What does it mean to be addicted?

The way we tend to think about addiction doesn’t usually awake sympathy or empathy.

We connect it to the weakness of the mind to fight the temptation we are faced with.

We seem to think that this is something that can never happen to us.

Even though addiction was originally framed by both Alcoholics Anonymous and psychiatry as a form of antisocial personality or “character” disorder, there’s no research to confirm this idea. [1]

Researchers are actually unable to find a type of personality common to everyone with addictions. [2] [3]

Basically, anybody could end up being addicted to something.

Just imagine not being able to stop yourself from doing something you know is bad for you.

Your loved ones encourage you to stop but that is not enough.

Your behavior seems to be out of your control. Your life becomes a cycle of obsessing over a thing or behavior followed by a compulsion to do something about it.

Do you feel more empathetic now?

At its worst, addiction harms more than just the addict. It is a serious condition that has an adverse effect for the person struggling with it and their family and friends.

Now, the word addiction can also be loosely used in everyday speech which brings more confusion to what it is.

People might say:

“I am addicted to shopping!”

Or share their enthusiasm by asking:

“Have you seen the new Netflix series? I am so addicted!”

It is important to know that even if people can get addicted to basically anything, not everything can be classified as addiction.

So, what is addiction?

American Society of Addiction Medicine defines addiction as:

“… a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

Its characteristics are:

• Inability to consistently abstain
• Impairment in behavioral control
• Craving
• Diminished recognition of significant problems with one’s behaviors and interpersonal relationships
• Dysfunctional emotional response

It involves cycles of relapse and remission. It can be progressive and detrimental, depending on what kind of addiction we’re talking about.
As you can see, it is more than just not being able to resist a dress on sale or turn off Netflix to go take a walk.

It is a serious condition that can affect your life and lives around you in so many different ways.

How often do people become addicted?

The statistics are alarmingly scary.

Researchers Sussman, Lisha, and Griffiths published a review in which they looked at the relationship between addictive behaviors that are usually mentioned in the academic literature: smoking tobacco, drinking alcohol, taking illicit drugs, eating, gambling, internet use, love, sex, exercise, work, and shopping.

Based on the data from 83 large-scale studies they reported a prevalence of addiction among US adults ranged from as low as 15% to as high as 61% in a 12-month period!

They also found that 47% of the US adult population suffers from maladaptive signs of an addictive disorder over a one year period. [4]

Can you imagine that almost half of the US is addicted to one or more behaviors?

So, why don’t we know about this?

Many addictions go unnoticed because we tend to treat them as bad habits that we can’t seem to shake off.

We are used to thinking about addictions in terms of drug misuse or abuse, alcohol or gambling.

Believe it or not, according to the American Board of Addiction Medicine, over 40 million Americans meet medical criteria for addiction involving nicotine, alcohol or other drugs (and that is more than the number of Americans with cancer, diabetes or heart conditions!)

Statistics from Addiction.com about gambling addictions show that:

• Over 80 percent of American adults gamble on a yearly basis
• Three to five gamblers out of every hundred struggles with a gambling problem
• As many as 750,000 young people, ages 14 to 21 has a gambling addiction
• 75 percent of college students report having gambled during the past year
• The risk of developing a gambling addiction more than doubles for young adults in college settings

The numbers are discouraging.

Now, why do so many people develop addictions?

What makes a person addicted and what can we do about it?

The answer seems to be in a combination of genetics, environment and personality.

For example, genetic factors seem to account for 40-70% of the risk factors for alcoholism.

Some people are more prone to developing addictions, simply because the neurobiology of their brain is different. For this reason, it is important to know that not everybody reacts to the initial drug use the same way. [5,6,7,8]

The biggest contributing factor for getting addicted to drugs is being exposed to them. [9] This is how the environmental factors come into play. When it comes to drugs, the National Institute on Drug Abuse claims that lack of parental supervision, the number of peers consuming the substance, drug availability and poverty are the dominant risk factors for substance use among children and adolescents. [10]

There is, however, a lot that we can do to prevent addictions.

Across five domains – individual, family, peer, school and community, there are protective factors that we can enhance [11]

[table id=19 /]

In each of these five domains, we can make things better though education and connection.

For example, it is so important that we invest in learning coping skills. Knowing how to recognize what makes you angry, anxious, powerless, hopeless or sad, and how to reach out for support, stay in control or comfort yourself is undoubtedly a protective factor.

This is something that we need to be teaching our children, too. Think of coping skills as a shield that helps you fight the battles you’re facing in life.

As parents, we need to be supervising what our kids are doing. That does not mean tracking every single step they take, but being observant to the changes in their behavior, emotional reactions and physical appearance. Developing the sense of accountability for your choices usually starts by being accountable to others. Parents can be that protective authority the children look up to when they need to make important decisions.

Making education look cool in peer groups is another protective factor. The more you’re invested in succeeding in school, the less likely are you to take drugs, start gambling or party with alcohol.

Now, college students might say that it is the pressure that succeeding at school is what increases the pressure and the anxiety.

This is why it is important that the drug availability is limited. School needs to have Anti-Drug Use Policies. The authorities at school need to make sure they provide the help and assistance and be a good enough resource to students. This way, when they need help, they have someone to reach out to in school.

Having a connected and supportive community to be there with you for better or worse is a strong protective factor. Just think of support groups, where you can always find comfort and support in people who’d been through the similar experiences. Well, we don’t need to wait to have something bad happen to reach out. Connecting with others – through hobbies, sports or art, academics etc. – can make a huge difference. Learning how to share with others, trust them to be by your side is what will help you have a resource to go to when you might feel tempted to try or do something else (potentially addictive) instead.

Seeing that we’re not as powerless as we might have thought sounds a bit more encouraging, right?

We can do so much for ourselves and others.

But, how about personality?

Is there something in the way we are that makes us develop addictions?

You might have heard about the term “addictive personality”. It has been used quite a lot in popular psychology.

It is commonly used in two ways:

• First, to imply that there is a certain personality type, a structure of traits that causes an individual to become addicted.
• Second, to imply that certain personality traits are present only in people who are addicted, or that they are present in a stronger way compared to others. [12]

What does the research say?

While there is a good amount of scientific evidence that most people with addictions are highly neurotic, neuroticism as a personality trait cannot predict development of addictive behaviors. There are highly neurotic people who never develop addictions. [1] Studies show that there is no single set of psychological characteristics that are common for all the addictions. [2]

That means we cannot do a psychological assessment and identify the future addicts.

However, what we can do is to continue studying the personality in hope to better map the risk factors.

One of the most influential studies about the role of personality in addictions was done by Alan L. Rang, a psychology professor at Florida State University.

The study was prepared for the National Academy of Sciences with the conclusion that there are certain “significant personality factors” that can potentially contribute to developing addictions. [2]

These risk factors are:

• Impulsive behavior, difficulty in delaying gratification
• An antisocial personality
• Disposition towards sensation seeking
• Nonconformity combined with weak commitment to socially valued goals for achievement
• Social alienation and tolerance for deviance
• Heightened stress accompanied with lack of coping skills.

So, just because you can recognize some of these in yourself, doesn’t mean that you are going to develop an addiction.

We need to have in mind that, when genetics, environment and personality factors are combined, the chances for developing addictions increase.

This is why we must use this research to promote the awareness and increase the number of prevention programs.

What types of addiction are there?

The most common addictions are alcohol and drug addiction.

It is important to have in mind that it is not only the illegal drugs that we are concerned about!

For example, barbiturates (Seconal), benzodiazepines (Valium, Xanax, Ativan, Klonopin, Librium) or hypnotics (Ambien, Intermezzo, etc.) are often used and misused in person’s need to relax or switch-off, to forget stress-related thoughts or feelings. [13] There’s a lot said about abuse of Adderall, a drug known to be used in treatment of ADHD as well. [14]

Prescription drug addictions are a growing problem.

If we put drugs and alcohol on the side, smoking, gambling, shopping, sex, pornography, gaming, social media… you name it. Everything can become an object of addiction.

We just tend to notice some more easily than others due to their prevalence or terrifying effects addiction can have.

• An estimated 88000 people die from alcohol-related causes annually, which makes alcohol addiction the third leading preventable cause of death in the United States. The first one is, believe it or not, tobacco. Alcohol-impaired driving fatalities accounted for around a third of overall driving fatalities! [16]
• According to the research of the National Center for Health Statistics at the Centers for Disease Control and Prevention, more than 64000 Americans died from drug overdoses in 2016. This includes both illicit drugs and prescription opioids. The increase in one decade is almost double! [18]
• Almost 10 million people in the US have a gambling addiction. Compulsive betting behavior costs the US economics about 6 billion dollars per year. [19]

Drug Addiction

The risk of addiction and how fast a person becomes addicted depends on the drug.

With time, a person develops a tolerance to its effects and starts needing larger doses to get high. Being without the drug becomes increasingly hard. Trying to stop using drugs starts causing intense cravings and can make a person feel physically ill. This is referred to as withdrawal symptoms. [12]

Symptoms of recent marijuana, hashish, and other cannabis-containing substances include:

• A sense of euphoria or feeling “high”
• A heightened sense of visual, auditory and taste perception
• Increased blood pressure and heart rate
• Red eyes, dry mouth, decreased coordination
• Difficulty concentrating or remembering
• Slowed reaction time
• Anxiety or paranoid thinking
• Odor on clothes or yellow fingertips
• Exaggerated cravings for certain foods at unusual times

Symptoms of barbiturates, benzodiazepines, and hypnotics abuse:

• Drowsiness and Irritability or changes in mood
• Slurred speech
• Lack of coordination, Involuntary eye movements
• Problems concentrating or thinking clearly
• Memory problems
• Lack of inhibition
• Slowed breathing and reduced blood pressure
• Falls or accidents
• Dizziness

Symptoms of Meth, Cocaine and other Stimulants:

• The feeling of exhilaration and excess confidence
• Increased alertness, energy and restlessness
• Behavior changes or aggression
• Rapid or rambling speech
• Dilated pupils
• Confusion, delusions, and hallucinations
• Irritability, anxiety or paranoia
• Changes in heart rate, blood pressure, and body temperature
• Nausea or vomiting with weight loss
• Impaired judgment
• Nasal congestion and damage to the mucous membrane of the nose (if snorting drugs)
• Mouth sores, gum disease and tooth decay from smoking drugs (“meth mouth”)
• Insomnia
• Depression as the drug wears off

It is important to know that stimulants, besides meth and cocaine, include methylphenidate (Ritalin, Concerta, others) and amphetamine-dextroamphetamine (Adderall, Adderall XR, others).

Abuse of so-called club drugs, such as ecstasy or molly (MDMA), gamma-hydroxybutyric acid (GHB), flunitrazepam (Rohypnol, also called roofie) and ketamine, include the following symptoms:

• Hallucinations
• Paranoia
• Dilated pupils
• Chills and sweating
• Involuntary shaking (tremors)
• Behavior changes
• Muscle cramping and teeth clenching
• Muscle relaxation, poor coordination or problems moving
• Reduced inhibitions
• Heightened or altered sense of sight, sound, and taste
• Poor judgment
• Memory problems or loss of memory
• Reduced consciousness
• Increased or decreased heart rate and blood pressure

Symptoms of lysergic acid diethylamide (LSD) use include:

• Hallucinations
• Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
• Impulsive behavior
• Rapid shifts in emotions
• Permanent mental changes in perception
• Rapid heart rate and high blood pressure
• Tremors
• Flashbacks, a re-experience of the hallucinations — even years later

Opioid painkillers include drugs produced from opium or made synthetically to ease the pain. They include heroin, morphine, codeine, methadone and oxycodone.

The symptoms of narcotic use include:

• Reduced sense of pain
• Agitation, drowsiness or sedation
• Slurred speech
• Problems with attention and memory
• Constricted pupils
• Lack of awareness or inattention to surrounding people and things
• Problems with coordination
• Depression
• Confusion
• Constipation
• Runny nose or nose sores (if snorting drugs)
• Needle marks (if injecting drugs)

Alcohol Abuse

2015 National Survey on Drug Use and Health shows that 86.4 percent of people ages 18 or older reported that they consumed alcohol at some point in their lifetime, 70.1 percent reported they drank in the past year, and 56 in the past month.

The same Survey shows that 15.1 million adults have Alcohol Use Disorder, 9.8 million men and 5.3 million women. Only 6.7 percent had received treatment. [16]

The symptoms associated with alcohol use disorder include [15]

• Using alcohol to relax, to cheer up, to sleep, to deal with problems, or to feel “normal”
• Drinking alone, in mornings or in secret
• Temporary blackouts or memory loss
• Recurrent fights with family members or friends
• Irritability, depression or mood swings
• Headache, anxiety, insomnia, nausea or other unpleasant symptoms when one stops drinking
• Flushed skin, broken capillaries on the face
• Husky voice, trembling hands, bloody or black/tarry stools or vomiting blood, chronic diarrhea

Gambling addiction

It is characterized by a compulsive desire to gamble. A person has no control over their behaviors when gambling.
No matter how difficult their financial, legal or social situation is, the people who have gambling addiction will continue to gamble (daily or on a binge).

Signs include: [17]

• Being preoccupied with gambling, playing lotto, going to the casino, gambling online, etc
• Avoiding obligations at work, school, home or socially in order to spend time gambling
• Avoiding friends or family members who have voiced concern of a potential gambling addiction
• Financial hardships such as loss of house, car, job, or other possessions to gambling
• Stealing money to gamble or to pay debts
• Selling possessions to acquire money to gamble or pay debts
• Inability to control behaviors despite a desire to have such control
• Neglecting expenses such as bills or other financial obligations in order to gamble
• Sneaking around, telling lies about gambling or otherwise masking a potential problem
• Denying actions or minimizing problems

What are the signs of addiction?

How do we know that we’ve taken one step too far?

People with addiction tend to show the 3 Cs:

• Craving for the object of the addiction
• Loss of Control over the use of the object of the addiction
• Continued engagement with the object of addiction in spite of harmful consequences.

Addiction is a physical or psychological dependence on the object or behavior.

When unable to use the substance or engage in a behavior, the dependence leads to withdrawal symptoms.

The object of addiction becomes an obsession. The need to get it and consume is urgent.

Depending on the addiction, the symptoms can vary in their intensity.

For instance, drug and alcohol addictions can be noticed through physical, behavior and emotional signs.

The symptoms include:

• Being over- or under- active
• Change in physical appearance, weight loss, unusual odors
• Isolation/secrecy about activities
• Financial difficulties
• Missing school or work
• Defensiveness
• Inability to cope with stress
• Slow thinking, easily confused
• Denial
• Irritability
• Anger

If you have any concerns, it is important to look at the symptoms of the specific addiction you’re suspecting of.

Consulting with a professional is always the best option.

How do you stop being addicted?

Not all of the addictions are the same.

Some, such as drug or alcohol abuse, can significantly affect the way our body functions and require medical treatment and care.

Others might require psychological help through mental health counseling or psychotherapy.

Either way, if you notice that someone close to you might be struggling with the addiction, it is necessary that you help them get medical and psychological assistance by contacting the experts.

People struggling with addictions see quitting as threatening.

The symptoms of withdrawal in some addictions can be very painful and psychologically hard to bear. After all, the problem with addiction is that even though you might want to stop – you feel like that is impossible.

In overcoming the addiction, one needs to recognize the value that object or behavior carries for them.

The person is addicted because the addiction became a powerful resource – to distance yourself from things, to allow yourself to experience joy, to relax and stop anxiety, to be a part of a community…

No matter what the initial benefit was – social, psychological or physical – it is beyond important to recognize what addiction does for a person and to provide the alternative.

There are many clinics and rehabilitation centers across the world that help people with specific addictions.

Recovering is hard.

Since addiction involves cycles of relapse and remission, it is important to be patient and persistent.

Depending on the addiction, the path of recovery requires more or less energy and strength.

You’ll hear smokers say often: “I can quit whenever I want”

But then, you’ll see them crave for the cigarette and look for the alternatives to get their minds off of smoking.

It is never easy!

Addictions and Mental Health problems

What is the relationship between mental health problems, such as depression or anxiety and the tendency to develop addictions?

We might be able to find a connection in a difficulty to cope and a need to find a reliable resource to ease our struggles. Something that was a solution, like prescription medicine, becomes a problem – addiction.

The addiction serves a purpose.

It is a resource to help us achieve a certain goal. Now, that goal might have been to ease the anxiety or to feel pain-free, physically or psychologically.

However, mental health problems are not causing addictions even though they might accompany them.

Figuring out what came first, addiction or a mental health problem is in most of the cases a difficult task. [12]

Drug abuse may increase the chances that mental health problems will emerge. There is an increased risk of psychosis in vulnerable marijuana users.

The 10-year research study in Germany with 1923 participants, aged 14-24 during showed that those participants who had no psychotic symptoms and never tried marijuana before the study, but then started using it during the study, had nearly doubled the risk of experiencing psychotic symptoms! Those who used marijuana before the start of the study and continued using it during the study had an increased risk of persistent psychotic symptoms. [14]

On the other side, mental disorders can lead to drug abuse, as a means of “self-medication”. In trying to deal with anxiety or depression, people may rely on alcohol, tobacco or other drugs.

Alcohol has mood-depressant effects in larger quantities. About 15 million US adults have social anxiety disorder. Drinking helps them cope or avoid the symptoms. Murray Stein, MD, MPH, and John Walker, PhD, the authors of Triumph Over Shyness: Conquering Social Anxiety Disorder state that social anxiety disorder “frequently travels in the company of other emotional difficulties” such as alcohol or drug abuse, depression, and other anxiety disorders.

Opioid abuse has been linked to higher rates of depression, anxiety, and bipolar disorders. Self-medication, to manage the symptoms can be a viable path to developing an addiction. [20] Depression is common among illicit opioid users. [21]

People struggling with addiction can be feeling guilty and ashamed of their behavior once in remission and realizing the difficulties in managing to stay clean, sober or in control. These feelings often seem like triggers to go back to addictive behaviors. Alcohol abuse seems to be increasing the risk of depression.[23] Chronic alcohol misuse impacts the mood significantly and can often lead to suicide or suicide attempts. Anxiety frequently goes along with drinking and tends to amplify the effects of depression.[24]

About 25 percent of US adults with ADHD suffer from substance dependence every year. People with ADHD seem to be 2.5 times more likely to develop an addiction than those without the disorder. [22]

So, the connection between addictions and mental health issues seems to go both ways.

Suffering makes us more vulnerable and more in need of a viable resource to ease the pain. Raising awareness about mental health problems and assisting people in finding alternative resources to cope – mental health professionals or support groups, for example – can make a huge difference!

On the other side, quitting addiction a rough path. The addiction can cause major impairments to our body, our mind, relationships, work, etc. These are yet, another challenges to deal with. This is why psychological help is necessary for getting through the hardship of recovery.

The Opposite of Addiction is Connection

If you haven’t had a chance to see Johann Hari’s TED talk about the cause of addictions, I highly suggest you watch it.

https://youtu.be/PY9DcIMGxMs

He is an author of the New York Times best-selling book “Chasing The Scream: The First and Last Days of the War on Drugs”.

He believes that the cause of addiction has been largely misunderstood.

In his opinion, the opposite of every addiction is not sobriety, but a lack of human connection.

No matter what the addiction is, from drugs and gambling up to the over-use of mobile phones, it is the connection that is missing.

He says: “Human beings have a natural and innate need to bond. And when we’re happy and healthy we’ll bond and connect with each other. But if you can’t do that — because you’re traumatized or isolated or beaten down by life — you will bond with something that will give you some sense of relief. Now that might be gambling, that might be pornography, that might be cocaine, that might be cannabis, but you will bond and connect with something because that’s our nature, that’s what we want as human beings.”

In the world dominated by social media, the first step in preventing addiction may be re-learning how to be there with each other and for each other. That gives us a chance to educate with care and provide the support to people to better cope with the challenges they are facing

References:

1. Szalavitz, M. (2016, April 05). The Addictive Personality Isn’t What You Think It Is. Retrieved from https://www.scientificamerican.com/article/the-addictive-personality-isn-t-what-you-think-it-is/

2. Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136(5), 768-821.

3. Lang, Alan R. (1983). “Addictive Personality: A Viable Construct?”. In Levison, Peter K.; Gerstein, Dean R.; Maloff, Deborah R. Commonalities in Substance Abuse and Habitual Behavior. Lexington Books. pp. 157–236.

4. Sussman, S., Lisha, N., & Griffiths, M. (2011). Prevalence of the addictions: a problem of the majority or the minority?. Evaluation & the health professions, 34(1), 3-56.

5. Agrawal, A., & Lynskey, M. T. (2008). Are there genetic influences on addiction: evidence from family, adoption and twin studies. Addiction, 103(7), 1069-1081.

6. Enoch, M. A., & Goldman, D. (1999). Genetics of alcoholism and substance abuse. Psychiatric Clinics, 22(2), 289-299.

7. Goldman, D., Oroszi, G., & Ducci, F. (2005). The genetics of addictions: uncovering the genes. Nature Reviews Genetics, 6(7), 521.

8. Lynskey, M. T., Agrawal, A., & Heath, A. C. (2010). Genetically informative research on adolescent substance use: methods, findings, and challenges. Journal of the American Academy of Child & Adolescent Psychiatry, 49(12), 1202-1214.

9. Nestler, E. J. (2013). Cellular basis of memory for addiction. Dialogues in clinical neuroscience, 15(4), 431.

10. National Institute on Drug Abuse. (n.d.). What are risk factors and protective factors? Retrieved from https://www.drugabuse.gov/publications/preventing-drug-abuse-among-children-adolescents/chapter-1-risk-factors-protective-factors/what-are-risk-factors

11. Kerr, J. S. (1996). Two myths of addiction: The addictive personality and the issue of free choice. Human Psychopharmacology-Clinical And Experimental, 11, S9-S14.

12. Drug addiction (substance use disorder) – Symptoms and causes (n.d.). Retrieved from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112

13. Adderall Abuse. (2017, May 25). Retrieved from https://drugabuse.com/library/adderall-abuse/

14. Kuepper, R., van Os, J., Lieb, R., Wittchen, H. U., Höfler, M., & Henquet, C. (2011). Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. Bmj, 342, d738.

15. Wilcox, S. (n.d.). Signs and Symptoms. Retrieved from https://www.ncadd.org/about-addiction/signs-and-symptoms/signs-and-symptoms

16. Alcohol Facts and Statistics. (n.d.). Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

17. Gambling Addiction – Signs, Symptoms & Treatment for Problem Gambling. (n.d.). Retrieved from https://www.addictions.com/gambling/

18. National Institute on Drug Abuse. (2017, September 15). Overdose Death Rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

19. Problem Gambling Statistics – 2016. (n.d.). Retrieved from https://nafgah.org/statistics-gambling-addiction-2016/

20. Martins, S. S., Fenton, M. C., Keyes, K. M., Blanco, C., Zhu, H., & Storr, C. L. (2012). Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions. Psychological medicine, 42(6), 1261-1272.

21. Depression and Substance Abuse. Retrieved from https://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/FE16C454A782A8AFCA2575BE002044D0/$File/m715.pdf

22. ADHD and Addiction. (n.d.). Retrieved from https://www.drugrehab.com/co-occurring-disorder/adhd/

23. Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906-914.

24. Madden, J. S. (1993). Alcohol and depression. British journal of hospital medicine, 50(5), 261-264.