Addiction is a dependence, on a behavior or substance, that a person is powerless to stop. The term has been partially replaced by the word dependence for substance abuse. Addiction has been extended, however, to include mood-altering behaviors or activities. Some researchers speak of two types of addictions: substance addictions such as alcoholism, drug abuse, and smoking; and process addictions such as gambling, spending, shopping, eating, and sexual activity. Many addicts are addicted to more than one substance or process.

Addiction is one of the most costly public health problems in the United States. It is a progressive syndrome, which means that it becomes a more severe problem over time unless it is treated.

Addiction to substances results from several factors. Some substances are more addictive than others, either because they produce a rapid and intense change in mood; or because they produce painful withdrawal symptoms when stoppedsuddenly. Some people are more likely than others to become addicts because their body chemistry increases their sensitivity to drugs. Some forms of substance abuse and dependence seem to run in families. It is possible that addiction is due to genes, family and social environment, or a combination of both.

Social learning is considered the most important single factor. It includes patterns of use in the addict's family or social environment, peer pressure, and advertising or media influence. Inexpensive or readily available tobacco,alcohol, or drugs produce marked increases in rates of addiction.

Before the 1980s, the so-called addictive personality was used to explain addiction. A person with an addictive personality was described as escapist, impulsive, dependent, devious, manipulative, and self-centered. Many doctors nowbelieve that these traits develop in addicts as a result of the addiction, rather than the traits being a cause of the addiction.

In addition to a preoccupation with using and acquiring the abused substance,the diagnosis of addiction is based on five criteria. Those criteria are a loss of willpower; harmful consequences; unmanageable lifestyle; tolerance orescalation of use; and withdrawal symptoms upon quitting.

Treatment requires both medical and social approaches. Substance addicts mayneed hospital treatment to manage withdrawal symptoms. Individual or group psychotherapy is often helpful, but only after substance use has stopped. Antiaddiction medications, such as methadone and naltrexone, are also commonly used. The most frequently recommended social form of outpatient treatment is twelve-step programs such as Alcoholics Anonymous. Such programs are also frequently combined with psychotherapy. There are twelve-step groups for all majorsubstance and process addictions.

The prognosis for recovery from any addiction depends on the substance or process, the individual's circumstances, and his or her personality. People whoare addicted to several substances or activities have the most difficulty inbreaking their addictions.

The most effective form of prevention appears to be a stable family that models responsible attitudes toward mood-altering substances and behaviors. Prevention education programs are also widely used to inform the public of the harmfulness of substance abuse.

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