Addiction

Addiction (a-DIK-shun) refers to the use of a substance, such as alcohol or another drug, to the point where a person develops a physical or psychological need for it. The term also may be used to describe a harmful habit that is out of control, such as gambling or spending too much time on the Internet.

When friends first told Josh that his drinking and drug use were out of control, he ignored them. He liked to party, he said, but he could stop anytime he wanted. He did not stop, though, no matter how much his grades fell and his soccer game suffered. He still did not stop even after he was kicked off the soccer team and lost many of his friends. Eventually, Josh had to admit that his use of alcohol and drugs had gotten out of hand. He had developed an addiction, he now said, and he needed help to fight it.

What Is Drug Addiction?

We often say that people who have an addiction are "hooked" on a substance or behavior. It is an apt choice of words, since addicts often feel as if they are dangling like a trout from a fishing hook and that they cannot break free. Fortunately, this is not true. Treatment can help people with an addiction overcome their bad habits and regain control of their lives.

Physical dependence

People with an addiction to alcohol or another drug develop a dependence on it, which is a strong need to use the substance no matter how bad the consequences may be. Sometimes the need is physical. One sign of physical dependence is called tolerance. When someone develops tolerance for a certain substance, it means that over time he or she starts to need more and more of it to get drunk or feel high. If someone keeps using the same amount of the substance, after a while he or she may notice that it does not have the same effect anymore.

Another sign of physical dependence is withdrawal, which means that people who are hooked on a substance can have physical symptoms and feel sick if they stop using it. The symptoms are so unpleasant that people may be driven to start drinking or using drugs again just so they can feel better. This is one effect that keeps people coming back for more of a substance, even after they realize that they have a serious problem.

Psychological dependence

Some people feel as if they have lost control of their drinking or drug use, yet they do not show signs of tolerance or withdrawal. While these people may not be physically hooked on a substance, they can still have a strong psychological dependence on it. Like people with a physical dependence, they may feel an intense craving and find themselves drinking or using drugs in larger amounts or more often than they intend.

People who are dependent on alcohol or other drugs, either physically or psychologically, often spend much of their time finding ways of getting the substance, using it, hiding it, and recovering from its ill effects. Friendships, school, work, sports, and other activities all may suffer as a result. As the problems pile up, people may want desperately to give up the substance, yet they find it very hard to do so despite repeated efforts to kick the habit. Often, users will not see the connection between drug use and life problems. They think that the issues in their lives justify their drug and alcohol use and deny that their substance abuse is a real problem.

What Causes Drug Addiction?

Addiction usually begins with a conscious choice to drink or use drugs. People often turn to alcohol or other drugs to avoid things that bother them. For teenagers, this may mean pressure from friends, stress at home, or problems at school. Teenagers also may think that drinking or using drugs will help them fit in, let them overcome their shyness at parties, or make them look older or "cooler." Some just like the feeling of being high. In the long run, though, they end up feeling worse. The more they drink and use drugs, the more problems arise, and the harder it is to stop. By this point, however, people may feel as if they no longer have a choice, because the urge to use alcohol or drugs has become so powerful.

To understand how alcohol and drugs can gain such a strong hold on people, it helps to grasp how these substances act inside the body. Once a substance is taken in through drinking, smoking, injecting, or inhaling, it travels through the bloodstream to the brain, which has its own built-in reward system. When people do things that are important for survival, such as eating, special nerve cells in the brain release chemicals that make people feel pleasure. In this way, the brain is programmed so that people want to repeat these actions that make them feel good.

Substances that are addictive affect the brain's reward system. Instead of teaching people to repeat survival behaviors, though, they "teach" them to take more drugs. The way this happens varies from substance to substance. Some drugs, such as heroin ^* or LSD ^* , mimic the effects of a natural brain chemical. Others, such as PCP ^* , block the sending of messages between nerve cells. Still others, such as cocaine ^* , interfere with the molecules that carry brain chemicals back to the nerve cells that released them. Finally, some drugs cause brain chemicals to be released in larger

amounts than normal. Methamphetamine, a type of amphetamine ^* also known as "speed," is one example. At first, drug use may seem fun, because it leads to feelings of pleasure or relaxation. Over time, though, drug use gradually changes the brain so that people need to take drugs just to feel normal.

Who Is at Risk of Addiction?

Addicts come in all shapes and sizes. The homeless man sleeping on the street may have an addiction, but so may the captain of the high school soccer team. Any person who abuses alcohol or other drugs is at risk of becoming addicted. For some people, however, the risk is especially high. For one thing, problems with drinking and drug use, just like heart disease or cancer, often run in families. Children whose parents are addicted to alcohol, for example, may be more likely than other people to have an alcohol or drug problem themselves.

People who have certain mental disorders also have a higher than average risk of addiction. This is not surprising, since it is thought that many mental disorders are caused in part by an imbalance in the same kinds of brain chemicals that drugs affect. People who suffer from depression, for example, may find that a certain drug lifts their mood for a while. The "self-medication" theory of addiction says that people learn to respond to a particular mood by taking a drug, in a misplaced effort to relieve their mental pain.

What Are Some Addictive Drugs?

People can become addicted to a wide range of substances, including alcohol, amphetamines, cocaine, heroin, inhalants ^* , LSD, marijuana ^* ,

morphine ^* , tobacco, PCP, and sedatives ^* , just to name a few commonly abused drugs.

Marijuana addiction

Some people believe that marijuana use is relatively safe, because it does not lead to addiction. However, regular marijuana users may become psychologically dependent on the drug. Some longtime, heavy users also can experience mild signs of physical dependence, including tolerance and withdrawal. Some studies suggest that marijuana affects the brain's reward system in much the same way as other addictive drugs.

Alcohol addiction

Alcoholism (AL-ko-hall-i-zm) is the common name for an addiction to alcohol. Some people with alcoholism develop a tolerance that lets them drink large amounts of alcohol without seeming drunk or passing out. Others have nasty withdrawal symptoms if they stop drinking. Delirium tremens (de-LEER-ee-um TRE-munz) is the name given to the most severe withdrawal symptoms seen in people who have alcoholism. These symptoms include confusion, disordered thoughts, and hallucinations ^* .

Tobacco addiction

Cigarette smoking is a very tough habit to overcome. This is because tobacco contains nicotine, a highly addictive substance that is added to tobacco when it is made into cigarettes. Smokers can build up a tolerance for nicotine, as shown by the fact that most smokers work up to smoking at least a pack a day by the age of 25. They also go through withdrawal when they are unable to smoke, which explains why many smokers rush to light up as soon as they leave a place where smoking is not allowed.

Caffeine addiction

Among the most widely used mind-altering chemicals in the world is caffeine (ka-FEEN), a substance found in coffee, tea, colas, and many nonprescription medicines. It is no accident that coffee, a potent source of caffeine, is the favorite wake-up drink in so many homes. People often use caffeine for the temporary surge of energy it produces, much like the "buzz" that comes from some other drugs. Owing to tolerance, however, it eventually takes more and more caffeine to get this feeling. When daily coffee drinkers stop using caffeine, they may have withdrawal symptoms, such as headaches, fatigue, and irritability.

What Is an Addictive Disorder?

People also may develop harmful behavior patterns that share many of the same traits as dependence on alcohol or other drugs. Such behaviors sometimes are referred to as addictions too. Among the types of behavior that can be taken to an unhealthy extreme are gambling, sexual activity, and Internet use. When people say they have an addiction to gambling, for example, they mean that they have trouble controlling their desire to gamble, even when they experience harmful consequences, such as losing a lot of money.

Experts disagree about whether this kind of out-of-control behavior should be termed an addiction. Many doctors prefer to call it an impulse control disorder. People with an impulse control disorder are unable to curb their urge to do something that is harmful to themselves or others, even though they may try to resist and feel guilty for failing to do so. In everyday conversation, though, people often refer to excessive gambling, sexual behavior, and Internet use as addictions, since people with these problems act much like people who are addicted to alcohol or other drugs. Rather than responding to outside chemicals, however, such people may be responding in part to natural chemicals released inside the brain. Exciting activities, such as gambling and sexual behavior, can trigger the release of brain chemicals that have an arousing effect. This is similar to the effect that people get from taking cocaine or amphetamines.

Gambling addiction

Gambling addiction, also sometimes called pathological (pa-tha-LAH-ji-kal) gambling, refers to out-of-control gambling with harmful consequences. Like people addicted to substances, gambling addicts may need to risk ever-increasing amounts of money to feel the same excitement they got from gambling a small amount at first. They also may become restless or cranky if they try to cut down or stop gambling, which makes it hard for them to quit. The continued gambling causes trouble at home, school, or work. Yet gambling addicts use their habit as a way of escaping problems or feeling better, much the way someone else might use alcohol or drugs. They may find that much of their time is spent thinking about their next bet or scheming to get more money. They also may start lying to friends and family to hide how much they are gambling, or they may need to borrow money to cover their losses. As things get worse, they may even turn to stealing. Despite the problems, such people find it nearly impossible to stop gambling.

Sexual addiction

Sexual feelings and desires are a normal, healthy part of life, but some people take these natural feelings to an unhealthy extreme, to the point where they are unable to control their sexual thoughts or behavior. Some people might spend hour after hour looking at pornography ^* , while others might have casual sex with partner after partner. In either case, there can be serious negative consequences. People who spend too much time looking at sexual pictures or videos may lose friends or drop out of other activities. Those who have numerous sex partners risk an unwanted pregnancy or a sexually transmitted disease (an infection, such as herpes or HIV, that can be passed from person to person by sexual contact).

Internet addiction

A new problem in the computer age is seen among people who are unable to control their on-line behavior. Some people feel driven to "surf websites or play computer games for hours on end, to the point where they lose interest in off-line activities. Others spend so much time "chatting" with on-line buddies that they have no time for real-world friends. Still others who already have trouble controlling their desire to gamble or look at pornography spend a lot of time at websites that cater to their frequent, strong cravings.

What Are the Signs of a Drug Addiction?

It is not always easy to tell when someone is suffering from an alcohol or drug addiction, since the person may go to great lengths to hide the problem. Nonetheless, there are usually signs that something is terribly wrong. Typical warning signs in young people include:

• getting drunk or high on a regular basis
• having to use more alcohol or drugs to get the same effect
• wanting to quit but being unable to do so
• lying about or hiding the alcohol or drug use
• avoiding friends in order to get drunk or high
• giving up other activities, such as homework or sports
• pressuring others to drink or use drugs
• taking risks, including having unsafe sex
• driving under the influence of alcohol or drugs
• getting into trouble with the law
• being kicked out of school for a reason related to alcohol or drugs
• thinking that the only way to have fun is to drink or use drugs
• being unable to remember actions the night before while drunk or high
• feeling run-down, hopeless, or depressed.

What Are the Signs of an Addictive Disorder?

People with an addictive disorder may act much like those with alcohol or drug addiction. Typical warning signs include:

• taking part in the behavior more often or intensely than intended
• having to increase the behavior to get the same effect
• wanting to quit but being unable to do so
• feeling restless or cranky if the behavior stops
• continuing the behavior despite knowing that it causes real problems
• giving up other activities, such as homework or sports
• thinking about or planning for the behavior all the time
• spending a lot of time on the behavior and its aftereffects.

How Is an Addiction Diagnosed and Treated?

An addiction is a tough problem to beat, but it can be done. The first step is to seek professional help. To make a diagnosis, a physician or mental health professional, such as a psychologist, social worker, or counselor, will ask the person about past and present alcohol and drug use. If possible, the doctor or mental health professional also will talk to the person's family or friends. In addition, he or she will perform a full medical checkup and may order tests to check for diseases that are more common among addicts. For example, a person who injects drugs might be tested for HIV infection, which can be contracted by sharing needles with an infected person.

Once a diagnosis has been made, there are several treatment options. Medications can help control drug cravings and relieve withdrawal symptoms. These are not the same kinds of drugs that are involved in the addiction but rather medications that help lessen the addiction problem. Talk therapy can help people with addictions understand their own behavior, develop higher self-esteem, and cope better with stress. For most people, a combination of medication and talk therapy works best. Talk therapy can be done one-on-one with a therapist or in a group.

Many people do quite well being treated at a clinic while living at home, but others may need to spend a short time in a hospital. This is especially true if they have other mental disorders, are not motivated to change, have friends who still use alcohol or drugs, or have failed in past treatment efforts. Peer group self-help programs, such as Alcoholics Anonymous or Narcotics Anonymous, have become cornerstones of treatment for addiction problems.

Medications

Some medications block the effects of addictive drugs and relieve withdrawal symptoms. For example, methadone (METH-a-don) is a medication used to treat heroin withdrawal, while naltrexone (nal-TREK-zone) blocks the effects of heroin and related drugs. Other medications discourage the use of addictive drugs. For example, disulfiram (dy-SUL-fi-ram) works against alcohol use by causing severe nausea and other unpleasant symptoms when a person drinks alcohol.

Talk therapy

Several kinds of talk therapy (psychotherapy) are used to treat addiction. Cognitive (COG-ni-tiv) therapy targets the faulty thinking patterns that lead to alcohol and drug use. For example, people who think that alcohol protects them from pain may be helped to recognize the pain alcohol has caused them (such as loss of friends, work, self-esteem). People who use drinking as the only way to cope with problems may be helped to identify other ways to cope with problems. They are then helped to reconsider their old beliefs that alcohol is the only way to cope, and that drinking protects them from pain. By discovering that old beliefs are false, it is possible for them to decide what beliefs are more accurate. In this way, with time and effort, thinking patterns and false beliefs can change. Behavioral (bee-HAV-yor-al) therapy takes aim at negative forms of behavior, often by using a system of rewards and punishments to replace harmful behaviors with more positive ones. A teenager, for example, might get movie tickets for having a drug-free urine sample or lose the privilege of driving the car as a result of a setback. Behavioral therapy may also focus on identifying behaviors that keep a drug or alcohol problem in place (such as going to bars for recreation or spending time with friends who drink) and choosing behaviors that help beat the problem (going to the gym instead of a bar). Family therapy works on problems at home that may play a role in alcohol or drug abuse, such as conflict between family members. Family members may be taught to communicate better, or to solve problems more effectively.

Self-help groups

Self-help groups can be very helpful to people who are trying to deal with an addiction and to their family members. Many are 12-step groups, patterned on the 12 steps that are the guiding principles of Alcoholics Anonymous. Those who attend group meetings receive personal support from other people who are fighting the same addiction and winning.