How addiction works
Addiction is a complex disease, but nearly a century of scientific study has helped researchers come to a deeper understanding of how it works.
This research has culminated in an important change in how we talk about addiction: Addiction is now classified as a disease that affects the brain, not a personal failing or choice.
Most people think of substance use when they hear about addiction, but that’s not the only type of addiction.
Research Trusted Source suggests that addictions to substances work similarly to patterns of compulsive behavior, like gambling or shopping.
Today, most experts recognize two types of addiction:
- Chemical addiction. This refers to addiction that involves the use of substances.
- Behavioral addiction. This refers to addiction that involves compulsive behaviors. These are persistent, repeated behaviors that you carry out even if they don’t offer any real benefit.
Before getting into the different types of addiction, it’s helpful to understand a few general elements of addiction.
The reward system
Addiction interferes with normal brain function, particularly in the reward system.
When you do something you find enjoyable, whether that’s hanging out with your best friend, drinking a bottle of wine, or using cocaine, this reward system releases the neurotransmitter dopamine along with other chemicals.
Contrary to popular belief, dopamine doesn’t appear to actually cause feelings of pleasure or euphoria. Instead, it seems to reinforce your brain’s association between certain things and feelings of pleasure, driving you to seek those things out again in the future.
Cravings and tolerance
The desire to experience this euphoria again can trigger cravings for the substance or behavior, especially when you encounter the same cues (like a party where people are drinking, for example). These cravings often serve as the first sign of addiction.
As you continue using a substance or engaging in a behavior, your brain continues to produce larger amounts of dopamine. Eventually, it recognizes that there’s plenty of dopamine in your brain already and starts producing less in response to normal triggers.
There’s one problem, though: Your brain’s reward system still needs the same amount of dopamine to function as it should.
Before long, you need to use more of the substance to make up for what your brain isn’t releasing. This effect is called tolerance.
Disinterest in other activities
As addiction develops, it’s common to lose interest in hobbies and other things you once enjoyed.
This happens because your brain no longer produces much dopamine in response to natural triggers, like having sex or making art.
Even when you want to stop using a substance or engaging in a behavior, you might feel like you still need them in order to feel good about anything.
Loss of control
Addiction usually involves an inability to control substance use or specific behaviors. This can result in job loss, health issues, and relationship concerns, among other things.
In response, you might decide to quit the substance or behavior, only to find that you keep falling short, despite your best efforts.
Chemical addiction can be tricky to talk about because there’s often confusion around what constitutes substance misuse, dependency, and addiction.
This is partly why the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recommends using the term “substance use disorder.” This classification includes more diagnostic criteria to help healthcare professionals differentiate between mild, moderate, and severe cases.
Many experts also prefer it because it avoids terms like “abuse,” which can further stigmatize addiction and prevent people from seeking help.
Common symptoms of substance use disorder include:
- cravings intense enough to affect your ability to think about other things
- a need to use more of the substance to experience the same effects
- unease or discomfort if you can’t easily access the substance
- risky substance use, like driving or working while using it
- trouble managing work, school, or household responsibilities because of substance use
- friendship or relationship difficulties related to substance use
- spending less time on activities you used to enjoy
- an inability to stop using the substance
- withdrawal symptoms when you try to quit
Some of the more common addictive substances include:
- opioids, including both heroin as well as prescription pain medication like oxycodone and morphine