FAQs about Addiction
What is addiction?
Addiction is a disease. It is defined by the American Society of Addiction Medicine as a “primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”
Read ASAM’s long definition of addiction.
What are the signs of addiction?
Signs and symptoms of addiction can be emotional, physical, behavioral, social and spiritual. According to the American Society of Addiction Medicine, addiction is characterized by an:
- Inability to consistently abstain;
- Impairment in behavioral control;
- Craving or increased “hunger” for substances;
- Diminished recognition of significant problems with one’s behaviors and relationships; and
- A dysfunctional emotional response.
More specific signs of addiction include:
Some behavioral signs of addiction, primarily due to impaired control, can include:
- Excessive use, at higher frequencies and/or quantities than the person intended, often with a persistent desire for and unsuccessful attempts at behavioral control;
- Excessive time lost in substance use or recovering from the effects of use, with negative impact on relationships or the neglect of responsibilities at home, school or work;
- Continued use, despite persistent or recurrent physical or psychological problems caused or worsened by substance use;
- A narrowing of behaviors focused on rewards that are part of addiction; and
- Lack of ability and/or readiness to take consistent action to make things better, despite recognition of problems.
Cognitive or thinking changes can include:
- Preoccupation with substance use;
- Altered evaluations of the relative benefits and detriments associated with drugs or alcohol; and
- The inaccurate belief that problems are because of other causes rather than a consequence of addiction.
Emotional changes in addiction can include:
- Increased anxiety, dissatisfaction and emotional pain;
- Increased sensitivity to stressors such that “things seem more stressful” as a result; and
- Difficulty identifying feelings, distinguishing between feelings and bodily sensations of emotional arousal, and describing feelings to other people.
Am I addicted or do I just drink too much?
Alcohol and other drug problems range greatly in severity, from mild to severe, life-threatening chronic addiction. Many people with less serious problems are able to resolve them on their own, without professional help.
Those with fully developed addiction need specialized health care treatment and support. If you feel that your drinking or drug use is causing you problems, or if you have a desire to stop, talk with your physician or contact us for free support and we’ll help you navigate the process.
How is addiction diagnosed?
To be diagnosed with addiction, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and used by doctors, mental health professionals and other health providers to diagnose mental health conditions.
For each disorder included in DSM, a set of diagnostic criteria indicate what symptoms must be present (and for how long) as well as symptoms, disorders, and conditions that must not be present in order to qualify for a particular diagnosis.
The current version of the manual, referred to as the DSM-5, refers to addiction as a “substance use disorder.” The illness is defined on a continuum from mild to severe based on the criteria. Each specific substance is addressed as a separate use disorder but nearly all substances are diagnosed based on the same overarching criteria. Mild substance use disorder requires two to three symptoms from a list of 11.
Why is addiction a disease?
A disease is defined as a disorder of structure or function in the body that produces specific signs or symptoms, prevents the body or mind from working normally and is not simply a direct result of physical injury. More than 70 years of study, including highly advanced brain research, has determined that addiction is a disease. People suffering from addiction have altered brain function. When the disease takes hold, these changes in the brain erode a person’s self-control and ability to make sound decisions, while sending highly intense impulses to take drugs. This helps explain the compulsive and destructive behavior around addiction.
Why is addiction a “chronic” disease?
A chronic disease is a long-lasting illness that can be controlled but not cured. Chronic diseases with similarities to addiction include type II diabetes, hypertension, heart disease, depression and asthma.
Medical experts have identified features of addiction that are common to these other chronic illnesses. These include: (1) medical care can reduce the symptoms but cannot address the root cause of the disease; (2) lifestyle and behavioral changes are needed to maximize the treatment; and (3) ongoing care is needed to help prevent re-occurrence of symptoms.
The bottom line is that people suffering from addiction can’t be cured or get well after a 30 day stay in treatment. Getting well from addiction requires a lifelong commitment to disease management and wellness.
If addiction is a disease, does that mean that a person who has addiction isn’t responsible for their behavior?
This is a tough question. Addiction is unlike most other diseases in the way that it impairs the brain and leads to destructive behavior. There’s no denying that addiction causes people to act compulsively and do bad things. Often people are so sick they can’t recognize their illness.
But this doesn’t mean to excuse their behavior. In fact, the threat of consequences, such as the loss of family support or even jail time, is sometimes necessary to force a loved one into treatment. People suffering from the disease also have a personal responsibility to manage their illness in order to stay well.
The main point is to try and have compassion. Whether addiction is someone’s “fault” is beside the point. The point is understanding that the destructive behavior is a sign that someone is very sick and needs medical treatment.
What causes addiction?
Addiction is caused by a combination of biological, environmental and behavioral factors. No single factor can predict whether or not a person will develop addiction. The risk for addiction is influenced by a person's biology, influences in their social environment and development. The more risk factors an individual has, the greater the chance that using drugs or alcohol can lead to addiction.
Genetics, in combination with environmental influences, account for about half of someone’s addiction vulnerability. Other factors such as gender, quality of life, peer pressure, physical and sexual abuse, stress, parental involvement and age of first use can also influence the development of this disease.
Does a relapse mean there’s no hope?
We don’t like the term “relapse” because it comes with so much baggage. What we’re really talking about is a reoccurrence of symptoms of the disease. Many people suffering from any chronic illness, like diabetes or hypertension, will experience a reoccurrence at some point, given the way these diseases work and the fact that they have to be carefully managed over a lifetime.
The first thing to know is that reoccurrence is not a reason to lose hope – it doesn’t mean that the person can’t get well. Usually a reoccurrence means that something is not working in the treatment or addiction management plan and it’s time to reevaluate and try something else.
Why do so many people relapse?
Relapse is not inevitable. In fact, many people get well and never experience a reoccurrence of symptoms.
That said, the chronic nature of addiction means that that the disease can flare up again if it’s not being managed properly. This can be caused by many things, including cues that can trigger craving, emotional challenges and other issues. Vulnerability to reoccurrence may depend on brain circuitry, severity of the illness and whether the person is getting the right support and medical care.
It’s important to realize that a reoccurrence of symptoms does not mean that the person can’t get well. Relapse rates (how often symptoms recur) for addiction are about the same as for other chronic conditions such as diabetes, hypertension and asthma.
Why can’t people use their willpower to just stop on their own?
For someone with addiction, the urge to use alcohol or drugs can be as powerful as the need for air or water. It’s a matter of survival. The initial decision to take drugs or drink is mostly voluntary. However, when the disease takes hold, changes in the brain erode a person’s self-control and ability to make sound decisions, while sending highly intense impulses to take drugs. This helps explain the compulsive and destructive behavior around addiction.
Why does my loved one make such bad decisions?
For family members, addiction is often a baffling illness. Addiction is a disease of the brain that greatly impairs decision-making. Self-destruction, dishonesty and irrational behavior are all hallmarks of the disease. Often times, those with the disease keep making bad choices, even when they’re losing everything. This is because the illness fundamentally changes brain function, driving a compulsion to use drugs or alcohol. People acting this way are not bad, but very sick and need help.
What is withdrawal?
When someone has been heavily using drugs or alcohol and they abruptly stop or cut back, they often experience withdrawal symptoms. The intensity and length of these symptoms can vary greatly depending on the substance involved, the biological make up of the person and the severity of their addiction. Withdrawal symptoms can be both physical and psychological. Withdrawal can sometimes be dangerous, so you should be sure to seek out help from a qualified health care provider.
What is dual diagnosis?
This means that someone has been diagnosed with both a type of mood disorder (such as depression, anxiety or bipolar disorder) and drug or alcohol addiction. The person has two illnesses and must be treated for both.
What’s the difference between physical dependence and addiction?
Addiction is characterized by compulsive alcohol or drug use despite serious harmful consequences. As part of addiction, a person usually also experiences physical dependence. Physical dependence includes tolerance to the substance (needing more of the drug to experience the same effects) and withdrawal symptoms when they cut back or abruptly stop using.
However, physical dependence can exist without addiction. It means that a person’s body has developed tolerance to a drug and may experience withdrawal symptoms. A natural physical dependence can develop with the chronic use of many types of drugs—including many prescription drugs, even if taken as instructed.
Inside Rehab by Anne Fletcher
Clean by David Sheff
Addiction Medicine: Closing the Gap between Science and Practice, CASA at Columbia University
Recovery Management and Recovery-Oriented Systems of Care, William White
National Institute on Drug Abuse
American Society of Addiction Medicine
Substance Abuse and Mental Health Services Administration