What is Addiction?

In the United Kingdom, thousands are living with addiction or substance abuse. This includes alcoholism, drug abuse and other types of dependency like smoking and gambling. In 2020 alone, almost 3,000 people died from drug misuse while another 4,500 died owing to drug poisoning.

When it comes to alcohol addiction, the problem has been increasing over the last three decades. In 1995, around 4,500 people died because of alcohol. By 2016, this figure had doubled. Furthermore, within these statistics, the number of alcohol-related deaths was double in men compared to women.

As for smoking, a 2016 survey revealed that 15.8% of adults in the UK smoked. This equates to 7.6 million people in the country.

With addiction being such a problem, this article will aim to address this large topic and provide details and dispel associated myths.

What is addiction?

When a person has an addiction, they are unable to control what they do, use or take. This being to the point of being potentially harmful. Typically, addiction is associated with alcohol, drugs, smoking and gambling, but you can be addicted to almost anything.

Addictions can be behavioural or psychological. They’re characterised by compulsion, cravings and an inability to stop the behaviour. They’re also associated with lifestyle dysfunction as a result.

What are the types of addiction?

There are lots of different types of addiction. This ranges from addictions to alcohol, tobacco and drugs to other addictive behaviours like stealing and gambling. Certain addictions are listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), but others aren’t.

A behavioural addiction doesn’t involve taking in a substance. This type of addiction could also be defined as an impulse control disorder. Many diagnosticians won’t diagnose a behavioural addiction as they don’t meet the official addiction requirements as per the DSM-5.

Addictions to substances

Substance addictions occur when a person is addicted to or dependent on the following substances:

• Tobacco.
• Alcohol.
• Opioids (e.g., heroin).
• Cocaine.
• Prescription drugs (e.g., hypnotics, anxiolytics (like tranquillisers or sleeping pills) and sedatives.
• Marijuana (cannabis).
• Amphetamines (including “meth” – methamphetamines).
• Inhalants.
• Hallucinogens.
• Phencyclidine (also called Angel dust or PCP).
• Other substances.

Addictions classed as Impulse Control Disorders

There are impulse control disorders which are also addiction-like. This occurs when someone has an impulse that they can’t resist.

Examples include:

• Kleptomania (a compulsion to steal).
• Intermittent explosive disorder (compulsive assaultive or aggressive acts).
• Gambling.
• Pyromania (a compulsion to start fires).

Behavioural addictions

The following types of addiction are classed as behavioural:

• Sex – The concept of having a sex addiction is contentious and many sexologists, psychologists and psychiatrics debate its existence.
• Food – Many people find it hard to believe that a food addiction is real rather than just gluttony. However, it can be very serious. When addictive foods are eaten, the brain “rewards” the person by flooding their body with dopamine. When you overstimulate this, it can mean that you need more and more of that food to create the same amount of dopamine.
• Internet/computer use – Being addicted to the internet means having a compulsion to be online, so much so that other aspects of a person’s life like work, health and relationships are affected.
• Exercise – An addiction to exercise is characterised by a compulsion to exercise despite there being negative consequences.
• Video games – With the use of electronic devices increasing all the time, there has been an increase in video game addictions as well as mobile phone and computer addictions. People who are addicted to gaming or mobile technology might spend hours and hours a day playing or being online and neglecting things in their lives as a result.
• Pornography – It has been controversial to apply the addiction model to pornography. It could be part of a compulsion for certain sexual behaviours, but most people don’t class it as an addiction by definition.
• Cutting – Self-injury mirrors substance addiction for many people as it’s a way of self-medicating. This means that people can crave the release it gives them, causing them to find it difficult to stop.
• Work – Believe it or not, it is possible to be addicted to work. Some people end up so obsessed with work that it affects other aspects of their lives, like their health, social life and family relationships.
• Shopping – There is a difference between enjoying shopping as a hobby and being addicted to it. With a shopping addiction, you end up buying things that you don’t really want or need, just because you enjoy the buzz you get when you buy something. The buzz doesn’t last long, however, and the feeling is often followed by despair, shame or guilt.

What are the signs and symptoms of addiction?

The signs and symptoms of addiction will vary depending on the type of addiction and the individual affected. However, there are many common signs that someone might experience when they have an addiction.

These include:

Psychological symptoms:

• Increased temper.
• Easy to anger.
• Mood swings.
• Lethargy and tiredness.
• Agitation.
• Defensiveness.
• Being unable to concentrate or focus.
• Paranoia.
• Memory problems.
• Poor judgement.
• Low self-worth and self-esteem.
• Feeling hopeless.
• Worsening of other mental health problems like stress, anxiety and depression.

Social and behavioural signs of addiction

• Dishonest or secretive behaviour.
• Poor attendance or performance at school or work.
• Social withdrawal.
• Withdrawal from responsibilities.
• Losing interest in hobbies.

Physical signs of addiction

• Poor personal hygiene.
• Lack of interest in physical appearance.
• Insomnia or poor sleep patterns.
• Smaller or larger than normal pupils.
• Bloodshot eyes.
• Unusual appetite.
• Dry mouth.
• Persistent cough.
• Sleepiness or extreme fatigue.
• Excessive energy.
• Shaking or twitching.
• Vomiting or nausea.

What are the stages of addiction?

While there isn’t a scientific formula that identifies an addiction, most people agree that there are four stages in an addiction’s development.

For a drug addiction, for example, there will typically be a stage of experimentation. This is when a person experiments and there is no negative effect, for example, smoking marijuana, drinking alcohol or taking cocaine. Many people experiment with these things and don’t go on to the next stage.

The second stage of developing an addiction is when substances begin to be misused. An example of misuse would be someone who gets drunk and does something they shouldn’t but isn’t an alcoholic. A negative consequence of the act has occurred but it’s not yet a regular occurrence or problem.

After misusing a substance, not everyone will go on to become an addict. However, when a person frequently misuses a substance even despite the negative effects, they have moved on from misusing to abusing. Abusing a substance often occurs when someone is in crisis and tries to escape emotionally. Over time, substance abuse leads to problems.

The final stage of addiction is actually becoming dependent. After abuse of a substance has occurred, it is much more likely that a person will continue their behaviour, resulting in a dependency or addiction.

What causes addiction?

Substance abuse and addiction are complex diseases of the brain. Someone who has an addiction will experience cravings or compulsions even when the consequences are so negative. When there’s a craving, the person physically misses the drug, substance or activity to a point where they experience withdrawal symptoms.

There is evidence to suggest that biological traits and genetic susceptibilities have a role to play in the formation of an addiction. That said, an addiction developing is usually influenced by the environment a person finds themselves in, too. For example, someone who doesn’t have alcohol in their environment can’t become an alcoholic.

How addictive a substance is depends on how strongly it activates the brain’s reward circuits. Addictive behaviours and substances change the brain’s reward circuits just like when we experience something pleasurable. This can go some way to explain why addicts will forsake everything for their ‘drug’ – even their own health.

How is addiction diagnosed?

Diagnosing an addiction is not straightforward. It requires assessments and evaluations by a psychologist, a psychiatrist or another specialist. There might be lab tests like urine, blood or liver function tests to look for problems, but these aren’t a diagnostic test. They can, however, be useful for monitoring how someone is recovering.

To diagnose an addiction, most professionals will use the DSM-5 criteria. In order to even begin the process, however, the first step is for the person (or a family member or friend) to realise that there is a problem and acknowledge that they need to seek help and support. Of all the steps in recovery, this one is the most difficult one. Sometimes there might need to be a group intervention if the person doesn’t know just how bad their problem is.

Seeing a GP – the first step

After realising there is a problem, the person needs to start seeking help. The first place to go is their GP. The GP can then refer them to a specialist. The GP will ask questions about the addiction and how it’s impacting daily living. They will also ask about how it affects things like work, education or social life.

If the person has tried to stop, the GP will ask about any withdrawal symptoms they experienced. There will probably be some blood work done to assess overall health as well as a physical exam.

Criteria for receiving an addiction diagnosis

In order to have a diagnosis, the person has to show two of the criteria within 12 months.

These are:

• Consuming large amounts of a substance regularly or for longer than you should.
• Expressing a wish or attempting to moderate intake and not reducing consumption.
• Spending a lot of time sourcing a substance, using it, or trying to recover from using it.
• Having cravings or feeling a strong desire to use the substance.
• Not fulfilling potential – whether it’s educational, professional or family obligations.
• Regularly consuming a substance despite of personal, emotional or social issues that it causes or makes worse.
• Giving up hobbies and social activities because of the addiction.
• Consuming a substance in a situation or location that could cause injury.
• Continuing consuming something even though the person knows they’re causing psychological or physical harm.
• Developing an increased tolerance, which means they need to consume more to achieve the same level of intoxication.
• Experiencing a physical response or withdrawal symptoms when not having the substance. This might appear as nausea, shaking or sweating.

The more criteria a person can apply to their situation, the more severe their dependence. If a person regularly sees themselves fulfilling two or three of these, they would be classed as having a mild disorder. When a person can tick off four or five, their disorder would be moderate. Six or more criteria ticked would indicate a severe addiction.

How is addiction treated?

Treatment for addiction is very individual. It depends on the type of addiction and what the person is addicted to. For treatment to be effective, it needs to address the person’s multiple needs as well as the actual addiction. There also needs to be a regular assessment and modification of the treatment plan.

Participating in treatment or being in a treatment programme needs to be for a substantial amount of time. For the majority of patients, it takes at least three months into treatment to see a significant improvement.

Changing behaviour is a crucial element of addiction treatment. This often requires talking therapies or behaviour modification treatment.

Some types of addiction will require medication during withdrawal. This can be more effective when behavioural therapy and counselling happen alongside.

If a patient suffers from a coexisting disorder like anxiety or depression, both disorders should be treated simultaneously.

Treatment can still be effective even if it is not voluntary. Family members or employers can help to encourage those with an addiction to seek help and treatment.

Recovering from an addiction takes a long time and it will likely require more than one type of treatment.

Medication

Many patients require medication to help them recover from addiction. Some common medications are buprenorphine, methadone and LAAM (levo-alpha-acetylmethadol). These are used when people are addicted to opiates like heroine. For alcohol abuse, acamprosate can help people maintain abstinence.

Rehab

For many people with an addiction, a residential rehab programme is the most effective way of recovering.

Final thoughts

Addiction is problematic for many reasons and there is a lot of stigma. Getting a diagnosis and support is crucial. There is lots of help available and admitting there’s a problem is the first and most difficult step.