Addiction

Addiction
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Compulsive behavior, craving, inability to stop using a substance or engaging in a behavior despite negative consequences
Complications	Health problems, social issues, legal issues, financial problems
Onset	Varies depending on substance or behavior
Duration	Chronic, often lifelong
Types	N/A
Causes	Genetic predisposition, environmental factors, psychological factors
Risks	Family history of addiction, mental health disorders, peer pressure, stress
Diagnosis	Based on DSM-5 criteria, ICD-10 criteria
Differential diagnosis	Substance use disorder, compulsive behavior disorder, impulse control disorder
Prevention	Education, early intervention, supportive environment
Treatment	Behavioral therapy, counseling, medication, support groups
Medication	N/A
Prognosis	Varies; can be managed with treatment
Frequency	Common; affects millions worldwide
Deaths	N/A

Brain metabolism and drug addiction

File:ΔFosB accumulation.svg

ΔFosB accumulation in addiction

An alcoholic man experiencing delirium

Addiction is a complex, chronic brain disorder characterized by compulsive substance use or behavior despite harmful consequences. Individuals with addiction, also referred to as severe substance use disorder, exhibit an intense focus on using certain substances—such as alcohol or drugs—to the extent that it dominates their daily life and functioning.

Overview

Addiction is not limited to dependency on illegal substances like heroin or cocaine. It can also involve legal substances such as alcohol and prescription medications, or even behaviors like gambling. A person suffering from addiction is typically unable to control their urges, often continuing the behavior despite negative social, occupational, or health consequences.<ref>,

 Neurobiologic Advances from the Brain Disease Model of Addiction, 
 New England Journal of Medicine, 
 2016,
 Vol. 374(Issue: 4),
 pp. 363–371,
 DOI: 10.1056/NEJMra1511480,
 PMID: 26816013,</ref>

Types of Addiction

Substance Addiction

Substance-related addictions involve dependence on chemical substances that alter brain chemistry:

• Alcoholism ‚Äì dependence on alcohol
• Tobacco addiction ‚Äì nicotine dependence
• Opioid addiction ‚Äì includes heroin and prescription painkillers
• Cannabis addiction ‚Äì marijuana use disorder
• Cocaine addiction
• Amphetamine addiction

Behavioral Addiction

These are compulsive behaviors that activate reward systems in the brain similarly to substance use:

• Gambling addiction
• Sex addiction
• Internet addiction
• Video game addiction
• Food addiction
• Exercise addiction

Pathophysiology

Addiction primarily affects the brain’s reward system, particularly pathways involving dopamine. The repeated exposure to addictive substances or behaviors alters the brain's normal functioning, resulting in:

• Changes in motivation and reward
• Impaired decision-making and impulse control
• Long-term neuroplasticity in brain circuits associated with habit and compulsion

These biological changes contribute to the persistence of addictive behaviors, even after cessation attempts.<ref>,

 Neurobiology of addiction: a neurocircuitry analysis, 
 Lancet Psychiatry, 
 2016,
 Vol. 3(Issue: 8),
 pp. 760–773,
 DOI: 10.1016/S2215-0366(16)00104-8,
 PMID: 27475769,</ref>

Diagnosis

The diagnosis of addiction is typically made using established criteria, such as those in the DSM-5, which consider:

• Persistent desire or unsuccessful efforts to cut down
• Tolerance and withdrawal symptoms
• Continued use despite knowledge of harm
• Cravings and loss of control

These indicators reflect both psychological and physiological aspects of addiction.<ref>,

 Diagnostic and Statistical Manual of Mental Disorders (DSM-5®), 
  
 Washington, D.C.:American Psychiatric Pub, 
 2013, 
  
  
 ISBN 9780890425572,</ref>

Treatment

Effective addiction treatment is individualized and often involves a combination of:

• Behavioral therapies: e.g., cognitive-behavioral therapy (CBT), motivational interviewing
• Pharmacological treatment: e.g., methadone, buprenorphine, naltrexone
• Support systems: peer support groups, family therapy

Long-term follow-up and relapse prevention are essential for successful recovery.<ref>,

 The Affordable Care Act and treatment for "substance use disorders:" Implications of ending segregated behavioral healthcare, 
 Journal of Substance Abuse Treatment, 
 2014,
 Vol. 46(Issue: 5),
 pp. 541–545,
 DOI: 10.1016/j.jsat.2014.01.008,
 PMID: 24572761,</ref>

Risk Factors

Addiction arises from a combination of biological, psychological, and environmental influences:

• Genetic susceptibility: Genetics account for approximately 40‚Äì60% of a person's vulnerability.<ref>,

 Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review, 
 JAMA Psychiatry, 
 2016,
 Vol. 73(Issue: 3),
 pp. 292–297,
 DOI: 10.1001/jamapsychiatry.2015.3278,
 PMID: 26842658,</ref>

• Environmental factors: Stress, peer pressure, socioeconomic status, and early exposure to drugs play a critical role.<ref>,

 Chronic stress, drug use, and vulnerability to addiction, 
 Annals of the New York Academy of Sciences, 
 2008,
 Vol. 1141(Issue: 1),
 pp. 105–130,
 DOI: 10.1196/annals.1441.030,
 PMID: 18991954,</ref>

• Psychological factors: Conditions such as depression, anxiety, PTSD, and traits like impulsivity can predispose individuals.<ref>,

 Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions, 
 Journal of Clinical Psychiatry, 
 2006,
 Vol. 67(Issue: 2),
 pp. 247–257,
 
 PMID: 16566619,</ref>

Prevention

Prevention efforts are most effective when they address multiple risk factors at early developmental stages:

• School-based programs: Educating adolescents can reduce the onset of substance use.<ref>,

 The effectiveness of a school-based substance abuse prevention program: 18-Month follow-up of the EU-Dap cluster randomized controlled trial, 
 Drug and Alcohol Dependence, 
 2010,
 Vol. 108(Issue: 1–2),
 pp. 56–64,
 DOI: 10.1016/j.drugalcdep.2009.11.018,
 PMID: 20047888,</ref>

• Community and family interventions: Programs that involve parents and the broader community enhance protective factors.<ref>,

 Youth problem behaviors 8 years after implementing the communities that care prevention system: a community-randomized trial, 
 JAMA Pediatrics, 
 2014,
 Vol. 168(Issue: 2),
 pp. 122–129,
 DOI: 10.1001/jamapediatrics.2013.4009,
 PMID: 24285388,</ref>

Prognosis

Recovery outcomes vary greatly depending on the severity of addiction, the presence of co-occurring disorders, and the individual's support system. Many individuals achieve long-term recovery, though relapse is common and should be viewed as a part of the chronic disease process.<ref>,

 Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation, 
 JAMA, 
 2000,
 Vol. 284(Issue: 13),
 pp. 1689–1695,
 DOI: 10.1001/jama.284.13.1689,
 PMID: 11015800,</ref>

Society and Culture

Addiction is not only a medical issue but also a major societal challenge. It is associated with:

• Increased healthcare costs
• Criminal justice involvement
• Homelessness and unemployment
• Stigmatization and discrimination

These factors often prevent people from seeking treatment and contribute to the chronic nature of addiction.<ref>,

 Stigma, discrimination and the health of illicit drug users, 
 Drug and Alcohol Dependence, 
 2007,
 Vol. 88(Issue: 2–3),
 pp. 188–196,
 DOI: 10.1016/j.drugalcdep.2006.10.014,
 PMID: 17118578,</ref>

See Also

• Relapse prevention
• Self-help groups for mental health
• Substance abuse prevention
• Substance dependence

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