There has been a good deal of attention given in recent years to substance abuse, largely due to the ongoing opioid crisis. Opioids are far from the only substance whose use can result in addictive behaviors. Additionally, it can be difficult for those who are struggling with substance abuse disorders to recognize what is going on. Maybe you’re worried about a loved one. How do you really know if there is an addiction? Understanding what constitutes an addiction is the best place to start.
The American Society of Addiction Medicine (ASAM) offers the following definition. “Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry…This is reflected in an individual pathologically pursuing reward and/or relief by substance use.” While the definition of addiction offered by the ASAM may be helpful to professionals in the mental health field, it is not very clear to the average reader. This article will attempt to define addiction disorder in an easy to understand way. It will offer up information that can help readers determine when it is time to seek professional help for themselves or their loved ones.
Basic characteristics of addiction
Addiction is characterized by several different unhealthy behaviors or emotional responses. These include:
- an inability to consistently abstain from a substance or an activity,
- marked impairment in behavioral control,
- cravings, dysfunctional emotional responses, and
- diminished recognition of behavioral and interpersonal problems.
Substance abuse and dependence can impair perception, impulse control, learning, and judgment. This makes it difficult for sufferers to recognize the extent of their problems. These very characteristics are what makes it so hard for substance abusers to recognize the need for seeking professional help. More often than not, it is a friend or family member that first recognizes the extent of the person’s problem, rather than the addict him or herself. Thankfully, this doesn’t mean there is no hope for those who are struggling with drug and alcohol abuse.
Behavioral signs of addiction
Friends and family members who are concerned about their loved ones’ problem should stay on the lookout for certain behaviors indicative of the disease. These include excessive use of drugs or alcohol, and excessive time spent using or recovering from controlled or illicit substances. Other behavioral changes typical to substance use disorders:
- the narrowing of behaviors to those that focus on pursuing addictive substances,
- the lack of desire to give up the behavior, and
- the apparent lack of ability to take action toward overcoming addiction despite the recognition of the underlying problem.
Cognitive and emotional changes
It can be more difficult to observe cognitive and emotional changes from the outside, although it certainly is possible. Look for:
- a worsening preoccupation with drugs or alcohol,
- The altered ability to understand the relative benefits and disadvantages of using substances, and
- an inability to make appropriate associations between substance use and predictable consequences of drug addiction.
Those who abuse drugs and alcohol often suffer from negative emotional consequences such as increased anxiety, stress, and dysphoria and difficulty distinguishing between emotions and bodily sensations. Complicating matters is that drug abuse can influence underlying mental illnesses or potentially cause them.
The “high” is diminished
While substance users who are not exhibiting addictive behaviors tend to experience a “high” associated with increased dopamine and activity in the reward centers of their brains, this response decreases as the dependency develops. This makes the activities themselves feel less subjectively rewarding while simultaneously creating a situation where ceasing the activities leads to withdrawal symptoms. Most people struggling with addiction do not actually experience much, or any, pleasure from their substance use. As the problem gets worse, the addict continues to engage in these activities in an attempt to avoid the physiological symptoms or dysphoria emotional states resulting from withdrawal. The average reader may be tempted to assume that addiction can be defined by the quantity of alcohol or drugs being consumed or the frequency with which someone consumes them. The reality, though, is that addiction impacts the qualitative experience of substance use as well. Addiction changes the way that drug and alcohol users engage in and respond to substance use. It creates a preoccupation with the chosen substance, despite the prevalence of negative consequences for continuing use. This reflects the impaired impulse control.
The symptoms of withdrawal from substances are different depending on what type of drug is being used. Some drugs like alcohol, opiates, and tranquilizers produce significant physical symptoms and others create only emotional withdrawal symptoms. Each addict also experiences withdrawal differently. However, there are many symptoms that are common across a variety of substances and substance users. Physical withdrawal symptoms may include headaches, dizziness, chest tightness or breathing difficulties, heart palpitations, nausea, vomiting, or diarrhea, muscle tension and aches, tremors, and twitches, and sweaty or tingling skin. Mental and emotional withdrawal symptoms include increased anxiety and depression, fatigue, sleep difficulties, and poor concentration. Many of these symptoms can be self-diagnosed by the substance abuser him or herself.
Recognizing addictive behaviors
While the majority of research and healthcare resources tend to be devoted to drug and alcohol abuse, it’s important to realize that behaviors can also be addictive. In fact, both the American Psychiatric Association (APA) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the leading diagnostic manual of mental disorders, explicitly recognize gambling disorders, the most common behavioral addiction, in their diagnostic criteria.
How do you define addiction to a behavior, rather than a substance, though?
Behavioral addictions tend to follow similar patterns to their more widely-recognized substance-based alternatives. Those struggling with them tend to spend the majority of their time either engaging in addictive behaviors, arranging to engage in them, or recovering from them. They feel dependent on them to cope. The behavior often continues despite negative physical or mental consequences, and sometimes experience emotional withdrawal symptoms, when attempting to stop.
When to seek treatment
The easiest answer is “when it begins to create problems for the addict or their loved ones,” but that isn’t necessarily the best answer. Whether it manifests itself as behavioral or substance abuse, addiction is a chronic and progressive disease. It will get worse and the addict may not even see it. Those who are struggling to overcome addiction often have difficulty understanding the negative consequences of their choices, making it difficult to accept that it’s time to seek help. To make matters worse, relapse after periods of abstinence is very common. Absent of behavioral therapies, it can be very difficult to remain drug-free. A combination of credentialed addiction specialists and long-term support offers addicts the best possible chances of ongoing recovery. Some individuals need additional support from medical and mental health physicians to treat underlying issues impacting the disorder. Whether readers are seeking help for themselves or their loved ones, they should know that like all diseases, addiction is treatable and recovery is possible.