ADDICTION

DEFINITION

Addiction is a dependence on a substance, such as the drug heroin, or a type of behavior, such as gambling. The dependence is so strong that it may seem as if the person is unable to break away from the dependence.

DESCRIPTION

At one time, the term "addiction" was used almost exclusively for substance addiction. That is, addicts were thought of as people who were totally dependent on drugs such as heroin, cocaine, nicotine, or alcohol. That form of addiction is now known as "substance addiction."

Experts also recognize that people can become addicted to certain behaviors. Some individuals may develop a dependence on gambling, shopping, sexual activity, eating, or many other activities. Addictions of this kind are sometimes called "process addictions."

The costs associated with addiction cannot be calculated. They go beyond the actual dollar amount that individuals spend. Addictions cause enormous personal harm to not only the addict, but to their families and friends as well. People who become addicted to drugs may develop any number of health problems. They may also experience personality changes and lose the ability to interact with other people socially.

Addicts may have trouble staying in school or holding a job. If they do hold a job, they may pose a certain risk to their co-workers, to their customers, and to any individuals with whom they interact. For example, a truck driver who is addicted to alcohol may pose a serious safety threat to other drivers on the road.

Addiction is also responsible for a host of societal problems. Because many addictions are very expensive, addicts may turn to crime in order to get the money they need. The business of providing addicts with the substances and activities they require has become a huge enterprise. Casino operators, tobacco and alcohol companies, and other operations are kept in steady business.

CAUSES

Addiction is a very complex behavior. Humans have been trying to understand its causes for many years. At one time, moral weakness was accepted as the primary reason for addiction. According to this theory, some people do not have the moral strength to withstand an addiction. Although still believed by some members of the general public, this theory is no longer accepted by professionals.

Today, researchers understand that a variety of factors can contribute to making a person an addict. Many events in a person's background may

An opium addict peals gauze off an infected sore, caused by injecting opium up to ten times a day. (Reproduced by permission of

AP/Wide World Photos

)

lead him or her to begin using addictive substances. Some of these events include:

• Use of illegal substances by family members and friends.
• Poor family upbringing where love, warmth, praise, and acceptance are lacking.
• Lack of direction from the family about the proper ways to get along with others.
• Poverty, poor living conditions, or isolation from other people.
• Failure in school.
• Failure to develop the ability to get along with peers.
• Growing up in a neighborhood in which drug use is common and widely accepted.
• Frequent family moves to new homes.
• Medical use of prescription drugs for legitimate reasons. For example, a doctor may prescribe a drug to an individual suffering from back pain. While the drug is intended to alleviate the pain, it may also contain some addictive side effects. Such drug use is carefully monitored by the physician, but it is also up to the patient to use the drug only as prescribed.

Addictions grow stronger over time for two reasons. First, a person's body may become biologically dependent on the substance or behavior. That is, the body may begin to need and expect that it will receive a certain substance each day or each hour. If it does not receive that substance, it responds by becoming ill. When this happens, the person is said to be physiologically dependent on the substance or activity.

This explanation has been used for addictive behavior as well as addictive substances. Some types of behavior cause a person to become very excited. Their body chemistry may actually

Counseling is often used to help people overcome their addictions. Both individual and group counseling are common treatments for addiction. (© 1994

Joseph R. Siebert

, Ph.D. Reproduced by permission of

Custom Medical Stock Photo

.)

change as they win a jackpot or make another sexual conquest. Over time, body chemistry may demand repetition of the activities that produced this level of excitement.

People can also become psychologically addicted to substances and activities. That is, the substance or activity makes them feel happy, more self-confident, or better in some other way. In order to keep experiencing these feelings, they believe they must continue to use the substance or activity that gave them these feelings. In this case, a person is said to be psychologically dependent. In many cases, addictions involve both physiological and psychological aspects.

SYMPTOMS

All forms of addictions have some common symptoms, including:

• Loss of control. Addicts are unable to manage their behavior or their use of a substance. They may decide to quit the behavior or using the substance one day and then fall back into the habit the next day.
• Tolerance. In most forms of addiction, a person needs more and more of the substance or behavior over time. Early in an addiction, a person may need only one "hit" of heroin a day. A few months later, he or she may need two, six, or a dozen "hits" to get the same response.
• Impairment. Addicts often continue to use a substance or demonstrate a behavior even when they know the undesirable effects it may have. For example, a gambling addict may continue to wager money even though he or she has lost everything in previous gambling experiences.

DIAGNOSIS

Diagnosis of an addiction may be made by a medical doctor or by a mental health professional. Often, patients go for help because they feel they can no longer deal with their addictive behavior by themselves. Sometimes family or friends intervene and bring the patient for diagnosis and treatment. In some cases, individuals are brought to the attention of professionals because of legal problems related to their addiction.

The standards used for diagnosing addiction include the three symptoms listed under Symptoms. A person who displays these three symptoms is diagnosed as being addicted to some substance or type of behavior.

TREATMENT

There are many treatments available for people who suffer from addiction. These treatments are designed to deal with one or both forms of addiction: physiological and psychological. For example, people who are addicted to certain substances must often go through withdrawal therapy. Withdrawal therapy involves placing patients in a protected area where they are no longer allowed to use and where they have no access to the substance to which they are addicted.

This form of withdrawal therapy is sometimes called "drug detoxification." The term means that the toxins (poisons) in a person's system caused by drug addiction are being removed from the body.

Withdrawal therapy can be very difficult. The person's body may still be expecting its daily ration of the abusive substance. When the substance is not provided, the body may react strongly. Nausea, vomiting, pain, and hallucinations are common side effects of withdrawal therapy. In some cases, patients must be physically restrained to help them get through this period.

Medications are also available for treating addictions. Perhaps the best known example is methadone. Methadone is a chemical that has many properties similar to heroin. For example, it is addictive, just as heroin is. But methadone does not have the narcotic effects of heroin. A narcotic is a substance that dulls the senses and makes a person drowsy and sleepy. People who are addicted to heroin may be treated by giving them methadone instead. Ideally, the methadone treatment can very slowly be reduced until the patient is no longer addicted to either drug.

Various forms of counseling are also used to treat addictions. The theory behind counseling is that people become addicts because of serious problems in their lives. If those problems can be resolved, they may be less inclined to depend on addictive substances or behavior.

In some cases, one-on-one counseling may work best. An addict meets regularly with a trained mental health worker, and the two discuss the patient's life and try to find solutions to problems that may have led to addiction. Group counseling is another option. People with common addictions may meet with a professional counselor to discuss their problems.

Perhaps the best-known examples of group counseling are the so-called 12-step programs. The original 12-step program was Alcoholics Anonymous (AA). The term "12-step" comes from the stages of recovery through which AA members are expected to pass. The AA 12-step model is now used by other groups working to overcome other types of addiction.

Alternative Treatment

Acupuncture (a Chinese therapy technique where fine needles puncture the body) has been used to decrease withdrawal symptoms. Meditation and yoga have been suggested to help control behavior addictions.

PROGNOSIS

The prognosis for addictions is varied. Many factors are involved in determining whether a person can recover from an addiction, including:

• The substance or activity to which a person is addicted
• The reasons for the addiction
• The length of time the addiction has existed
• The patient's desire to be cured of the addiction
• The amount and type of support available to the addict

Medications may be successful in treating the immediate symptoms of some addictions. But recovery is likely to be partial and temporary unless underlying issues that led to the addiction have been resolved.

PREVENTION

One way to prevent addictions is to eliminate the substances and activities to which one may become addicted. One major thrust of the drug prevention program in the United States is to prevent illegal drugs from entering the country. People who support this method of prevention argue that if illegal drugs are not available, people cannot become addicted to them. Similarly, people who are concerned about addictions to gambling argue that legal gambling should not be permitted. They claim that if gambling casinos do not exist, people are less likely to become addicted to them.

Another approach to prevention is to deal with the kinds of problems that lead to addiction. People who grow up in warm, supportive, healthy, financially secure environments may be less likely to become dependant on certain substances and activities to achieve happiness or security. In this regard, improving family structures, home life, and social institutions is an important step in preventing addictions.

See also: Alcoholism.

FOR MORE INFORMATION

Books

Carnes, Patrick. Out of the Shadows: Understanding Sexual Addiction. Center City, MN: Compcare Publications, 1992.

Horvath, A. Thomas, Reid K. Hester, and G. Alan Marlatt. Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions. San Luis Obispo, CA: Impact Publishers, 1999.

Landau, Elaine. Hooked: Talking about Addictions. Brookfield, CT: Millbrook Press, 1995.

Peel, Stanton, and Archie Brodsky, with Mary Arnold. The Truth about Addiction and Recovery. New York: Simon and Schuster, 1991.

Smith, Miriam, et al. Addiction: The 'High' That Brings You Down. Hillsdale, NJ: Enslow Publishers, 1997.

West, James W., and Betty Ford. The Betty Ford Center Book of Answers: Help for Those Struggling with Substance Abuse and for the People Who Love Them. New York: Pocket Books, 1997.

Organizations

Al-Anon Family Groups, PO Box 182, Madison Square Station, New York, NY 10159. http://www.al-anon-alateen.org.

Center for Substance Abuse Prevention, 1010 Wayne Avenue, Suite 850, Silver Springs, MD 20910. (800) 729–6686.

National Institute on Drug Abuse, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201. (301) 443–3673.

Web sites

"About Drug Addiction and Drug Abuse." [Online] http://www.addiction2.com/faq.htm (accessed on October 5, 1999).

"Addiction Resource Guide." [Online] http://www.hubplace.com/addictions (accessed on October 5, 1999).

"Alcoholism/Drug/Teen/Gambling Treatment Information." [Online] http://www.robertperkinson.com (accessed on March 27, 1999).

"Gambling Addiction." [Online] http://addictionrecov.org/addicgam.htm (accessed on March 27, 1999).

The National Center on Addiction and Substance Abuse at Columbia University. [Online] http://www.casacolumbia.org (accessed on June 15, 1999).

The National Clearinghouse for Alcohol and Drug Information. [Online] http://www.health.org (accessed on October 5, 1999).