Addiction

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Brain metabolism and drug addiction
ΔFosB accumulation in addiction
An alcoholic man experiencing delirium

Addiction is a complex, chronic brain disorder characterized by compulsive substance use or behavior despite harmful consequences. Individuals with addiction, also referred to as severe substance use disorder, exhibit an intense focus on using certain substances—such as alcohol or drugs—to the extent that it dominates their daily life and functioning.

Overview[edit | edit source]

Addiction is not limited to dependency on illegal substances like heroin or cocaine. It can also involve legal substances such as alcohol and prescription medications, or even behaviors like gambling. A person suffering from addiction is typically unable to control their urges, often continuing the behavior despite negative social, occupational, or health consequences.[1]

Types of Addiction[edit | edit source]

Substance Addiction[edit | edit source]

Substance-related addictions involve dependence on chemical substances that alter brain chemistry:

Behavioral Addiction[edit | edit source]

These are compulsive behaviors that activate reward systems in the brain similarly to substance use:

Pathophysiology[edit | edit source]

Addiction primarily affects the brain’s reward system, particularly pathways involving dopamine. The repeated exposure to addictive substances or behaviors alters the brain's normal functioning, resulting in:

  • Changes in motivation and reward
  • Impaired decision-making and impulse control
  • Long-term neuroplasticity in brain circuits associated with habit and compulsion

These biological changes contribute to the persistence of addictive behaviors, even after cessation attempts.[2]

Diagnosis[edit | edit source]

The diagnosis of addiction is typically made using established criteria, such as those in the DSM-5, which consider:

  • Persistent desire or unsuccessful efforts to cut down
  • Tolerance and withdrawal symptoms
  • Continued use despite knowledge of harm
  • Cravings and loss of control

These indicators reflect both psychological and physiological aspects of addiction.[3]

Treatment[edit | edit source]

Effective addiction treatment is individualized and often involves a combination of:

  • Behavioral therapies: e.g., cognitive-behavioral therapy (CBT), motivational interviewing
  • Pharmacological treatment: e.g., methadone, buprenorphine, naltrexone
  • Support systems: peer support groups, family therapy

Long-term follow-up and relapse prevention are essential for successful recovery.[4]

Risk Factors[edit | edit source]

Addiction arises from a combination of biological, psychological, and environmental influences:

  • Genetic susceptibility: Genetics account for approximately 40–60% of a person's vulnerability.[5]
  • Environmental factors: Stress, peer pressure, socioeconomic status, and early exposure to drugs play a critical role.[6]
  • Psychological factors: Conditions such as depression, anxiety, PTSD, and traits like impulsivity can predispose individuals.[7]

Prevention[edit | edit source]

Prevention efforts are most effective when they address multiple risk factors at early developmental stages:

  • School-based programs: Educating adolescents can reduce the onset of substance use.[8]
  • Community and family interventions: Programs that involve parents and the broader community enhance protective factors.[9]

Prognosis[edit | edit source]

Recovery outcomes vary greatly depending on the severity of addiction, the presence of co-occurring disorders, and the individual's support system. Many individuals achieve long-term recovery, though relapse is common and should be viewed as a part of the chronic disease process.[10]

Society and Culture[edit | edit source]

Addiction is not only a medical issue but also a major societal challenge. It is associated with:

  • Increased healthcare costs
  • Criminal justice involvement
  • Homelessness and unemployment
  • Stigmatization and discrimination

These factors often prevent people from seeking treatment and contribute to the chronic nature of addiction.[11]

See Also[edit | edit source]

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  1. ↑ , Neurobiologic Advances from the Brain Disease Model of Addiction, New England Journal of Medicine, 2016, Vol. 374(Issue: 4), pp. 363–371, DOI: 10.1056/NEJMra1511480, PMID: 26816013,
  2. ↑ , Neurobiology of addiction: a neurocircuitry analysis, Lancet Psychiatry, 2016, Vol. 3(Issue: 8), pp. 760–773, DOI: 10.1016/S2215-0366(16)00104-8, PMID: 27475769,
  3. ↑ , Diagnostic and Statistical Manual of Mental Disorders (DSM-5®), Washington, D.C.:American Psychiatric Pub, 2013, ISBN 9780890425572,
  4. ↑ , The Affordable Care Act and treatment for "substance use disorders:" Implications of ending segregated behavioral healthcare, Journal of Substance Abuse Treatment, 2014, Vol. 46(Issue: 5), pp. 541–545, DOI: 10.1016/j.jsat.2014.01.008, PMID: 24572761,
  5. ↑ , Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review, JAMA Psychiatry, 2016, Vol. 73(Issue: 3), pp. 292–297, DOI: 10.1001/jamapsychiatry.2015.3278, PMID: 26842658,
  6. ↑ , Chronic stress, drug use, and vulnerability to addiction, Annals of the New York Academy of Sciences, 2008, Vol. 1141(Issue: 1), pp. 105–130, DOI: 10.1196/annals.1441.030, PMID: 18991954,
  7. ↑ , Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions, Journal of Clinical Psychiatry, 2006, Vol. 67(Issue: 2), pp. 247–257, PMID: 16566619,
  8. ↑ , The effectiveness of a school-based substance abuse prevention program: 18-Month follow-up of the EU-Dap cluster randomized controlled trial, Drug and Alcohol Dependence, 2010, Vol. 108(Issue: 1–2), pp. 56–64, DOI: 10.1016/j.drugalcdep.2009.11.018, PMID: 20047888,
  9. ↑ , Youth problem behaviors 8 years after implementing the communities that care prevention system: a community-randomized trial, JAMA Pediatrics, 2014, Vol. 168(Issue: 2), pp. 122–129, DOI: 10.1001/jamapediatrics.2013.4009, PMID: 24285388,
  10. ↑ , Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation, JAMA, 2000, Vol. 284(Issue: 13), pp. 1689–1695, DOI: 10.1001/jama.284.13.1689, PMID: 11015800,
  11. ↑ , Stigma, discrimination and the health of illicit drug users, Drug and Alcohol Dependence, 2007, Vol. 88(Issue: 2–3), pp. 188–196, DOI: 10.1016/j.drugalcdep.2006.10.014, PMID: 17118578,
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Contributors: Prab R. Tumpati, MD