Addiction is a mental health disorder that impacts both the structure and function of the brain. As a complex biological and psychological condition, addiction can cause you to lose control of substance use despite its harmful consequences.
Research has shown that the brain plays a significant role in addiction and that substance use disorders, like other diseases, occur with specific signs and symptoms. Over time, addiction alters the neural pathways in your brain, changing how you think and act.
If you’re concerned about how you or someone you care about uses substances, it can help to learn more about the condition. We want you to know that addiction is a legitimate medical illness. Though addiction is a serious, chronic illness, it can be overcome with treatment and willingness.
What is addiction?
Addiction is a mental health condition that’s referred to in a clinical context as substance use disorder. Substance-related and addictive disorders are a rapidly evolving field of mental health research. Although you might feel like you intuitively know what addiction means, the clinical definition is actually relatively narrow.
For this reason, not all dependency problems with harmful consequences fit the medical criteria for addiction.
The medical definition
Throughout most of the 20th century, an addiction diagnosis hinged on physical dependence and the need for ever-increasing amounts.
Based on this, the clinical definition of addiction related to substances only involves the following:
- Opioid painkillers
In years past, scientists and doctors had thought of behaviors like gambling as impulse-control disorders. But this changed with the most recent version of The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). —
The DSM-5 is the definitive guidebook used by medical professionals to diagnose mental health disorders. Published in 2013, the latest diagnostic criteria for and definition of addiction expanded to include compulsive behaviors that share certain qualities with drug and alcohol addiction.
Since studies show a link between gambling and substance abuse, the latest version of the DSM grouped both of these forms of addiction within the larger category of substance-related and addictive disorders.
The National Institute on Drug Abuse also reports that medical professionals consider any diagnosis that fits the DSM-5 criteria for addiction to be a chronic disease.
What about behavioral “addiction”?
In the most recent publication of the DSM, other compulsive behaviors didn’t qualify as clinical addictions. The American Psychiatric Association (APA), the group that published the DSM-5, said that more research was needed to include other behavioral addictions, such as internet addiction, gaming, food, and pornography, under the umbrella of addictive disorders.
In the future, the APA will consider compulsive behaviors, including sex, pornography, general internet use, social media, food, exercise, and shopping.
Substance-related and addictive disorders are among the most prevalent mental health issues impacting people today. Because addiction also often co-occurs with other mental health disorders like anxiety and depression, it can be challenging to treat.
- 20.2 million American adults had a substance use disorder in 2014.
- Of these 20.2 million, 7.9 million had another co-occurring mental health disorder.
- More than 81,000 Americans died from drug overdoses in 2020.
- 11 – 14% of North Americans meet the criteria for substance use disorder at some point in their lives.
What causes addiction?
There are several contributing factors to the development of addiction that have emerged in scientific research. In addition to these, there are also risk factors that increase the chances you’ll develop an addiction.
Several influences can make you more likely to develop substance use disorder. These include peer pressure, lack of parental supervision, exposure to drugs at home or school, neighborhood poverty, sexual abuse, physical abuse, and other forms of trauma.
Scientists believe that specific genes may be connected to addiction. For example, studies have linked alcohol and cocaine use to both the presence and absence of particular genetic signatures. People with two copies of a specific gene variation may be less likely to develop alcohol addiction.
Specific neuropeptides, proteins produced by neurons, also influence this disorder. When it comes to behavioral addiction, the heritability of gambling is significantly higher for men than it is for women.
Changes in the brain
Over time, addiction influences brain development, specifically the centers involving learning and memory. When a person with addiction engages with an addictive behavior or substance, the neurotransmitter dopamine overproduces that chemical in the brain’s reward center.
Then dopamine floods your neurons with as much as 10x the normal dopamine level. This rewrites the way that the hippocampus records memories, and the amygdala forms a conditioned response.
As time goes on, less dopamine is released, so the reward becomes less pleasurable— but the connection between the addictive behavior and the pleasure response becomes stronger. Changes to the brain’s reward system are part of the pathophysiology of addiction.
Because this mental illness rewires your brain, chronic substance abuse can change how you make decisions, use your judgment, and practice impulse control. Many people with addiction experience this as an intense craving or need to use. But chronic addiction can also cause changes in your personality, interests, and priorities.
In addition to the causes listed above, other factors can contribute to alcohol or drug addiction:
Substance of choice
Some drugs are more addictive than others.
Early substance use
Since drugs cause changes to the developing brain, drug use during childhood and adolescence can be especially dangerous.
A mental health disorder
Certain conditions, such as post-traumatic stress disorder (PTSD) and attention-deficit/hyperactivity disorder (ADHD), may increase the likelihood of developing a substance use disorder.
People who have had bariatric surgery are more likely to develop alcoholism.
The complications of substance abuse depend on the substance being used. Drug and alcohol use can lead to the following physical complications:
- Dehydration and electrolyte imbalance
- Impaired memory
- Withdrawal symptoms, including sweating, vomiting, shaking, and delirium tremens (DTs)
- Certain cancers
- Chronic diseases, such as cirrhosis and pancreatitis
- Brain damage
Substance use disorder is also associated with added complications, such as the possibility you’ll contract a communicable disease and the risk of life-threatening accidents.
Types of addiction
The DSM-5 recognizes many types of substance use disorders, involving both legal and illegal drugs.
To date, only one behavioral addiction has met the medical criteria for an addictive disorder—gambling. That being said, emerging research supports the possible inclusion of other compulsive behaviors in the future.
The majority of addictive disorders apply to substance addictions. Someone with this type of addiction uses a substance or substances compulsively despite the harmful consequences of their substance use.
Substance use disorder can be diagnosed as mild, moderate, and severe, depending on how many of the symptoms of addiction you currently exhibit. A diagnosis of substance use disorder relies on a count of the following symptoms:
- Using more than you meant to or using over a longer period than intended.
- Making unsuccessful attempts to limit or control your substance use.
- Using most of your time and energy to get, use, and recover from the substance.
- Experiencing intense cravings to use the substance.
- Failure to fulfill obligations at work, school, or home because of substance use.
- Using despite repeated social or interpersonal problems related to your use.
- Losing interest or no longer participating in hobbies or activities due to substance use.
- Using in a physically hazardous way.
- Continuing to use despite ongoing mental or physical problems caused by your use.
- Developing a tolerance means you need more of the substance to get the desired effect or that you get a diminished effect if you keep using the same amount.
- Experiencing characteristic withdrawal symptoms when not using the substance or needing to use it to avoid withdrawal symptoms.
If you display 2 or 3 symptoms, you’ll meet the requirements for mild substance use disorder.
On the other hand, if you show 4 or 5 symptoms, you’ll likely be diagnosed with moderate substance use disorder. To qualify as having severe substance use disorder, you need to show 6 or more symptoms.
Subtypes of substance addictions
A range of substances can cause clinical addiction. Health care providers typically divide substance-related disorders into the following categories, although more than one disorder may co-occur within the same person:
Alcohol use disorder
This diagnosis refers to an addiction to alcohol or products that contain alcohol.
Opioid use disorder
People with this diagnosis are addicted to legal and illegal pain-relieving narcotics. This includes methadone, pethidine, tramadol, fentanyl, carfentanil, heroin, oxycodone, hydrocodone, codeine, morphine, and similar drugs.
Tobacco use disorder
This diagnosis covers any nicotine-related addiction.
Cannabis use disorder
This diagnosis refers to marijuana addiction or addiction to cannabis or cannabis-related products.
Stimulant use disorder
With 3 main categories, this disorder describes addictions to amphetamine-type substances, cocaine, and to unspecified stimulants, including Ritalin, Adderall, Vyvanse, and others.
Inhalant use disorder
This is the classification for an addiction to inhaling fumes from glues, sprays, and cans.
Phencyclidine (PCP) use disorder
PCP use disorder describes addiction to the hallucinogen PCP, also known as “angel dust.”
Sedative, hypnotic, or anxiolytic use disorder
People with this diagnosis have addiction to benzodiazepines, like Xanax, Ativan, Valium, Klonopin, barbiturates, such as pentobarbital and Z-drugs, like Ambien, Lunesta, Sonata, and Imrest.
Other hallucinogen use disorders
Finally, this diagnosis includes addiction to LSD, ecstasy, Ketamine, psilocybin, and peyote.
Gambling is currently the only behavioral addiction that meets the medical criteria for addiction.
To be diagnosed with gambling disorder, you must have at least 4 of the relevant symptoms within the past year.
- Needing to gamble with an increasing amount of money to achieve excitement.
- Experiencing restlessness or irritability when gambling is reduced or eliminated.
- Repeated, unsuccessful efforts to reduce or stop your gambling.
- Preoccupation with gambling, like reliving past experiences, planning, or fantasizing.
- Gambling when feeling distressed.
- Returning to gambling after significant losses.
- Lying to conceal gambling behavior or losses.
- Gambling despite the serious social or interpersonal problems it causes.
- Turning to others for help with money problems caused by gambling.
Finally, to be diagnosed with gambling addiction, a medical professional must conclude that a manic episode doesn’t better explain your symptoms.
Although food addiction is not considered an addictive disorder in the clinical sense, some research indicates that food does have addictive properties similar to illegal drugs.
For example, chocolate has been used to demonstrate drug-like behavioral conditioning in monkeys. And people often describe compulsive use of food, especially sugar, as “sugar addiction.”
Another study showed that conditioned behavioral responses to food could be blocked with medication, suggesting that food conditioning is tied to neurobiological changes.
One electroencephalographic (EEG) study demonstrated that people with 3 or more symptoms of this condition exhibited brain changes similar to those with recognized addictive disorders.
Sex & porn addiction
The latest edition of the International Classification of Diseases (ICD-11), published by the World Health Organization in 2019, includes “compulsive sexual behaviour disorder” as a type of impulse control disorder.
In 2013, the authors of the DSM-5 considered including hypersexual disorder as a diagnosis, with a pornography subtype. While “pornography addiction” and “sex addiction” aren’t currently medical diagnoses, many people struggle with their relationship to porn and sex.
While there was limited evidence to support the inclusion of hypersexual disorder in the DSM in 2013, there have been several studies in the years that followed to both support and refute the addiction model.
In 2013, the DSM-5 included a proposal for internet gaming disorder with an outline of possible symptoms and diagnostic criteria. But the authors decided that more research was necessary before this behavior could be included as an addictive disorder.
Since then, scientists have discovered a possible link between online gaming and structural deficits in the orbitofrontal cortex. In addition, studies have also shown a relationship between online gaming behaviors and impulsivity in adolescents.
In 2019, the ICD-11 categorized gaming disorder as an impulse control disorder rather than an addictive disorder.
Signs of addiction
The signs that you have substance-related or addictive disorder may include:
Problems at school or work
For example, you may drop out of school or get fired from your job due to active addiction.
Substance abuse can cause both mental and physical health problems. With severe, chronic substance use, these can be life-threatening.
Changes in behavior
Significant changes in behavior, such as recent episodes of antisocial or violent behavior, unexplained absences, and signs of physical impairment, may indicate an addiction.
Both substance abuse and gambling are expensive habits. Family members may be asked for money, notice items missing from the home, or observe secretive behavior involving money.
Substance-related and addictive disorders are chronic diseases. Under the disease model of addiction, doctors consider both gambling disorder and substance use disorder to be legitimate medical conditions.
There is a formal field dedicated to the study of addiction medicine which is recognized by the American Board of Medical Specialties.
In other words, it’s essential to understand that this mental illness doesn’t represent a moral failing, a character flaw, or a lack of willpower. With proper treatment and support, you can recover from your addiction and reduce your risk of relapse.
This condition can cause changes to your brain chemistry that make it difficult for you to quit. Medical research in this field is evolving fast, and health care providers may be able to offer treatment approaches guided by cutting-edge science.
Seeking help early on can reduce the long-term impacts on your job, your relationships, and your health.
Testing & diagnosis
If you live in North America, a doctor will most likely determine your diagnosis and the severity of your symptoms based on the criteria in the DSM-5.
A health care provider may ask you questions related to your addictive habit. They might also ask for permission to talk to your loved ones to learn more about your behavior.
Your health care provider will likely review your medical information and ask you questions about the drugs, supplements, and prescription medications you take. This can help them rule out an underlying medical condition or side effects from a particular med that may contribute to your addictive behavior.
You’ll also get asked questions about your thoughts, feelings, symptoms, and the behaviors related to your addiction.
Some mental health disorders may compound or influence addictive behaviors, so your health care provider may aim to build a comprehensive picture of your psychological health.
Alcoholism, gambling, and drug abuse all have different treatment modalities, including outpatient and inpatient addiction treatment.
Readiness to change is an essential factor in the success of treatment. In most treatment models, accepting that you have a problem and a desire to change are prerequisites. Although acceptance can be difficult, it enables you to take steps towards restoring your relationships, health, and well-being.
When people feel forced into treatment, it may be difficult to accept support and even recognize that there’s a problem. If you aren’t ready for treatment, you can still see a professional who can provide information, education, and support as you ultimately make your own decision.
Depending on the substance you are addicted to, you may need medically supervised withdrawal therapy, also known as “detox,” before beginning long-term drug addiction treatment. Detox usually involves the gradual reduction of a chemically addictive drug, which is sometimes replaced with a similar substance.
Treatment approaches can range from abstinence to harm reduction. Abstinence means cutting out the substance one is addicted to fully and completely. Harm reduction works to lessen the negative impacts of the substance without requiring abstinence.
Inpatient and residential treatment programs for alcoholism, drug abuse, and gambling usually involve group and individual therapy sessions, education about the nature of addiction, and individualized levels of care.
Cognitive behavioral therapy (CBT) is a popular therapeutic model used to treat substance abuse, alcoholism, and gambling addiction. This therapy aims to provide coping strategies that you can use when you experience cravings.
It also helps you learn to identify irrational negative beliefs and replace them with healthier ways of thinking.
Family therapy or couples therapy may help you rebuild relationships and address underlying problems but may require a certain recovery level before it can be productive.
Narcotic antagonists may be used to treat both substance abuse and compulsive gambling. In some cases, antidepressants are used to help reduce gambling behavior. Nicotine replacement therapy (NRT) is a standard treatment for tobacco use disorder.
Alcoholics Anonymous, Narcotics Anonymous, and Gamblers Anonymous are support groups designed to encourage addiction recovery. These groups are often donation-based, making them an affordable, accessible approach to treat addiction. They also offer pathways for daily support, which can be helpful in the early stages and for relapse prevention.
If left untreated, addiction can cause changes to your brain that alter your decision-making abilities— making it more difficult to stop the addictive behavior over time. Chronic addictive issues can also lead to neurobiological changes that may make you more vulnerable to relapse.
Addictions can be fatal. Addictive substances and behaviors may lead to drug overdoses, cancers of the lung and throat, fatal liver diseases, and suicide.
If you’re experiencing addiction to drugs or alcohol, you may need medical detox to sober up safely. Cold turkey withdrawal from some substances, including alcohol, can be fatal.
That’s why alcohol and drug abuse treatment programs often involve a detoxification period, which allows you to clear addictive substances from your system.
You can promote your wellness and recovery through treatment programs, ongoing behavioral therapy, medication, and recovery groups. Accepting that you have a problem is an essential first step in many recovery models.
All forms of substance-related and addictive disorders have the potential to harm your health. That’s why we encourage you to seek immediate treatment if you think you have an addiction.
- Addiction is a legitimate medical condition that deserves treatment. It’s not a sign of weakness or character flaw.
- The DSM-5 includes only one behavioral addiction—gambling disorder.
- Other compulsions, such as pornography, internet gaming, and food, are not considered clinical “addictions” at this time.
- Addiction can cause long-term changes to your brain, making it challenging to quit without outside support.
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- The American Psychiatric Association. (2020). What Is a Gambling Disorder? https://www.psychiatry.org/patients-families/gambling-disorder/what-is-gambling-disorder
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- Contra Costa Behavioral Health. (N.D.) Diagnosis reference guide. https://cchealth.org/aod/pdf/DSM-5%20Diagnosis%20Reference%20Guide.pdf
- County of Los Angeles Public Health. (N.D.) DSM-5 & ICD 10 Table. http://publichealth.lacounty.gov/sapc/NetworkProviders/ClinicalForms/TS/DSM5Diagnoses.pdf
- Grant (2002). Pathological Gambling and Alcohol Use Disorder. https://pubs.niaaa.nih.gov/publications/arh26-2/143-150.htm
- Fleury et al. (2015). Training in Substance-Related and Addictive Disorders, Part 1: Overview of Clinical Practice and General Recommendations. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679170/
- Harvard Health Publishing. (2011). How Addiction Hijacks the Brain. https://www.health.harvard.edu/%E2%80%A6/how-addiction-hijacks-the-brain
- Hu et al. (2017) Sensation Seeking and Online Gaming Addiction in Adolescents: A Moderated Mediation Model of Positive Affective Associations and Impulsivity. https://doi.org/10.3389/fpsyg.2017.00699
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- The National Center for Responsible Gaming. (N.D.) Fact Sheet: Gambling Disorders. https://www.icrg.org/sites/default/files/oec/pdfs/ncrg_fact_sheet_gambling_disorders.pdf
- The National Institute for Drug Abuse. (2003). Diagnosis and Treatment of Drug Abuse in Family Practice – American Family Physician Monograph. https://archives.drugabuse.gov/publications/diagnosis-treatment-drug-abuse-in-family-practice-american-family-physician-monograph/pathophysiology
- Potenza. (2014). Non-substance addictive behaviors in the context of DSM-5. https://doi.org/10.1016/j.addbeh.2013.09.004
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- Weir (2014). Is pornography addictive? http://www.apa.org/monitor/2014/04/pornography
- Xuan et al. (2017). Genetic and Environmental Influences on Gambling: A Meta-Analysis of Twin Studies. https://doi.org/10.3389/fpsyg.2017.02121
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- Szalavitz (2013). My Name Is John and I Am a Sex Addict. (Or Maybe Not). https://healthland.time.com/2013/07/23/my-name-is-john-and-i-am-a-sex-addict-or-maybe-not/
- Zhou et al. (2019). Orbitofrontal gray matter deficits as marker of Internet gaming disorder: converging evidence from a cross‐sectional and prospective longitudinal design. https://doi.org/10.1111/adb.12570
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