What Is Drug Addiction?

The Pathological Pursuit of Rewards

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Question: What Is Drug Addiction?

Answer: Drug addiction has been characterized by the National Institute on Drug Abuse as a complex and chronic brain disease.

People who have a drug addiction experience compulsive, sometimes uncontrollable, craving for their drug of choice. Typically, they will continue to seek and use drugs in spite of experiencing extremely negative consequences as a result of using.

Characteristics of Addiction

According to the American Society of Addiction Medicine (ASAM), addiction is characterized by:

  • Inability to consistently Abstain
  • Impairment in Behavioral control
  • Craving; or increased “hunger” for drugs or rewarding experiences
  • Diminished recognition of significant problems with one’s behaviors and interpersonal relationships
  • A dysfunctional Emotional response

Although the above five characteristics are usually present in most cases of addiction, ASAM noted that these five features cannot be used to diagnose addiction. "The diagnosis of addiction requires a comprehensive biological, psychological, social and spiritual assessment by a trained and certified professional," ASAM's website says.

Behavioral Manifestations of Addiction

When friends and family members are dealing with a loved one who is addicted, it is usually the outward behaviors of the addicted person that are the obvious symptoms of addiction.

Those behaviors are primarily centered around the addict's impaired control:

  • Excessive frequency of drug use in spite of attempts to control
  • Increased time using or recovering from drug effects
  • Continued use in spite of persistent problems
  • A narrowing of focus on rewards linked to addiction
  • An inability to take steps to address the problems

    The Inability to Abstain

    Research has shown that prolonged drug use causes a chemical change in the brain of the addict that alters the brain's reward system that prompts compulsive drug seeking in the face of growing negative consequences.

    This state of addiction, when the activity continues in spite of negative consequences and despite the fact it is no longer rewarding, is termed by addiction experts the "pathological pursuit of rewards." It is the result of chemical changes in the reward circuitry of the brain.

    How Addiction Gets Started

    The reason that people engage in activity that can become addictive in the first place is either to achieve a feeling of euphoria or to relieve an emotional state of dysphoria - discomfort, dissatisfaction, anxiety or restlessness. When they drink, take drugs or participate in other reward-seeking behavior - such as gambling, eating or having sex - they experience a "high" that gives them the reward or relief they are seeking.

    This high is the result of increased dopamine and opioid peptide activity in the brain's reward circuits. But after the high they experience, there is a neurochemical rebound which causes the reward function of the brain to drop below the original normal level.

    When the activity is repeated, the same level of euphoria or relief is not achieved.

    Simply put, the person never really gets as high as they did that first time.

    Lower Highs and Lower Lows

    Added to the fact that the addict develops a tolerance to the high - requiring more to try to achieve the same level of euphoria - is the fact that the person does not develop a tolerance to the emotional low they feel afterward. Rather than return to "normal," they revert to a deeper state of dysphoria.

    For those who have become addicted, they increase the amount of drugs they take, alcohol they drink or increase the frequency of other addictive behaviors in an effort to get back to that initial euphoric state, but in fact end up experiencing a deeper and deeper low as the brain's reward circuitry reacts to the cycle of intoxication and withdrawal.

    When Reward-Seeking Becomes Pathological

    According to the American Society of Addiction Medicine (ASAM), this is the point at which the pursuit of rewards becomes pathological:

    • Reward-seeking becomes compulsive or impulsive.
    • The behavior ceases to be pleasurable.
    • The behavior no longer provides relief.

    No Longer a Function of Choice

    To put it another way, the addicted person finds themselves compelled - despite their own intentions to stop - to repeat behaviors that are no longer rewarding to try to escape an overwhelming feeling of being ill at ease but find no relief.

    According to ASAM, at this point addiction is no longer solely a function of choice. Consequently, the state of addiction is a miserable place to be, for the addict and for those around them.

    Chronic Disease, Relapses

    Also, according to ASAM, "Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death."

    For many addicts, addiction can become a chronic illness, meaning that they can have relapses similar to relapses than can happen with other chronic diseases - such as diabetes, asthma and hypertension - when patients fail to comply with their treatment.

    These relapses can occur even after long periods of abstinence.

    Do you think you may be addicted? Take the Drug Abuse Screening Quiz

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    Sources:

    American Society of Addiction Medicine. "The Definition of Addiction (Long Version). 15 August 2011.

    American Society of Addiction Medicine. "Definition Of Addiction: Frequently Asked Questions (PDF)," 15 August 2011.

    National Institute on Drug Abuse. "Frequently Asked Questions." The Science of Drug Abuse and Addiction. Accessed February 2014

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