Addiction Health Article

Definition

Most definitions refer to addiction as the compulsive need to use a habit-forming substance, or an irresistible urge to engage in a behavior. Two other important defining features of addiction are tolerance, the increasing need for more of the substance to obtain the same effect, and withdrawal, the unpleasant symptoms that arise when an addict is prevented from using the chosen substance.

Description

The term addiction has come to refer to a wide and complex range of behaviors. While addiction most commonly refers to compulsive use of substances, including alcohol, prescription and illegal drugs, cigarettes, and food, it is also used to describe excessive indulgence in activities such as work, exercise, shopping, sex, the Internet, and gambling.

Causes

Some experts describe the range of behaviors designated as addictive in terms of five interrelated concepts: patterns, habits, compulsions, impulse control disorders, and physical addiction. There is ongoing controversy as to whether addictions constitute true physical disease in the same sense that diabetes and hypertension are considered physical diseases. Indeed, the most prevalent model of substance dependence today is the so-called disease model. This model, first introduced in the late 1940s by E. M. Jellinek, was adopted in 1956 by the American Medical Association. Since that time, the disease model of alcoholism and drug addiction has been well accepted throughout the world.

Other experts disagree with the analogy between substance abuse and physical disease. They believe that addictive behaviors can be better understood as problematic habits or behavior patterns that have been learned in accordance with the principles that guide all learning. To these experts, addictive behaviors are maladaptive habits and behavior patterns that can be "unlearned" and replaced with new, alternative, more healthful behaviors. According to learning theorists, one's past and present experiences, environment, family history, peer group influences, and individual beliefs and expectations, determine who will or will not become addicted to a substance or behavior.

Psychodynamic theorists believe that addicts suffer from an inability to soothe themselves or comfortably manage the emotions of day-to-day life. Feelings such as anxiety, depression, shame, discomfort in social situations, and anger are often believed to be causes of substance abuse. In this sense, many experts believe that addicts self-medicate, that is, use destructive substances to ease their painful emotions.

Disease model adherents believe that the compulsion to use is genetically and physiologically based and that, while the disease can be arrested, the disease is progressive and, if unchecked, fatal. Researchers have found the sons of alcoholics to be twice as prone to alcoholism as other people. Among pairs of identical twins, if one is alcoholic, there is a 60% chance that the other will be also. In spite of an apparent inherited tendency toward alcoholism, the fact that the majority of people with alcoholic parents do not become alcoholics themselves demonstrates the influence of psychosocial factors, including personality factors and a variety of environmental stressors, such as occupational or marital problems.

Symptoms

Both disease model and learning model adherents agree that initial positive consequences of substance abuse or addictive activities are what initially "hook," and then later keep, the addict addicted. Addicts describe feelings of euphoria when using their substance or engaging in their activity of choice. Many experts believe that these substances and activities affect neurotransmitters in the brain. Use causes an increase in endorphin levels, which is believed to be one of the chief causes of the "high" sensation experienced by addicts.

As the addict continues to use, his or her body adjusts to the substance and tolerance develops. Increasing amounts of the substance are needed to produce the same effect. Levels of substances that addicts routinely ingest would be lethal to a non-addict.

Over time, physical symptoms of dependence strengthen. Failure to use leads to withdrawal symptoms, which include flu-like aches and pains, digestive upset, and, in severe cases, seizures, and hallucinatory-like sensations, such as the feeling of bugs crawling on the skin. Damage to various organs of the body, including the brain and liver, can lead to serious and even fatal illness as well as mental symptoms such as dementia. Severe disruption of social and family relationships, and of the ability to maintain a steady job, are also symptoms of the addictive process.