What is addiction? How does it develop? What are the key distinguishing features?
Addiction is a challenging condition and it can affect anyone. It develops slowly, often without our awareness. It touches all aspects of our lives, and it causes significant harms. Addiction doesn't respect who you are. It doesn't respect your background, whether you're rich or poor, privileged, educated, male, or female. But addiction happens for a reason. It's functional. It serves a purpose. For some people, it's seeking the experience of a good time. For others, it's the means of escape from physical or emotional pain.
The first step towards using a drug or developing an addictive behaviour is that it gives us something that we need. It removes our pain, our sadness. It helps us cope, or it just helps us relax and enjoy our spare time. The most obvious and fundamental initial experience is that drug use feels good. No matter what the mechanism of action, all drugs share a common feature, and that common feature is that it increases activity in the reward centre or the pleasure centre of our brain. Drug abuse will increase a chemical within our brain called dopamine; a neurotransmitter that's presence in regions of our brain that regulate emotion, movement, cognition, thinking, development of new memories and most importantly; the feelings of pleasure, also known as the dopamine reward pathway of the brain which usually becomes activated when we do something that's important for our survival, like eating, spending time with our loved ones etc. By engaging in these behaviours, we are rewarded with feelings of pleasure and euphoria.
We feel good, so we like to do it again. What drugs do, and what drugs of abuse do so very well is that they overstimulate this rewards system, it makes us want to take drugs again and again.
Finally, the journey out of addiction is one of great challenge and effort. It can be really difficult to quit an addiction, to just say no, and it often takes several attempts.
But at the end of the day, addiction can be treated successfully.
Not everyone who uses a drug will become addicted.
What is it that makes some people become addicted and others not? Understanding addiction and developing effective responses is important personally, socially and economically.
What is addiction?
Well, this is both a simple and a very complex question.
We've all probably got a gut feeling in a broad sense in understanding what addiction is about. But do those of us who drink lots of coffee and get headaches if we miss our morning cup of coffee consider ourselves coffee addicts?
Do we only think of the stereotypes of injecting drug users, the stereotypes of criminals or drug fiends? I don't know. Before we can answer that question what is addiction, we need to question our own beliefs and stereotypes. Do we see people with addiction as weak, poor, sick, criminal, or lacking in moral strength?
A really useful starting point is to look at how we actually make a diagnosis of addiction.
The Diagnostic and Statistical Manual of Mental Health Disorders (DSM) is used by many clinicians to identify and diagnose mental health disorders. The newly released fifth edition of the DSM combines categories of substance abuse and dependence into a single addictive disorder that is measured on a continuum from mild to severe.
This is an interesting development. It highlights how the word addiction is a generic term for a range of drug and non-drug disorders that can span a range of severity.
The DSM gives a set of key symptoms for diagnosing addiction. These can include taking the drug in larger amounts or longer than you meant to, wanting to cut down or stop but not being able to, spending more and more time getting a drug, using it, and then recovering from its effects, craving.
(I think I would like to come back to craving another day...it's an interesting one)
Not managing what you should do at work, home, or at school, and continuing to use even when you know that it's causing you problems or it's putting you in danger. Continuing to use even though you know you're experiencing some physical or psychological problems is perhaps the key defining criteria in diagnosing addiction.
Needing to use more of the drug to get the desired effect, or experiencing symptoms of depression and maybe some physical signs and symptoms that are uncomfortable when you stop using the drug or when the blood levels drop. These symptoms can only be relieved by taking more of the drug.
These criterias are a good starting point for understanding addictions.
The hallmark of addiction is that it takes precedence over other needs and we spend more and more time obtaining a drug or engaging in our addiction, using the drug, and then recovering from its effects, so much so that we have less time available to focus on other important tasks in our daily life.