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What Is Addiction?

Reviewed by Psychology Today Staff

A person with an addiction uses a substance, or engages in a behavior, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences. Addiction may involve the use of substances such as alcohol, inhalants, opioids, cocaine, and nicotine, or behaviors such as gambling.

There is evidence that addictive behaviors share key neurobiological features: They intensely involve brain pathways of reward and reinforcement, which involve the neurotransmitter dopamine. And, in keeping with other highly motivated states, they lead to the pruning of synapses in the prefrontal cortex, home of the brain's highest functions, so that attention is highly focused on cues related to the target substance or activity. It is important to know that such brain changes are reversible after the substance use or behavior is discontinued.

Both substance use disorders and gambling behaviors have an increased likelihood of being accompanied by mental health conditions such as depression and anxiety, or other pre-existing problems. Substance use and gambling disorders not only engage the same brain mechanisms, they respond to many of the same treatment approaches.

Substance use and gambling disorders are complex conditions that affect the reward, reinforcement, motivation, and memory systems of the brain. They are characterized by impaired control over usage; social impairment, involving the disruption of everyday activities and relationships; and craving. Continuing use is typically harmful to relationships as well as to obligations at work or school.

Another distinguishing feature of addictions is that individuals continue to pursue the activity despite the physical or psychological harm it incurs, even if it the harm is exacerbated by repeated use. Typically, one's tolerance to a substance increases as the body adapts to its presence.

Because addiction affects the brain’s executive functions, centered in the prefrontal cortex, individuals who develop an addiction may not be aware that their behavior is causing problems for themselves and others. Over time, pursuit of the pleasurable effects of the substance or behavior may dominate an individual’s activities.

All addictions have the capacity to induce a sense of hopelessness and feelings of failure, as well as shame and guilt, but research documents that recovery is the rule rather than the exception. There are many routes to recovery. Individuals can achieve improved physical, psychological, and social functioning on their own-so-called natural recovery. Others benefit from the support of community or peer-based networks. And still others opt for clinical-based recovery through the services of credentialed professionals.

The road to recovery is seldom straight: Relapse, or recurrence of substance use, is common-but definitely not the end of the road. For those who achieve remission of an addiction disorder for five years, researchers report, the likelihood of relapse is no greater than that among the general population. Neuroscientists report that synaptic density is gradually restored.

Myths About Addiction

[Marjan Apostolovic/Shutterstock+]

The processes that give rise to addictive behavior resist a simplistic explanation. There is not just one cause: Although genetic or other biological factors can contribute to a person’s vulnerability to the condition, many social, psychological, and environmental factors also have a powerful influence on substance use.

Some characteristics, such as a lack of ability to tolerate distress or other strong feelings, have been associated with addiction, but there is no one “addictive personality” type that clearly predicts whether a person will face problems with addiction.

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Symptoms of Addiction

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Recurrent use of a substance, or engagement with an activity, that leads to impairment or distress, is the core of addictive disorders. The clinical diagnosis of an addiction is based on the presence of at least two of a number of features:

The severity of the condition is gauged by the number of symptoms present. The presence of two to three symptoms generally indicates a mild condition; four to five symptoms indicate a moderate disorder. When six or more symptoms are present, the condition is considered severe.

Causes of Addiction

[Marjan Apostolovic/Shutterstock+]

Research makes it clear: There is n

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