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Addiction (Dependence)

Addiction is a chronic, progressive, relapsing disorder characterized by compulsive use of one or more substances that results in physical, psychological, or social harm to the individual and continued use of the substance or substances despite this harm. Addiction has two possible components, physical dependence and psychological dependence:

Physical dependence – A state of becoming physically adapted to alcohol or other drugs. There are two important aspects to physical dependence:

  • Tolerance – The need for higher and higher doses to achieve the same effects.
  • Withdrawal – The appearance of physical symptoms (e.g., nausea, chills, and vomiting) when someone stops taking a drug too quickly.

Psychological dependence – A subjective sense of need for alcohol or other drug, either for its positive effects or to avoid negative effects associated with no use.

Is everyone who tries alcohol or drugs destined for addiction?

No. Not everyone who uses alcohol or experiments with illegal drugs ends up addicted. In fact, alcohol can be enjoyed by many people without serious negative consequences. Unfortunately, it is not possible to tell early on whose use may lead to addiction. The following are several different ways that people use alcohol and drugs:

Experimental Use – Out of curiosity or through peer pressure, individuals may try drinking alcohol or using illegal drugs. If the use of the alcohol or drug continues irresponsibly, experimentation may become problematic.

Social/Recreational Use – Drinking alcoholic beverages is permitted in American society, and some excessive use may even be condoned. If use does not cause problems for the user, or cause problems for others, most people consider such use to be social or recreational.

Abuse – Abuse is a condition in which the use of alcohol or other drugs has become such a central part of an individual’s life that he or she is willing to let go of important activities in order to use the drug. Drug abuse involves the intake of a drug under circumstances that significantly increase the hazard potential. Examples of abuse include: use of alcohol or drugs in spite of a drug-free workplace policy, taking prescription drugs without a prescription or taking drugs in a way that are not prescribed, or use of over-the-counter drugs to the point of impairment.

What is the nature of addiction?

Although addiction unquestionably begins with a voluntary act of using a drug, continued use often becomes involuntary, ultimately to the point that the behavior is driven by a compulsive craving. The compulsion results from a number of factors, including dramatic changes in brain function produced by prolonged exposure to the drug. This is why addiction is considered a brain disease. It is this compulsion that causes most of the problems surrounding addiction and what requires multidimensional regimens of treatment. Once addicted, it is almost impossible for most people to stop the spiraling cycle of addiction on their own without treatment. Furthermore, addiction often becomes a chronic recurring disorder for which repeated treatment episodes are required before an individual achieves long-term abstinence.

What are the characteristics of addiction?

Addiction to alcohol or other drugs may be:

Chronic – Once an addiction is developed, it will always have to be addressed. An addict may manage to stop using alcohol or other drugs for significant periods of time, but the disease typically does not disappear. Rather, it goes into remission. Should "normal” drug use be attempted, "out of control” use will return rapidly.

Progressive – Addiction gets worse over time. With some drugs, the decline is rapid. With others, like alcohol, it can be more gradual.

Primary – Addiction is not just a symptom of some underlying psychological problem. Once the use of alcohol or drugs becomes an addiction, the addiction itself needs to be treated as the primary illness.

Terminal – Addiction to alcohol or other drugs often leads to death through damage to major organs of the body. Also, the risks of contracting Hepatitis C and HIV rise with use.

Is addiction a brain disease?

Yes. Research by the National Institute on Drug Abuse (NIDA) suggests that long-term exposure to drugs produces addiction – that is, the compulsion to take drugs – by eliciting changes in specific neurons in the central nervous system.

Does addiction result from moral weakness or overindulgence?

No. Addiction can be a life-threatening condition, like adult diabetes or hypertension, with roots in genetic susceptibility, social circumstance, and personal behavior.

If an addicted person has enough will power, can he or she stop using alcohol or other drugs?

Most people addicted to alcohol and other drugs cannot simply stop using them, no matter how strong their resolve. Most need one or more courses of structured treatment to reduce or end their dependence on alcohol and/or other drugs.

What is denial?

One of the most disturbing and confusing aspects of addiction is that it is characterized by denial. The user rejects the notion that his or her use is out of control or that it is causing any problems at home or on the job. There are effective strategies employed by professionals for helping break through this denial which must be overcome before treatment can take place.

What is enabling?

Any action by another person or an institution that intentionally or unintentionally has the effect of facilitating the continuation of an individual’s addictive process. Examples of enabling behavior include:

Covering up – Providing alibis, making excuses, or doing an impaired coworker’s work rather than allowing it to be known that he or she is not meeting his or her responsibilities.

Rationalizing – Developing reasons why the person’s continued use is understandable or acceptable.

Withdrawing – Avoiding contact with the person with the problem.

Blaming – Getting angry at the individual for not trying hard enough to control his or her use.

Controlling – Trying to take responsibility for the person’s use by throwing out his or her drugs or cutting off the supply.

Threatening – Saying that you will take action (e.g., turning the person in) if he or she does not control his or her use, but not following through when he or she continues to use.

What are the typical signs of addiction?

Emotional – Aggression, anxiety, burnout, denial, depression, and paranoia.

Behavioral – Excessive talking, impaired coordination, inability to sit still, irritability, lack of energy, limited attention span, poor motivation, slow reaction time, and slowed or slurred speech.

Physical – Chills, the smell of alcohol, sweating, and weight loss.

Can addiction be recognized in the workplace?

Yes. While the aforementioned emotional and physical signs will likely be present, employers and coworkers also should be cognizant of continual missed appointments, excessive and unexplained absences or days off from work, and repeated mistakes.

How can I know if I am at risk for addiction?

Many factors can lead to developing a problem with alcohol and other drugs. Unfortunately, accurate prediction is difficult. There is, however, some evidence that suggests certain behaviors or histories can increase the likelihood of addiction.

Addiction is a family disease – People with a history of drug abuse in their family are more susceptible to developing problems with addiction. Children of alcoholics or addicts are three times more likely to develop problems. If both parents are addicts or alcoholics, the risk increases fivefold. This is due to heredity as well as learned behavior. It is important for parents to realize that children learn much from watching the behaviors of others.

Prior abuse of alcohol and other drugs has a great impact on developing future problems – A pattern of abuse develops and can lead to addiction and psychological reliance on drugs or alcohol. Research demonstrates that the later in life an individual first drinks alcohol or uses other drugs, the less likely he or she will progress to drug abuse or addiction.

Other contributing factors – Some people use alcohol or drugs as part of a self-destructive lifestyle. Other people start to use drugs to seek relief from depression or crisis in their lives. Although some fortunate individuals never develop serious problems, and use diminishes or ceases once the precipitating events change, others develop a serious problem before they even realize it.

What is drug addiction treatment?

There are a number of science-based treatment approaches that can be used as part of a comprehensive treatment program. The general approach to addiction treatment can be described as breaking a big task into manageable bits, each tailored to the needs of the individual patient. Regardless of approach, there are core components, such as assessment, support groups, and drug abuse monitoring programs that are critical to the treatment regimen.

Can addiction be treated successfully?

Yes. Addiction is a treatable disease.The National Institute on Drug Abuse (NIDA) recently published Principles of Drug Addiction Treatment, the first-ever science-based guide to drug treatment. It provides a context by which both health professionals and the general public can begin to understand and evaluate addiction treatment approaches. The guide addresses some of the essential characteristics of addiction and its treatment and lays out the principles derived from over two decades of scientific research.