When we hear the word "addiction", many images come to our mind. We see the falling down drunk. We see a woman who sells her body in exchange for a "fix." We remember a permanently disabled teen in a wheelchair because of a drunk-driving accident. We read about a famous entertainer who died, and another whose sensational sex scandals are splashed across the tabloids. Most of us know a friend or family member, whose lives are affected by addiction. We all know that addiction is a serious problem. But behind that widely held agreement are many disagreements and questions. How big are addiction problems exactly? How does addiction differ from experimentation, misbehavior, and bad habits? What causes addiction? How does one overcome it? How successful is addiction treatment? How should society respond to individuals with addiction? What should governments do about addiction? Is addiction mostly a modern problem? Is the addiction problem getting worse?
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Fast Facts: Learn! Fast!
What is Addiction?
- In our definition, addiction:
- Includes both substances (drugs and alcohol) and activities (such as sex and gambling).
- Leads to substantial harm.
- Is repeated involvement despite substantial harm.
- Continues because it was, or is, pleasurable and/or valuable.
- Substance addiction includes any substances that are taken into the body, which may include street drugs, nicotine, and some prescription medications when used improperly.
- An activity or process addiction includes activities such as gambling, sex, the internet, pornography, and shopping.
- As someone's addiction gets worse, that person feels "out-of-control" or "powerless" over their own behavior and despite their best intentions to remain in control, there are repeated episodes with more negative consequences.
Using data reported for 2010 by the U.S. Substance Abuse and Mental Health Services Administration shows that:
- 51.8% of the U.S. population aged 12 or older, or 131.3 million people, are current drinkers of alcohol.
- Nearly one quarter (23.1%) of the U.S. population, or 58.6 million people, aged 12 or older participated in binge drinking during past 30 days, which includes having five or more drinks at least 1 day in the 30 days prior to the survey.
- 6.7% of the U.S. population aged 12 or older, or 16.9 million people reported heavy drinking, which is binge drinking on at least 5 days in the past 30 days.
- 40.6% of young adults in the U.S. (age18 to 25) participated in binge drinking and the rate of heavy drinking was 13.6%.
- 12.0% of persons aged 12 or older drove under the influence of alcohol at least once in the past year. 8.9% of the U.S. population, or 22.1 million people, aged 12 or older would meet the diagnostic criteria for a drug or alcohol use disorder (substance use disorder).
- 23.1 million people aged 12 or older needed treatment for an alcohol or substance use disorder and of these, only 2.6 million people received treatment at a specialized addiction facility.
How do I know if I have an addiction?
- There are many costs to addictive behavior and identifying those that you are currently experiencing can help you recognize whether the costs are beginning to cause substantial harm and may signal an addiction being present. In addition to your own evaluation, try to imagine how others might rate your behavior on this list.
- Emotional costs of addiction: living with daily feelings of fear, anger, sadness, shame, guilt, paranoia, loss of pleasure, boredom, emotional instability, self-loathing (disgust with oneself), loneliness, isolation, and feelings worthlessness.
- Social costs of addiction: disruption or damage to important relationships; decreased ability or interest in forming meaningful connections with others; and limiting one's social sphere to other unhealthy, addicted persons.
- Physical and health costs of addiction: poor general health; poor personal hygiene; lowered energy and endurance; diminished enjoyment of sex or sexual dysfunction; poor sleep; and damaging the health of an unborn child (with certain types of substance use).
- Intellectual costs of addiction: loss of creative pursuits; decreased ability to solve problems; and poor memory.
- Work and productivity costs of addiction: decreased productivity in all aspects of life; missing important deadlines and failing to meet obligations; impaired ability to safely operate tools and equipment (including driving); and lost time due to accidents arising from being impaired (e.g., falling and breaking a leg).
- Financial costs of addiction: money spent on the addiction itself; money spent dealing with the consequences of addiction (healthcare costs, legal costs, etc.).
- Legal costs of addiction: direct legal costs due to involvement with an illegal drug or activity (e.g. selling drugs, child pornography); indirect legal costs because of what someone did while engaging in their addiction (DUI, bar fights, domestic violence, divorce); or did not do (failing to care for children properly).
- Lost time due to addiction: sacrificing time spent in meaningful, life enriching activities in order to engage in addictive behaviors.
- Diminished personal integrity due to addiction: as addicted people gradually lose their moral compass, they begin to disrespect the rights and needs other people. They even mistreat the people that matter to them most. This begins by failing to meet certain responsibilities, commitments, or obligations and evolves into more obvious forms of disrespect and mistreatment as addiction progresses, such as flat-out lying and deception; stealing from loved ones; and threatening these same people if their demands are not met.
What causes addiction?
- While we do not yet know how various influences combine to form an addiction, we do know there are two basic types.
- One type of influence is biological forces, such a person's genetics.
- The second type is environmental influences, which includes people's life experiences, interpersonal relationships, and culture.
- There are many different explanations, or models, of addiction. One of these, the Bio-Psych-Social-Spiritual (BPSS) Model of addiction recognizes these different aspects of addiction are inter-related.
- Addiction is unlike many medical diseases where we can point to a certain germ or defect that caused the disease.
- Models of addiction have very practical applications and understanding the causes of addiction, can lead to effective treatments.
- The BPPS model of addiction accepts there are multiple causes and multiple solutions to addiction. In practice, it is possible to combine models or elements of models and these mergers regularly occur.
How do people get addicted?
- The Bio-Psycho-Social-Spiritual (BPSS) model of addiction says that there are 4 inter-related issues that lead to an addiction.
- The biological portion of the BPSS Model considers addiction a brain disease with biological, chemical, and genetic roots.
- We now know that certain activities, in addition to drugs or alcohol, can also be addictive (eating, sex, gambling). Addiction is a problem of brain functioning and our genetics greatly determine this. We become addicted to the chemicals our brain releases, not the substance or activity that causes this release.
- The psychological portion of the model views addiction as a learned behavior, a problem of faulty thinking, or of developmental delay. Other psychological disorders can also contribute directly or indirectly to the development of an addiction.
- The social portion of the model looks at multiple factors including the sociological forces that cause entire groups of people to be more vulnerable to addiction, the type and severity of sanctions that the society places on those that engage in addictive behavior, and the family and support system that a person has around them.
- Adding "Spirituality" to the Bio-Psycho-Social model assists some people to move beyond the physical aspects of their addiction. It is clear that the violation of deeply held beliefs and values is a significant consequence of addiction and restoring these beliefs and values becomes an important component of recovery.
What are the diagnostic criteria for Substance Use Disorders (Addiction)?
- The DSM-5 has established a group of Substance-Related Disorders including Alcohol, Cannabis or marijuana, Hallucinogens, Inhalants, Opioid such as heroin, Vicodin, and oxycontin, Sedatives/Hypnotics or Anxiolytics, Stimulants including cocaine and methamphetamine, and Tobacco.
- Regardless of the particular substance, the diagnosis of a substance use disorder is based upon a pathological set of behaviors related to the use of that substance that fall into four main categories including impaired control, social impairment, risky use, and tolerance and withdrawal.
- Impaired control includes 1) Using for longer periods of time than intended, or using larger amounts than intended; 2) Wanting to reduce use, yet being unable to do so; 3) Spending excessive time getting/using/recovering from the drug use; or 4) Cravings that are so intense it is difficult to think about anything else.
- Social impairment may occur when people continue to use despite problems with work, school or family/social obligations, despite having interpersonal problems because of the substance use and important and meaningful social and recreational activities may be given up or reduced because of substance use.
- Addiction may be indicated when someone repeatedly uses substances in physically dangerous situations and other risky situation. For instance, using alcohol or other drugs while operating machinery or driving a car, or continuing to use even though they are aware it is causing or worsening physical and psychological problems, such as the person who continues to smoke cigarettes despite having a respiratory disorder such as asthma.
- Tolerance occurs when people need to increase the amount of a substance to achieve the same desired effect.
- Withdrawal is the body's response to the abrupt stopping of a drug, once the body has developed a tolerance to it. These very unpleasant and sometimes fatal symptoms are specific to each drug.
What are the types of Addiction?
- Alcohol Use Disorder - Alcohol is the most widely used (and overused) drug in the United States. For more information
- Cannabis-Related Disorder - the more commonly used word for cannabis is marijuana. Other names are pot, hash, weed, Buddha grass, dope, ganga, herb, and reefer. Marijuana is the most commonly used illegal substance. For more information
- Hallucinogen-Related Disorder - Hallucinogens include a wide variety of substances, including LSD (also called acid), morning glory seeds, mescaline, mushrooms, and ecstasy. These substances create a high and have effects that cause visual and auditory perceptual distortions. For more information
- Inhalant Use Disorder - Inhalants refer to a wide variety of household products, such as glue, gasoline, paint thinners, cleaners, and various aerosols, which contain hydrocarbons that produce vapors. Intoxication occurs by inhaling these vapors, through a process known commonly as huffing. For more information
- Opioid-Related Disorder - The most common opioids are opium, morphine, heroin, codeine, methadone, oxycodone, and Vicodin. For more information
- Sedative, Hypnotic, or Anxiolytic Use Disorder - This class of drugs include sedatives, such as Valium, Librium, Ativan, Klonopin, Rohypnol, Barbiturates, such as Amytal, Nembutal, Seconal, Phenobarbital, and other antianxiety and sleeping medications. For more information
- Stimulant/Amphetamine Use Disorder - The most commonly known drug in this class is methamphetamine or "crystal meth" (also known as crank). For more information
- Tobacco-Related Disorder - Cigarettes are by far the most commonly used tobacco product. For more information
- Gambling Addiction - Gambling addiction occurs when an individual continues to gamble despite negative consequences. For more information
- Sexual Addiction and Pornography Addiction - Sexual activity, like alcohol, drugs, and gambling, increases levels of dopamine in the brain, which is the primary neurotransmitter in the brain's reward system. For more information
- Internet Gaming Addiction - The DSM-5 does not currently recognize Internet gaming disorder as an official diagnosis, but has proposed it for future consideration and further study. For more information
How are Addictions treated?
- Natural recovery is recovery that occurs without treatment or support groups. For more information
- Biological approaches to addiction treatment attempt to correct or modify the presumed underlying faulty brain chemistry. Medications can make recovery efforts more comfortable, and make addiction less rewarding. For more information
- Psychological approaches to addiction recovery aim to increase a person's motivation for change by helping them to accurately determine the costs and benefits of their addiction. For more information
- There is the social support approach to addictions recovery, which capitalizes upon the benefits of social support through groups that meet to discuss their hopes, disappointments, successes, and failures. For more information
How can I develop a personal action plan for addiction recovery?
- Prepare for a personal marathon (not a sprint) - You don't need to be perfect, or re-set the clock every time you slip.
- Determine whether you just need to work on an addiction problem, or whether you also need to address other life problems.
- Make a beginning plan with a few small and easily accomplished steps, not a huge master plan.
- Keep records - Find something truly meaningful that supports recovery and count it or measure it.
- Expect that the transition period is usually the most difficult and that it will end.
- Remain focused on the reasons you are making this change.
- Remember the three fundamental facts about craving - they are time-limited, will not harm you and cannot force you to use.
- Get private (anonymous) input if you need it.
- Devote your time and attention to the two great pleasures of life: love and meaningful work (in that order).
- Involve some other trustworthy people in your project.
- Check out a few therapists, and/or check out a few support groups.
- Keep at it and Re-cycle through these actions.
- Be creative and approach your addiction problems from a fresh perspective.
- More treatment is the backup plan.