Disease of Addiction
Addiction is a chronic but treatable brain disorder in which people lose the ability to control their need for alcohol or other drugs. The American Psychiatric Association says that a person is dependent if their pattern of substance use leads to clinically significant impairment or distress shown by three or more of the following in a 12-month period:
1. Tolerance as defined by any of the following:
- A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
- Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following:
- The characteristic withdrawal symptom of the substance.
- The same or a closely related substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than was intended (loss of control).
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use (loss of control).
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance or recover from its effects (preoccupation).
6. Important social, occupational or recreational activities are given up or reduced because of substance use (continuation despite adverse consequences).
7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (adverse consequences).
- People who are addicted cannot control their need for alcohol or other drugs, even in the face of negative health, social or legal consequences.
- The illness becomes harder to treat and the related health problems, such as organ disease, become worse.
Addiction is a chronic, but treatable, brain disorder. People who are addicted cannot control their need for alcohol or other drugs, even in the face of negative health, social or legal consequences. This lack of control is the result of alcohol- or drug-induced changes in the brain. Those changes, in turn, cause behavior changes.
The brains of addicted people “have been modified by the drug in such a way that absence of the drug makes a signal to their brain that is equivalent to the signal of when you are starving,” says National Institute on Drug Abuse Director Dr. Nora Volkow. It is “as if the individual was in a state of deprivation, where taking the drug is indispensable for survival. It’s as powerful as that.”
Addiction grows more serious over time. Substance use disorders travel along a continuum. This progression can be measured by the amount, frequency and context of a person’s substance use. As their illness deepens, addicted people need more alcohol or other drugs; they may use more often, and use in situations they never imagined when they first began to drink or take drugs. The illness becomes harder to treat and the related health problems, such as organ disease, become worse.
“This is not something that develops overnight for any individual,” says addiction expert Dr. Kathleen Brady. “Generally there’s a series of steps that individuals go through from experimentation and occasional use [to] the actual loss of control of use. And it really is that process that defines addiction.”
Symptoms of addiction include tolerance (development of resistance to the effects of alcohol or other drugs over time) and withdrawal, a painful or unpleasant physical response when the substance is withheld. Many people with this illness deny that they are addicted. They often emphasize that they enjoy drinking or taking other drugs.
People recovering from addiction can experience a lack of control and return to their substance use at some point in their recovery process. This faltering, common among people with most chronic disorders, is called relapse. To ordinary people, relapse is one of the most perplexing aspects of addiction. Millions of Americans who want to stop using addictive substances suffer tremendously, and relapses can be quite discouraging.
“It is devastating to me when I don’t get [recovery] right,” laments Brian, a Portland, Oregon, coffee shop owner who struggles with his cocaine addiction. “Man, I can’t even describe it. It’s just horrible. The guilt. The depression that comes with it because I screwed up again. It’s an indescribable feeling that’s just – man, it’s low, low, low.”
To appreciate the grips of addiction, imagine a person that “wants to stop doing something and they cannot, despite catastrophic consequences,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse. “We’re not speaking of little consequences. These are catastrophic. And yet they cannot control their behavior.”
- People who are addicted cannot control their need for alcohol or other drugs, even in the face of negative health, social or legal consequences.
- The illness becomes harder to treat and the related health problems, such as organ disease, become worse.
Addiction is a chronic, but treatable, brain disorder. People who are addicted cannot control their need for alcohol or other drugs, even in the face of negative health, social or legal consequences. This lack of control is the result of alcohol- or drug-induced changes in the brain. Those changes, in turn, cause behavior changes.
The brains of addicted people “have been modified by the drug in such a way that absence of the drug makes a signal to their brain that is equivalent to the signal of when you are starving,” says National Institute on Drug Abuse Director Dr. Nora Volkow. It is “as if the individual was in a state of deprivation, where taking the drug is indispensable for survival. It’s as powerful as that.”
Addiction grows more serious over time. Substance use disorders travel along a continuum. This progression can be measured by the amount, frequency and context of a person’s substance use. As their illness deepens, addicted people need more alcohol or other drugs; they may use more often, and use in situations they never imagined when they first began to drink or take drugs. The illness becomes harder to treat and the related health problems, such as organ disease, become worse.
“This is not something that develops overnight for any individual,” says addiction expert Dr. Kathleen Brady. “Generally there’s a series of steps that individuals go through from experimentation and occasional use [to] the actual loss of control of use. And it really is that process that defines addiction.”
Symptoms of addiction include tolerance (development of resistance to the effects of alcohol or other drugs over time) and withdrawal, a painful or unpleasant physical response when the substance is withheld. Many people with this illness deny that they are addicted. They often emphasize that they enjoy drinking or taking other drugs.
People recovering from addiction can experience a lack of control and return to their substance use at some point in their recovery process. This faltering, common among people with most chronic disorders, is called relapse. To ordinary people, relapse is one of the most perplexing aspects of addiction. Millions of Americans who want to stop using addictive substances suffer tremendously, and relapses can be quite discouraging.
“It is devastating to me when I don’t get [recovery] right,” laments Brian, a Portland, Oregon, coffee shop owner who struggles with his cocaine addiction. “Man, I can’t even describe it. It’s just horrible. The guilt. The depression that comes with it because I screwed up again. It’s an indescribable feeling that’s just – man, it’s low, low, low.”
To appreciate the grips of addiction, imagine a person that “wants to stop doing something and they cannot, despite catastrophic consequences,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse. “We’re not speaking of little consequences. These are catastrophic. And yet they cannot control their behavior.”
Despite its ubiquity, addiction is often misunderstood. Parents are blamed for a child’s addiction; managed care companies restrict treatment; relapse is seen as a moral failure, rather than a normal stage on the road to recovery from a disease in which the addictive substances themselves distort the brain’s reactions.
1) Like hypertension or diabetes, addiction is a lifelong illness.
2) Biological and behavioral factors influence addiction, as they do other chronic conditions.
3) Addiction can be effectively treated and managed through lifestyle changes
- Medical professionals follow certain criteria to determine if a person abuses alcohol or drugs.
- These established criteria also can mark whether the substance abuse has progressed to dependence.
- Alcohol and drug dependence cause people to suffer from withdrawal symptoms when they stop using the substance. Dependence also causes major behavioral changes, such as overwhelming preoccupation with drug or alcohol use.
Some people who start as casual drinkers or drug users will stay that way. But others will become substance abusers or dependent, feeling that they need a drug to feel alive. The difference between abuse and dependence is not always clear to the general public, but medical professionals use a set of criteria to distinguish between these two categories of problem use.
The essential feature of abuse is a pattern of substance use that causes someone to experience harmful consequences. Clinicians diagnose substance abuse if, in a twelve-month period, a person is in one or more of the following situations related to drug use:
- Failure to meet obligations, such as missing work or school.
- Engaging in reckless activities, such as driving while intoxicated.
- Encountering legal troubles, such as getting arrested.
- Continuing to use despite personal problems, such as a fight with a partner.
Dependence is more severe. Medical professionals will look for three or more criteria from a set that includes two physiological factors and five behavioral patterns, again, over a twelve-month period. Tolerance and withdrawal alone are not enough to indicate dependence. And not all behavioral signs occur with every substance.
The physiological factors are:
- Tolerance, in which a person needs more of a drug to achieve intoxication.
- Withdrawal, in which they experience mental or physical symptoms after stopping drug use.
The behavioral patterns are:
- Being unable to stop once using starts.
- Exceeding self-imposed limits.
- Curtailing time spent on other activities.
- Spending excessive time using or getting drugs.
- Taking a drug despite deteriorating health.