What Is Addiction?
Today, scientists view addiction as a psychological or physical vulnerability to a substance, which includes behavior. Historically, the term was applied only when the habitual use of a drug produced chemical changes in the user’s body. One such change is physical tolerance, in which the body adapts to a drug so that the initial dose no longer produces the same emotional or psychological effects. This process, caused by chemical changes in the brain, means the user has to take larger and larger doses of the drug to achieve the same high. Now, physiological and psychological effects are both criteria in the American Psychiatric Association’s (APA) descriptions of addictive behavior.
In 2013, after 10 years of revision, the APA released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The APA defines addiction as compulsive drug-seeking behavior, which falls on one end of a continuum of a “substance use disorder.” According to DSM-5, a person is neither alcoholic nor nonalcoholic, but someone with symptoms ranging from mild (an average college binge drinker) to severe (a person who is out of control). The term “substance use disorder” combines two categories used in the DSM’s previous editions, dependence and abuse. Dependence involves normal responses, such as tolerance and withdrawal, to prescribed medications; abuse or addiction are psychological or physical dependence on a substance or behavior. Dependence can occur without a physical component, based solely on compulsive use.
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According to the APA, the following are the criteria for diagnosis of a substance use disorder:
• 2-3 criteria indicate a mild disorder
• 4-5 criteria, a moderate disorder
• 6 or more, a severe disorder
1. Developing tolerance to the substance. When a person requires increased amounts of a substance to achieve the desired effect or notices a markedly diminished effect with continued use of the same amount, he or she has developed tolerance to the substance.
2. Experiencing withdrawal. In someone who has maintained prolonged, heavy use of a substance, a drop in its concentration within the body can result in unpleasant physical and cognitive withdrawal symptoms. Withdrawal symptoms are different for different drugs. For example, nausea, vomiting, and tremors are common withdrawal symptoms in people dependent on alcohol, opioids, or sedatives.
3. Taking the substance in larger amounts or over a longer period than was originally intended.
4. Expressing a persistent desire to cut down on or regulate substance use.
5. Spending a great deal of time getting the substance, using the substance, or recovering from its effects.
6. Giving up or reducing important social, school, work, or recreational activities because of substance use.
7. Continuing to use the substance despite the knowledge that it is contributing to a psychological or physical problem.
8. Craving or an intense desire or urge for a specific substance.
9. Use in situations that are physically hazardous.
10. Unsuccessful efforts at reducing amounts.
11. Failure to fulfill major obligations.
It is sometimes difficult to distinguish between a healthy habit and one that has become an addiction. Experts have identified some general characteristics typically associated with addictive behaviors.
• Reinforcement. The behavior produces pleasurable physical or emotional states or relieves negative ones.
• Compulsion or craving. The addict feels a compelling need to engage in the behavior.
• Loss of control. The addict loses control over the behavior and cannot block the impulse to do it.
• Escalation. More and more of the substance or activity is required to produce its desired effects.
• Negative consequences. The behavior continues despite serious negative consequences, such as problems with academic or job performance, difficulties with personal relationships, or health problems.