Addiction

Chronic treatable disorder involving compulsive substance use or behavior despite harmful consequences

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's weight loss doctor NYC
Philadelphia GLP-1 weight loss and GLP-1 clinic NYC

Addiction
Synonyms	Substance addiction, substance dependence, addictive disorder, behavioral addiction, severe substance use disorder
Pronounce	N/A
Specialty	Psychiatry, Addiction medicine, Clinical psychology, Neurology, Public health
Symptoms	Craving, impaired control, compulsive use, continued use despite harm, tolerance, withdrawal, relapse
Complications	Overdose, withdrawal syndrome, mental disorder, infection, liver disease, cardiovascular disease, social impairment, legal problems, financial problems
Onset	Often adolescence or early adulthood, but can occur at any age
Duration	Often chronic or recurrent; recovery is possible
Types	N/A
Causes	Interaction of genetic, neurobiological, psychological, developmental, social, and environmental factors
Risks	Family history, early exposure, trauma, stress, mental health disorders, chronic pain, peer influence, high drug availability, social disadvantage
Diagnosis	Clinical assessment using DSM-5-TR or ICD-11 criteria
Differential diagnosis	Substance use disorder, impulse-control disorder, obsessive-compulsive disorder, bipolar disorder, attention deficit hyperactivity disorder, personality disorder
Prevention	Early intervention, family support, school and community prevention, safe prescribing, harm reduction, mental health care
Treatment	Behavioral therapy, motivational interviewing, medication-assisted treatment, contingency management, counseling, peer support, recovery support services
Medication	Methadone, buprenorphine, naltrexone, naloxone, acamprosate, disulfiram, varenicline, nicotine replacement therapy
Prognosis	Variable; many people recover with evidence-based treatment and long-term support
Frequency	Common worldwide
Deaths	N/A

Addiction is a chronic, treatable medical and behavioral health condition characterized by compulsive use of a substance or repeated engagement in a behavior despite harmful consequences. It involves impaired control, craving, continued use despite harm, and changes in brain circuits related to reward, motivation, learning, memory, stress, and self-control. Addiction most commonly refers to substance use disorder involving alcohol, opioids, nicotine, stimulants, cannabis, sedatives, or other drugs, but the concept is also applied to recognized behavioral addictions such as gambling disorder.Drug Misuse and Addiction(link). National Institute on Drug Abuse.Treatment and Recovery(link). National Institute on Drug Abuse.

Addiction is not simply a matter of weak will or poor character. Repeated exposure to addictive substances or behaviors can produce long-lasting changes in the brain that increase craving, reduce impulse control, alter decision-making, and make relapse more likely. At the same time, addiction is treatable. Many people achieve remission or long-term recovery through a combination of medication, counseling, behavioral therapy, peer support, harm reduction, family support, and social stability."Neurobiologic Advances from the Brain Disease Model of Addiction".New England Journal of Medicine.2016;374(4)

363-371.doi:10.1056/NEJMra1511480.PMID:26816013.

Overview

Addiction is best understood as a biopsychosocial disorder. Biological vulnerability, brain adaptation, psychological distress, trauma, learning, environment, availability of substances, social context, and public policy all influence risk and recovery.

Substance addiction is clinically diagnosed as substance use disorder when a pattern of substance use causes significant impairment or distress. The DSM-5-TR classifies substance-related and addictive disorders according to impaired control, social impairment, risky use, and pharmacologic features such as tolerance and withdrawal. Gambling disorder is included in DSM-5-TR as a behavioral addiction, while internet gaming disorder is listed as a condition for further study. In ICD-11, both gambling disorder and gaming disorder are recognized as disorders due to addictive behaviors.Current Advances in Behavioral Addictions(link). American Journal of Psychiatry.

Terminology

Addiction-related terminology has changed over time.

• Addiction - Compulsive substance use or behavior despite harmful consequences.
• Substance use disorder - Clinical diagnosis for problematic use of alcohol or other drugs.
• Behavioral addiction - Addictive pattern involving a behavior rather than a psychoactive substance.
• Dependence - Older diagnostic term; may also refer to physiologic adaptation with withdrawal.
• Physical dependence - Physiologic adaptation that can produce withdrawal when a drug is stopped.
• Tolerance - Need for more of a substance to achieve the same effect, or reduced effect at the same dose.
• Withdrawal syndrome - Symptoms that occur after stopping or reducing a substance after repeated use.
• Craving - Strong desire or urge to use a substance or engage in a behavior.
• Relapse - Return to substance use or addictive behavior after a period of improvement or abstinence.
• Remission - Reduction or absence of diagnostic symptoms over time.
• Recovery - Process of improved health, function, purpose, and quality of life after addiction.
• Harm reduction - Strategies that reduce health risks even when abstinence has not occurred.
• Medication-assisted treatment - Use of medications with counseling and support, especially for opioid use disorder.
• Substance misuse - Use of a substance in a way that increases risk of harm.
• Problematic use - Use pattern causing distress, impairment, or danger.
• Addiction medicine - Medical specialty focused on prevention, evaluation, treatment, and recovery from addiction.

Types of addiction

Substance-related addiction

Substance-related addictions involve psychoactive substances that can reinforce use through reward, relief of distress, withdrawal avoidance, or social conditioning.

• Alcohol use disorder - Problematic alcohol use causing impairment, health consequences, or inability to control drinking.
• Tobacco use disorder - Addiction to nicotine-containing products such as cigarettes, cigars, smokeless tobacco, or some vaping products.
• Nicotine dependence - Physiologic and behavioral addiction to nicotine.
• Opioid use disorder - Addiction involving heroin, fentanyl, prescription opioids, or other opioids.
• Stimulant use disorder - Problematic use of cocaine, methamphetamine, amphetamine, or related stimulants.
• Cannabis use disorder - Problematic use of cannabis causing impairment or distress.
• Sedative use disorder - Problematic use of benzodiazepines, barbiturates, or other sedative-hypnotics.
• Hallucinogen use disorder - Problematic use of hallucinogenic drugs.
• Inhalant use disorder - Problematic use of volatile substances such as solvents, aerosols, or gases.
• Caffeine use disorder - Caffeine-related disorder recognized for further study in some diagnostic systems.
• Polysubstance use - Use of multiple substances, often increasing overdose and treatment complexity.
• Prescription drug misuse - Use of prescribed medicines in a way not directed by a clinician.

Behavioral addiction

Behavioral addictions involve repetitive behaviors that activate reward and reinforcement systems and continue despite harm.

• Gambling disorder - Recognized behavioral addiction involving persistent problematic gambling.
• Gaming disorder - Recognized in ICD-11 as a disorder due to addictive behaviors.
• Internet gaming disorder - Listed in DSM-5-TR as a condition for further study.
• Compulsive sexual behavior disorder - Classified in ICD-11 as an impulse-control disorder, not universally classified as addiction.
• Compulsive buying disorder - Proposed behavioral addiction or impulse-control problem, not universally recognized as a formal addiction diagnosis.
• Food addiction - Controversial concept; binge eating disorder and obesity have distinct diagnostic frameworks.
• Exercise addiction - Proposed behavioral addiction pattern, not a standard formal diagnosis in major diagnostic manuals.
• Social media addiction - Popular term for problematic social media use, but not a formal diagnosis in DSM-5-TR.
• Internet addiction - Broad and controversial term for problematic internet use.

Only some behavioral addictions are formally recognized in major diagnostic systems. For SEO and patient education, pages should distinguish recognized diagnoses from popular or emerging terms.

Neurobiology

Addiction involves changes in brain systems that regulate reward, motivation, learning, memory, stress, salience, and executive control.

• Reward system - Brain network that reinforces behaviors important for survival and pleasure.
• Mesolimbic pathway - Dopamine pathway from the ventral tegmental area to the nucleus accumbens.
• Dopamine - Neurotransmitter involved in reward prediction, motivation, reinforcement, and learning.
• Nucleus accumbens - Brain region involved in reward and reinforcement.
• Prefrontal cortex - Brain region involved in decision-making, impulse control, planning, and self-regulation.
• Amygdala - Brain region involved in emotion, fear, stress, and conditioned cues.
• Hippocampus - Brain region involved in memory and context.
• Ventral tegmental area - Dopaminergic brain region involved in reward circuits.
• Extended amygdala - Brain region involved in stress and negative emotional states during withdrawal.
• Neuroplasticity - Long-term change in brain circuits and synapses.
• ΔFosB - Transcription factor implicated in addiction-related neuroadaptation.
• Glutamate - Neurotransmitter involved in learning, craving, and relapse.
• GABA - Inhibitory neurotransmitter affected by alcohol, benzodiazepines, and other sedatives.
• Endogenous opioid - Natural opioid system involved in reward and pain.
• Stress response - Stress systems contribute to craving and relapse.

Addictive substances can produce intense dopamine signaling or relieve distress in ways that powerfully reinforce repeated use. Over time, brain adaptation may reduce sensitivity to natural rewards, increase craving, strengthen drug-related cues, and impair self-control."Neurobiology of addiction: a neurocircuitry analysis".Lancet Psychiatry.2016;3(8)

760-773.doi:10.1016/S2215-0366(16)00104-8.PMID:27475769.

Cycle of addiction

Addiction is often described as a repeating cycle.

• Binge intoxication - Use of a substance or behavior produces reward, relief, or intoxication.
• Withdrawal negative affect - When use stops, the person experiences discomfort, dysphoria, anxiety, irritability, craving, or physical withdrawal.
• Preoccupation anticipation - Craving, planning, cue-reactivity, and impaired control increase risk of return to use.
• Cue-induced craving - Environmental cues trigger desire to use.
• Negative reinforcement - Substance use continues to relieve withdrawal or emotional distress.
• Positive reinforcement - Substance use continues because of pleasurable or rewarding effects.
• Habit formation - Repeated use becomes automatic and less goal-directed.
• Compulsion - Behavior continues despite negative consequences.

Causes and risk factors

Addiction develops through interaction of multiple factors.

Genetic and biological factors

• Genetic predisposition - Inherited factors influence risk for substance use disorders.
• Family history - Addiction in close relatives increases risk.
• Neurodevelopment - Adolescence is a high-risk period because brain circuits for reward mature before full executive control.
• Sex differences - Risk, course, and complications may differ by sex and gender.
• Chronic pain - Can increase exposure to opioids or other medications.
• Sleep disorder - Sleep problems may increase substance use and relapse risk.
• Impulsivity - Trait associated with risk-taking and addiction vulnerability.
• Reward sensitivity - Individual differences in reward processing affect risk.

Psychological factors

• Depression - Common co-occurring condition that can increase risk and complicate recovery.
• Anxiety disorder - May contribute to self-medication and relapse.
• Post-traumatic stress disorder - Trauma-related symptoms increase addiction risk.
• Attention deficit hyperactivity disorder - Associated with impulsivity and increased risk of substance use disorder.
• Bipolar disorder - Mood episodes may increase substance use risk.
• Personality disorder - Some personality disorders are associated with higher substance use risk.
• Adverse childhood experience - Childhood trauma, neglect, or household instability increases later addiction risk.
• Stress - Chronic stress increases vulnerability to substance use and relapse.

Social and environmental factors

• Peer pressure - Social influence can increase initiation and continued use.
• Drug availability - Access increases risk.
• Poverty - Economic stress and reduced access to care can increase vulnerability.
• Unemployment - Can worsen substance use risk and reduce recovery stability.
• Homelessness - Increases exposure to trauma, stress, and barriers to care.
• Social isolation - Reduces protective support.
• Family conflict - Can increase risk and complicate treatment.
• Community violence - Trauma and stress exposure increase risk.
• Stigma - Discourages care-seeking and worsens outcomes.
• Advertising - Alcohol, nicotine, gambling, and other industries may influence use patterns.
• Prescription exposure - Medical exposure to opioids, sedatives, or stimulants can contribute to risk in susceptible people.

Signs and symptoms

Addiction symptoms vary by substance or behavior but often include impaired control, craving, continued use despite harm, and functional impairment.

• Craving - Strong urge to use a substance or engage in a behavior.
• Loss of control - Using more than intended or being unable to stop.
• Tolerance - Needing more for the same effect.
• Withdrawal - Physical or emotional symptoms when stopping.
• Preoccupation - Spending excessive time obtaining, using, or recovering from use.
• Neglect of responsibilities - Failure at work, school, or home.
• Social impairment - Relationship conflict or isolation.
• Risky use - Use in dangerous situations such as driving intoxicated.
• Continued use despite harm - Ongoing use despite medical, legal, social, or psychological consequences.
• Failed attempts to quit - Repeated unsuccessful efforts to cut down.
• Secrecy - Hiding use or minimizing severity.
• Financial problems - Spending excessive money on substances or behavior.
• Legal problems - Arrests, driving offenses, or other legal consequences.
• Mood changes - Irritability, depression, anxiety, or emotional instability.
• Sleep disturbance - Insomnia, hypersomnia, or disrupted sleep.
• Physical decline - Weight change, infections, injuries, organ damage, or poor self-care.

Diagnosis

Diagnosis is based on clinical assessment. Laboratory tests may support diagnosis or assess complications but do not replace a clinical evaluation.

DSM-5-TR criteria

DSM-5-TR diagnoses substance use disorder by the number of criteria present over 12 months. Criteria are grouped into impaired control, social impairment, risky use, and pharmacologic criteria.

• Impaired control - Taking more than intended, inability to cut down, craving, or spending excessive time using.
• Social impairment - Failure to fulfill roles, relationship problems, or giving up activities.
• Risky use - Use in dangerous situations or despite physical or psychological harm.
• Tolerance - Reduced effect or need for increased amount.
• Withdrawal - Substance-specific symptoms after stopping or reducing use.
• Mild substance use disorder - Usually 2 to 3 criteria.
• Moderate substance use disorder - Usually 4 to 5 criteria.
• Severe substance use disorder - Usually 6 or more criteria.

ICD-11

ICD-11 includes disorders due to substance use and disorders due to addictive behaviors.

• Substance dependence - ICD-11 diagnosis involving impaired control, priority of use, and physiologic features or persistence despite harm.
• Harmful pattern of substance use - Substance use causing damage to physical or mental health.
• Gambling disorder - Disorder due to addictive behavior.
• Gaming disorder - Disorder due to addictive behavior recognized in ICD-11.
• Hazardous substance use - Pattern that increases risk of harm.

Screening tools

• AUDIT - Alcohol Use Disorders Identification Test.
• AUDIT-C - Short alcohol screening tool.
• DAST - Drug Abuse Screening Test.
• CAGE questionnaire - Brief alcohol screening questionnaire.
• CRAFFT - Screening tool for adolescents.
• ASSIST - WHO Alcohol, Smoking and Substance Involvement Screening Test.
• TAPS tool - Tobacco, Alcohol, Prescription medication, and other Substance use tool.
• PHQ-9 - Depression screen often used because depression commonly co-occurs.
• GAD-7 - Anxiety screen often used in addiction care.
• Adverse childhood experiences screening - May identify trauma-related risk.

Assessment

• Substance use history - Substances used, amount, frequency, route, duration, and last use.
• Withdrawal history - Prior withdrawal symptoms, seizures, delirium tremens, or detoxification.
• Overdose history - Prior overdose and naloxone use.
• Mental health assessment - Screens for depression, anxiety, trauma, psychosis, and suicidality.
• Medical history - Identifies liver disease, infections, pain, pregnancy, sleep disorders, and other complications.
• Medication review - Identifies prescribed opioids, sedatives, stimulants, or other interacting drugs.
• Social history - Housing, employment, legal issues, family support, and safety.
• Readiness to change - Patient's goals and motivation.
• Urine drug testing - Used for monitoring and safety, not as a stand-alone diagnosis.
• Blood alcohol concentration - Assesses acute intoxication.
• Liver function test - Useful in alcohol-related disease and medication planning.
• Hepatitis C testing - Important in injection drug use.
• HIV testing - Important in people with injection or sexual risk.
• Pregnancy test - Important before medication decisions in people of reproductive potential.

Differential diagnosis

• Substance intoxication - Acute effects of a substance.
• Substance withdrawal - Symptoms after stopping or reducing use.
• Bipolar disorder - Mania or hypomania can mimic stimulant intoxication or impulsive behavior.
• Major depressive disorder - Can contribute to substance use or mimic withdrawal.
• Anxiety disorder - May lead to self-medication.
• Obsessive-compulsive disorder - Repetitive behavior driven by obsessions and compulsions.
• Impulse-control disorder - Difficulty resisting impulses not necessarily driven by craving or reinforcement.
• Attention deficit hyperactivity disorder - Impulsivity and inattention may complicate assessment.
• Personality disorder - Can involve impulsivity or unstable behavior.
• Chronic pain syndrome - May complicate opioid use assessment.
• Eating disorder - May overlap with compulsive eating or stimulant misuse.
• Neurocognitive disorder - Cognitive impairment may affect judgment and medication use.

Complications

Addiction can affect every domain of health and life.

Medical complications

• Overdose - Potentially fatal intoxication, especially with opioids, sedatives, alcohol, and polysubstance use.
• Respiratory depression - Life-threatening opioid or sedative effect.
• Alcohol withdrawal syndrome - Can cause tremor, seizures, hallucinosis, and delirium tremens.
• Delirium tremens - Severe alcohol withdrawal with confusion and autonomic instability.
• Opioid withdrawal - Usually not fatal by itself but highly distressing and relapse-promoting.
• Infective endocarditis - Infection of heart valves associated with injection drug use.
• HIV infection - Risk increased by injection sharing or risky sexual behavior.
• Hepatitis B - Bloodborne and sexually transmitted infection.
• Hepatitis C - Common bloodborne infection among people who inject drugs.
• Liver cirrhosis - Advanced liver scarring from alcohol or viral hepatitis.
• Pancreatitis - Can be caused by alcohol use.
• Cardiomyopathy - Heart muscle disease associated with alcohol, stimulants, or other substances.
• Stroke - Risk increased by stimulant use and other factors.
• Seizure - Can occur with withdrawal, stimulant toxicity, or other substances.
• Malnutrition - Can occur with alcohol, stimulant use, or severe behavioral addiction.
• Traumatic injury - Increased risk from intoxication, falls, violence, or driving impairment.
• Pregnancy complication - Substance use can affect pregnancy and neonatal outcomes.
• Neonatal abstinence syndrome - Newborn withdrawal after opioid exposure in pregnancy.

Psychiatric and social complications

• Depression - Common co-occurring condition.
• Anxiety disorder - Common co-occurring condition.
• Suicide - Risk may increase with substance use disorders.
• Psychosis - Can be substance-induced or co-occurring.
• Domestic violence - Substance use can increase risk and severity.
• Child neglect - May occur when addiction impairs caregiving.
• Homelessness - Can be both cause and consequence.
• Unemployment - Addiction can impair work function.
• Criminal justice involvement - Legal problems may occur due to possession, intoxication-related behavior, or drug-related offenses.
• Financial toxicity - Substance use or gambling can cause debt and poverty.
• Stigma - Creates barriers to treatment and recovery.

Treatment

Addiction treatment should be individualized, evidence-based, trauma-informed, culturally responsive, and matched to patient goals. Treatment may aim for abstinence, reduced use, harm reduction, improved function, or stabilization.

Principles of treatment

• Chronic disease management - Addiction often needs long-term care rather than one-time detoxification.
• Patient-centered care - Treatment should match patient goals, risks, and preferences.
• Trauma-informed care - Recognizes the high prevalence of trauma among people with addiction.
• Integrated care - Treats addiction, mental health, and medical conditions together.
• Medication-assisted treatment - Essential evidence-based treatment for opioid use disorder and useful for alcohol and tobacco disorders.
• Behavioral therapy - Helps change behavior, manage triggers, and build coping skills.
• Recovery support - Housing, employment, peer support, and social connection support long-term recovery.
• Harm reduction - Reduces death and disease even when substance use continues.
• Relapse prevention - Identifies triggers and prepares coping plans.
• Continuity of care - Ongoing follow-up improves outcomes.

Detoxification alone is not adequate treatment for most substance use disorders because it does not address craving, relapse risk, co-occurring disorders, or social drivers.

Behavioral therapies

• Cognitive behavioral therapy - Helps identify triggers, thoughts, and behaviors that maintain addiction.
• Motivational interviewing - Helps resolve ambivalence and strengthen motivation for change.
• Contingency management - Uses tangible reinforcement for treatment goals such as abstinence or attendance.
• Community reinforcement approach - Builds rewarding sober activities and social supports.
• Twelve-step facilitation - Encourages participation in 12-step mutual-help groups.
• Family therapy - Addresses family dynamics and support.
• Multisystemic therapy - Intensive family- and community-based treatment for adolescents.
• Dialectical behavior therapy - Useful when emotional dysregulation and self-harm risk are present.
• Mindfulness-based relapse prevention - Uses mindfulness skills to manage craving and triggers.
• Relapse prevention therapy - Identifies high-risk situations and coping plans.
• Trauma-focused therapy - May be needed for co-occurring PTSD.

Medications for opioid use disorder

Medications for opioid use disorder reduce mortality, cravings, illicit opioid use, HIV and hepatitis C transmission risk, and overdose risk.

• Methadone - Full opioid agonist used in opioid treatment programs.
• Buprenorphine - Partial opioid agonist available in office-based and other treatment settings.
• Buprenorphine/naloxone - Combination product used to reduce misuse risk.
• Extended-release buprenorphine - Long-acting injectable option.
• Naltrexone - Opioid antagonist used after detoxification.
• Extended-release naltrexone - Monthly injectable antagonist option.
• Naloxone - Opioid overdose reversal medication; should be available to people at risk and their families.
• Low-threshold treatment - Reduces barriers to starting medication.
• Medication retention - Continuing medication is associated with better outcomes.

Medications for alcohol use disorder

• Naltrexone - Reduces heavy drinking and craving in many patients.
• Acamprosate - Helps maintain abstinence after stopping alcohol.
• Disulfiram - Produces unpleasant reaction with alcohol and requires careful selection.
• Gabapentin - Sometimes used off-label for alcohol-related symptoms and relapse prevention.
• Topiramate - Off-label option with evidence for reducing drinking in some patients.
• Benzodiazepine - Used short-term for medically supervised alcohol withdrawal, not long-term treatment.
• Thiamine - Prevents or treats Wernicke encephalopathy in alcohol-related illness.

Medications for tobacco and nicotine addiction

• Nicotine replacement therapy - Patches, gum, lozenges, inhalers, or nasal spray.
• Varenicline - Partial nicotinic receptor agonist for smoking cessation.
• Bupropion - Antidepressant also used for tobacco cessation.
• Combination nicotine replacement therapy - Patch plus short-acting nicotine replacement can improve quit rates.
• Quitline - Telephone-based tobacco cessation support.
• Behavioral counseling - Improves success when combined with medication.

Stimulant use disorder treatment

There are no FDA-approved medications specifically for cocaine or methamphetamine use disorder as of 2026, but behavioral treatments can help.

• Contingency management - Strong evidence for stimulant use disorder.
• Cognitive behavioral therapy - Commonly used.
• Matrix model - Structured outpatient treatment model for stimulant use.
• Harm reduction - Reduces overdose, infection, and other risks.
• Treatment of co-occurring disorders - ADHD, depression, trauma, and sleep problems should be addressed.
• Medication research - Studies continue on medications for stimulant use disorder.

Cannabis use disorder treatment

• Motivational enhancement therapy - Helps build motivation for change.
• Cognitive behavioral therapy - Helps manage triggers and coping.
• Contingency management - Can improve abstinence.
• Family-based treatment - Useful in adolescents.
• Sleep management - Important because sleep disturbance is common during cannabis withdrawal.
• No approved medication - No FDA-approved medication specifically for cannabis use disorder as of 2026.

Behavioral addiction treatment

• Gambling disorder - Treated with CBT, motivational interviewing, financial safeguards, self-exclusion, peer support, and treatment of co-occurring disorders.
• Gaming disorder - Treated with behavioral therapy, family interventions, sleep restoration, school or work support, and treatment of co-occurring depression or anxiety.
• Financial counseling - Important in gambling disorder.
• Digital hygiene - Structured limits, app blocking, and replacement activities may help problematic gaming or internet use.
• Family therapy - Especially useful for adolescents and young adults.
• Comorbidity treatment - ADHD, depression, anxiety, and trauma may drive behavioral addiction.

Withdrawal management

Withdrawal management, sometimes called detoxification, treats acute physiologic withdrawal. It should be connected to ongoing treatment.

• Alcohol withdrawal - Can be life-threatening and may require benzodiazepines, thiamine, fluids, and monitoring.
• Benzodiazepine withdrawal - Can cause seizures and requires gradual tapering.
• Opioid withdrawal - Treatable with buprenorphine, methadone, clonidine, lofexidine, and supportive care.
• Nicotine withdrawal - Causes craving, irritability, insomnia, anxiety, and appetite changes.
• Stimulant withdrawal - May cause depression, fatigue, sleep disturbance, and craving.
• Cannabis withdrawal - May cause irritability, insomnia, reduced appetite, and anxiety.
• Medically supervised withdrawal - Recommended for severe alcohol or sedative withdrawal risk.
• Detoxification - Should not be used as a stand-alone treatment for addiction.

Harm reduction

Harm reduction saves lives and reduces disease.

• Naloxone - Reverses opioid overdose.
• Fentanyl test strip - Can help detect fentanyl in drug supplies where legal and available.
• Syringe services program - Reduces HIV and hepatitis transmission.
• Safer injection education - Reduces infection and injury risk.
• Overdose prevention education - Teaches recognition and response.
• Medications for opioid use disorder - Reduce overdose risk.
• Supervised consumption site - Provides monitored use and overdose response in some jurisdictions.
• Never use alone advice - Reduces fatal overdose risk.
• Avoid mixing substances - Combining opioids, alcohol, benzodiazepines, or other sedatives increases overdose risk.
• Infectious disease screening - HIV, hepatitis B, hepatitis C, and sexually transmitted infection testing.
• Vaccination - Hepatitis A and B vaccination where indicated.
• Wound care - Prevents complications of injection drug use.

Prevention

Prevention aims to reduce risk factors and strengthen protective factors.

• Early childhood intervention - Supports families and reduces later risk.
• Parent training - Improves communication, supervision, and family resilience.
• School-based prevention - Teaches refusal skills, social skills, and accurate risk information.
• Community prevention - Reduces access, strengthens norms, and improves youth opportunities.
• Prescription drug monitoring program - Helps identify risky prescribing and dispensing.
• Safe prescribing - Reduces unnecessary exposure to opioids and sedatives.
• Medication disposal - Reduces diversion of unused medicines.
• Alcohol policy - Taxation, age limits, outlet density, and impaired-driving laws reduce harm.
• Tobacco control - Pricing, smoke-free laws, marketing restrictions, and cessation support reduce nicotine addiction.
• Mental health care - Early treatment of depression, anxiety, ADHD, and trauma reduces risk.
• Trauma prevention - Reduces adverse childhood experiences and later addiction vulnerability.
• Youth engagement - Sports, mentoring, arts, faith communities, and social support can be protective.

Recovery

Recovery is a process of change through which people improve health and wellness, live self-directed lives, and work toward their full potential.

• Abstinence - Complete avoidance of a substance or behavior.
• Reduced use - Decreased frequency or amount of use.
• Medication-supported recovery - Recovery while using methadone, buprenorphine, naltrexone, or other medications.
• Peer support - Support from people with lived experience.
• Twelve-step program - Mutual-help program such as Alcoholics Anonymous or Narcotics Anonymous.
• SMART Recovery - Mutual-help approach using cognitive and behavioral tools.
• Recovery community organization - Community-based recovery support organization.
• Recovery housing - Substance-free housing with peer support.
• Employment support - Job training and work support.
• Social connection - Supportive relationships reduce relapse risk.
• Spiritual support - Meaning, faith, or spiritual community may support recovery for some people.
• Relapse prevention - Plans for triggers, cravings, and early warning signs.

Relapse

Relapse is common and should be treated as a signal to adjust the treatment plan, not as failure.

• Trigger - Cue, emotion, person, place, or situation that increases craving.
• Craving management - Skills and medications can reduce craving.
• High-risk situation - Context where return to use is more likely.
• Lapse - Brief return to use.
• Relapse - Return to sustained problematic use.
• Treatment intensification - Increased care after relapse.
• Medication adjustment - Dose or medication changes may reduce relapse.
• Safety planning - Overdose prevention and suicide prevention planning after relapse.
• Support network - Rapid contact with supportive people helps recovery.

Special populations

Adolescents

• Adolescent brain development - Ongoing brain maturation increases vulnerability.
• Early substance use - Earlier initiation increases risk of later disorder.
• Family therapy - Often central to adolescent treatment.
• School support - Academic and social support are important.
• Confidential care - Laws vary, but privacy concerns affect treatment access.
• Co-occurring ADHD - Requires careful assessment and treatment.
• Vaping - Nicotine vaping is a major youth addiction concern.

Pregnancy and parenting

• Pregnancy - Addiction treatment can improve maternal and infant outcomes.
• Opioid use disorder in pregnancy - Methadone or buprenorphine is recommended rather than abrupt withdrawal in many cases.
• Neonatal abstinence syndrome - Newborn withdrawal after prenatal opioid exposure.
• Fetal alcohol spectrum disorder - Preventable condition caused by prenatal alcohol exposure.
• Prenatal care - Should be nonjudgmental and integrated with addiction treatment.
• Breastfeeding - Depends on substance, medication, stability, and clinician guidance.
• Child safety - Family support and child protection may be needed when caregiving is impaired.

Older adults

• Alcohol use disorder - Often underrecognized in older adults.
• Benzodiazepine use - Increases fall, cognitive, and dependence risks.
• Polypharmacy - Increases interaction and misuse risk.
• Chronic pain - May complicate opioid prescribing.
• Cognitive impairment - Can affect medication safety.
• Social isolation - Important risk factor.

People with chronic pain

• Chronic pain - Requires balanced pain and addiction care.
• Opioid therapy - Should be monitored carefully.
• Opioid use disorder - Can coexist with pain and should be treated.
• Non-opioid analgesic - Options include NSAIDs, acetaminophen, antidepressants, anticonvulsants, and topical agents when appropriate.
• Physical therapy - Core part of chronic pain care.
• Behavioral pain management - CBT, mindfulness, and coping skills can help.

People in the criminal justice system

• Jail - High-risk setting for untreated substance use disorder.
• Prison - Treatment access varies.
• Reentry - Overdose risk is high after release.
• Medication for opioid use disorder - Continuation during incarceration and after release reduces overdose risk.
• Drug court - Treatment-oriented legal intervention in some jurisdictions.
• Diversion program - Routes eligible people toward treatment instead of incarceration.

Public health

Addiction is a major public-health issue.

• Overdose epidemic - Drug overdose deaths are a major cause of preventable mortality.
• Opioid epidemic - Public-health crisis involving prescription opioids, heroin, fentanyl, and other synthetic opioids.
• Fentanyl - Potent synthetic opioid driving many overdose deaths.
• Xylazine - Non-opioid veterinary sedative increasingly detected in some illicit drug supplies.
• Alcohol-related death - Alcohol contributes to liver disease, cancer, injury, violence, and overdose.
• Tobacco-related disease - Tobacco use remains a major preventable cause of cancer, cardiovascular disease, and lung disease.
• Health disparity - Addiction harm is shaped by race, poverty, geography, disability, housing, stigma, and treatment access.
• Treatment gap - Many people with substance use disorder do not receive evidence-based care.
• Recovery capital - Resources that support recovery, including housing, employment, relationships, health, and community.
• Syndemic - Addiction can interact with HIV, hepatitis C, homelessness, mental illness, and violence.

In the United States, CDC reported that provisional overdose deaths decreased by nearly 27% in 2024 compared with 2023, including large declines in opioid-involved deaths, but tens of thousands of people still died from overdose.U.S. Overdose Deaths Decrease Almost 27% in 2024(link). Centers for Disease Control and Prevention.

Stigma and language

Language affects whether people seek care.

• Person-first language - Terms such as "person with substance use disorder" reduce stigma.
• Stigma - Negative labeling and discrimination reduce treatment access.
• Medication stigma - Bias against methadone or buprenorphine can block lifesaving care.
• Recovery-oriented language - Emphasizes hope, health, and dignity.
• Nonjudgmental communication - Encourages honesty and care engagement.
• Structural stigma - Laws, policies, and systems that disadvantage people with addiction.
• Internalized stigma - Shame that prevents help-seeking.
• Discrimination - Can occur in healthcare, housing, employment, and legal systems.

Avoid stigmatizing terms such as "addict," "abuser," "junkie," or "dirty urine" in clinical and educational writing. Prefer "person with addiction," "person with substance use disorder," and "positive toxicology result."

Prognosis

The prognosis varies by substance, severity, co-occurring conditions, treatment access, social support, and recovery environment. Addiction can be chronic and recurrent, but recovery is common and achievable.

• Early intervention - Improves outcomes.
• Treatment retention - Longer engagement is associated with better outcomes.
• Medication adherence - Important for opioid, alcohol, and tobacco use disorders.
• Co-occurring disorder - Untreated mental illness increases relapse risk.
• Stable housing - Supports recovery.
• Employment - Can improve recovery stability.
• Social support - Strong support improves outcomes.
• Overdose prevention - Naloxone and medication treatment reduce death risk.
• Long-term recovery - Many people maintain remission for years or decades.
• Relapse - Common but treatable and not a sign that recovery is impossible.

Society and culture

Addiction has medical, legal, economic, spiritual, family, and cultural dimensions.

• Criminalization - Drug policies have historically emphasized punishment in many countries.
• Public health approach - Emphasizes prevention, treatment, harm reduction, and recovery.
• Disease model of addiction - Frames addiction as a chronic brain disorder.
• Moral model of addiction - Older view that addiction reflects moral weakness.
• Social determinants of health - Shape risk, treatment access, and recovery.
• Mutual aid - Peer support groups have major cultural influence in recovery.
• Faith-based recovery - Many people use religious or spiritual support.
• Workplace policy - Employee assistance programs and treatment protections may support recovery.
• Media portrayal - Can either reinforce stigma or promote understanding.
• Legalization - Changing laws for cannabis and gambling affect exposure and risk.
• Industry influence - Alcohol, tobacco, gambling, cannabis, and pharmaceutical industries influence policy and behavior.

Patient education

Patients and families should know that addiction is treatable and that asking for help early can save lives.

• Talk to a clinician - Primary care, psychiatry, addiction medicine, and community clinics can help.
• Do not stop suddenly - Alcohol, benzodiazepines, and some sedatives can cause dangerous withdrawal.
• Carry naloxone - People at risk of opioid overdose and their families should have naloxone.
• Avoid using alone - Using alone increases fatal overdose risk.
• Avoid mixing sedatives - Alcohol, opioids, and benzodiazepines together greatly increase overdose risk.
• Use medications when indicated - Medications for opioid, alcohol, and tobacco use disorders are evidence-based.
• Seek mental health care - Depression, anxiety, PTSD, and ADHD can worsen addiction.
• Build support - Recovery is strengthened by supportive people and safe environments.
• Plan for cravings - Cravings are common and can be managed.
• Reduce shame - Addiction is a treatable health condition, not a personal failure.
• Emergency care - Call emergency services for overdose, severe withdrawal, chest pain, seizures, confusion, or suicidal thoughts.

When to seek urgent help

Urgent or emergency care is needed for potentially life-threatening situations.

• Opioid overdose - Slow breathing, blue lips, unresponsiveness, or pinpoint pupils require naloxone and emergency care.
• Alcohol withdrawal - Seizures, confusion, hallucinations, fever, or severe shaking require urgent care.
• Benzodiazepine withdrawal - Seizure risk requires medical supervision.
• Stimulant toxicity - Chest pain, severe agitation, high fever, or paranoia may be dangerous.
• Suicidal ideation - Thoughts of self-harm require immediate help.
• Severe intoxication - Unconsciousness, vomiting, breathing problems, or injury require emergency care.
• Pregnancy with substance use - Needs prompt, nonjudgmental medical care.
• Injection-related infection - Fever, spreading redness, abscess, or shortness of breath needs care.
• Psychosis - Hallucinations, delusions, or severe paranoia require urgent evaluation.

Research

Addiction research includes neuroscience, genetics, medications, behavioral therapies, public health, harm reduction, implementation science, and recovery science.

• Neuroscience of addiction - Studies brain circuits and neuroadaptation.
• Genetics of addiction - Studies inherited risk and gene-environment interaction.
• Epigenetics - Studies how environment and substance exposure affect gene expression.
• Medication development - Seeks new treatments for stimulant, cannabis, alcohol, nicotine, and opioid use disorders.
• Vaccine research - Investigates vaccines against substances such as nicotine, cocaine, or fentanyl.
• Digital therapeutics - App-based or software treatments for substance use disorders.
• Telemedicine - Expands access to addiction treatment.
• Implementation science - Studies how to deliver evidence-based care in real-world settings.
• Overdose surveillance - Tracks drug-related deaths and emerging substances.
• Recovery research - Studies remission, recovery capital, and long-term outcomes.
• Harm reduction research - Evaluates naloxone, syringe services, fentanyl testing, and safer-use interventions.

See also

• Substance use disorder
• Alcohol use disorder
• Opioid use disorder
• Tobacco use disorder
• Nicotine dependence
• Cannabis use disorder
• Stimulant use disorder
• Gambling disorder
• Gaming disorder
• Behavioral addiction
• Addiction medicine
• Medication-assisted treatment
• Methadone
• Buprenorphine
• Naltrexone
• Naloxone
• Harm reduction
• Overdose
• Withdrawal syndrome
• Relapse prevention
• Recovery model
• Self-help groups for mental health
• Substance abuse prevention
• Mental disorder
• Public health
• Social determinants of health
• ΔFosB
• Reward system
• Dopamine

Further reading

• Drug Misuse and Addiction(link). National Institute on Drug Abuse.
• Treatment and Recovery(link). National Institute on Drug Abuse.
• 2024 National Survey on Drug Use and Health(link). Substance Abuse and Mental Health Services Administration.
• U.S. Overdose Deaths Decrease Almost 27% in 2024(link). Centers for Disease Control and Prevention.
• "Neurobiologic Advances from the Brain Disease Model of Addiction".New England Journal of Medicine.2016;374(4)

363-371.doi:10.1056/NEJMra1511480.PMID:26816013.

• "Neurobiology of addiction: a neurocircuitry analysis".Lancet Psychiatry.2016;3(8)

760-773.doi:10.1016/S2215-0366(16)00104-8.PMID:27475769.

• "Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation".JAMA.2000;284(13)

1689-1695.doi:10.1001/jama.284.13.1689.PMID:11015800.

• Current Advances in Behavioral Addictions(link). American Journal of Psychiatry.

External links

• NIDA - Drug Misuse and Addiction
• NIDA - Treatment and Recovery
• SAMHSA National Helpline
• SAMHSA - 2024 National Survey on Drug Use and Health
• CDC - Overdose Prevention
• CDC - U.S. overdose deaths decreased in 2024
• CDC - Naloxone
• WHO - Psychoactive drugs
• WHO - ICD-11
• Narcotics Anonymous
• Alcoholics Anonymous
• SMART Recovery