. Drugs and substances classified as Schedule I are those with the highest potential for abuse.
* hallucinations (ha-LOO-sin-AY-shuns) occur when a person sees, smells, tastes, or hears things that are not really there. Hallucinations can result from nervous system abnormalities, mental health disorders, or the use of certain drugs.
* amphetamines (am-FET-ameenz) are stimulants, drugs that produce a temporary feeling of alertness, energy, and euphoria.
* cocaine (ko-KAYN) is a stimulant, a drug that produces a temporary feeling of alertness, energy, and euphoria.
* LSD short for lysergic acid diethylamide (ly-SER-jik A-sid dy-e-thel- AM-eyed), is a hallucinogen, a drug that distorts a person's view of reality and causes hallucinations.
* PCP short for phencyclidine (fen- SY-kle-deen), is a hallucinogen, a drug that distorts a person's view of reality.
* withdrawal is a group of symptoms that occurs when a drug that causes physical or psychological dependence is regularly used for a long time and then is suddenly discontinued or decreased in dosage.
* pornography (por-NAH-gra-fee) refers to any material, such as magazines or videos, that shows sexual behavior and is meant to cause sexual excitement.