What is addiction?
Addiction is more than drinking too much, smoking or taking too many drugs. It is about experiencing difficulty in controlling the amount of alcohol, tobacco or drugs consumed and the consequences, usually negative, that follow. Addiction is an umbrella term covering: dependence, substance use or certain behaviours, and all of the associated problems, which include physical and mental ill-health, family disruption, poor work performance, criminal activity, financial difficulties, neglect of child care responsibilities and so on.
Understanding addiction #1
Stream this YouTube video which is derived from Johann Hari's New York Times best-selling book 'Chasing The Scream: The First and Last Days of the War on Drugs.' It shows why...
▶︎ Addiction is primarily a behaviour that people learn albeit that there may be serious physical consequences
▶︎ Behaviours, notably sex, exercise, gambling, mobile phone use have similar addictive potential to psychoactive substances and are referred to as behavioural addictions.
So, behavioural addictions, gambling, video games, sex for example, come about in the same way that drugs and alcohol can become addictive. The social consequences of both behavioural and substance use addiction may be similar but there are more likely to be serious physical health problems associated with alcohol and drugs. Let us look at the nature of dependence.
What is dependence?
Dependence is seen by many to be at the heart of addiction. It can be thought of as a 'strong habit' that is difficult to control. It is a psychological state which can be recognised when an individual becomes more preoccupied with substance use, spending more time drinking, smoking or taking other drugs, often at the expense of other important activities. Dependent drinkers and drug takers often want to be abstinent or at least in more control of their substance use but find the immediate rewards of alcohol and other drugs too powerful to resist. The rewards may simply be liking the effect, being intoxicated, to something utilitarian such as mood change.
Dependence and other terms
The addiction field has tended to use words loosely and without there being a consensus on the meaning...
✔︎ Dependence is a psychological state which needs to be separated from drinking or drug taking alone
✔︎ More severe dependence is associated with, but not the same as, heavier substance use, leading to tolerance (needing more of the drug to get the same effect) and withdrawal symptoms (physical symptoms such as shakiness and sweating as the drug wears off)
Use the Leeds Dependence Questionnaire (LDQ) to measure dependence
What causes dependence?
Dependence is a psychological state; it is not the result of brain pathology or genetics or an addictive personality. Anybody can become dependent and anybody can recover from being dependent. The psychological mechanisms leading to dependence are to be found in the slide show on the Why are drugs addictive page. There are two prerequisites to dependence…
❶ Availability
If there is no drug there can be no dependence. It is well understood that prohibition is not the same as there being no drug, rather it creates an illicit market which is often associated with violent crime. That said, governments can, within limits, control the availability of potentially addictive drugs. For example, in the UK alcohol is controlled by restricting pub opening times and by unit pricing; opiates are controlled by being prescription only medications. As a rule of thumb the greater the availability of a substance the more likely it is to be misused.
❷ Rewards
For someone to drink alcohol or take a drug repeatedly, and thereby become dependent, they have to get something out of it. There are two ways this can happen. First, the person may simply like being intoxicated and like the sociability and lifestyle that goes with drinking or drug taking. Second, they may find relief from something unpleasant or distressing such as a mental health problem, trauma, poor housing or a generally rubbish life.
The same principles apply for behavioural and substance related addictions. Watch the video…
Understanding addiction #2
Peter Judodihardjo is the creator behind the popular Behavioural Science YouTube chanel Pete Judo.
In this video Peter talks about why TikTok is addictive (dependence making) and for the same reasons alcohol and drugs are addictive ➜
What are withdrawal symptoms?
Some people think of withdrawal symptoms as the essential feature of addiction or talk about physical dependence as separate to psychological dependence. To avoid confusing terminology it is better to think of physical dependence under the umbrella term neuroadaptation which occurs as a result of the body’s response to regular and heavy use of some drugs. The body starts to metabolise drugs faster and, more significantly, brain cells adapt and become less responsive to the effects of a drug. This is known as tolerance so that the body is now in a new equilibrium, meaning functioning normally, only in the presence of the drug. Once someone has developed tolerance, then suddenly stopping the drug upsets the new equilibrium and withdrawal symptoms follow. For example, a heavy drinker becomes tolerant to alcohol and they function more a less normally: the body adjusts to the depressant effect of alcohol and so without it becomes hyperactive as manifest by symptoms such as racing heart beat, sweating, hallucinations and so forth. Other drugs, cocaine for example, do not have florid withdrawal symptoms and instead are thought of as having an abstinence syndrome. Equally, behavioural addictions do not have florid withdrawal albeit there may be some psychological reaction to stopping an addictive behaviour.
The terminology in addiction can be confusing, not least because practitioners in the field are inconsistent. The International Classification of Diseases is an authoritative source of terminology.
What is the difference between use, misuse, and harmful use of a substance?
Use and misuse have no precise meaning. The word 'use' implies consumption which is mainly without problems, whereas 'misuse' suggests something that is problematic - it is less judgemental than 'abuse'. Misuse could mean a whole range of things from occasional intoxication to severe dependence. 'Harmful Use' is defined by the World Health Organisation as use that causes actual physical or mental ill-health or harm, whereas 'hazardous use' refers to use that has the potential to cause harm, be that ill-health or social in nature.
