Many people assume that becoming addicted to drugs or alcohol is a matter of choice – a decision to continue chronic, habitual use of a substance. However, the process of chemical dependency and addiction is actually a physical and psychological condition that develops through continued use of drugs and becomes a true psychological and physical disorder, similar in character to other chronic disorders like asthma or diabetes, as described by the Journal of the American Medical Association.
One source of the confusion may be that many people believe that, because addiction is classified as a psychological disorder, it is a matter of willpower or “mind over matter.” However, this is a misunderstanding of how a mental health disorder such as addiction works. In other words, addiction is both physical and psychological. In fact, as described by an article from Psychology Today, the psychological aspects of addiction are part of and paired with the physical effects that addictive substances have on the brain and body.
Ultimately, a number of circumstances come together to create the risk that a person will become addicted to a substance:
- Addictive tendencies of the individual
- Addictive potential of the substance
- Regular use
- Dependency or addiction
Understanding how each of these elements contributes to the development of addiction or chemical dependency provides a more thorough, nuanced understanding of addiction in general and what types of treatments are most likely to help.
1. Addictive Tendencies of the Individual
The first and possibly most important element of addiction is the individual’s potential to become addicted. There are a number of reasons that a person might be at increased risk of developing addiction to substances based on biological, environmental, and developmental factors, including:
- Individual genetics
- Family history of substance abuse
- History of other mental health disorders
- Social relationships and peer pressure
- Stress or life pressures
- Age when starting to use a substance
All of these elements can affect the susceptibility of an individual’s brain chemistry to alteration through addictive substances, and combining multiple factors creates a higher risk of addiction. As an example, a study from Clinical Pharmacology & Therapeutics explains that certain genetic patterns will change brain chemistry in areas that govern pleasure and reward responses, such as the dopamine system. On the other hand, a person might not even start using a drug unless stress, self-treatment of other mental health disorders, or high levels of stress come into play, making the idea of using drugs more palatable to the individual.
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2. Addictive Potential of the Substance
Contributing to the individual’s tendency to become addicted is how addictive the substance is. Substances that interact with the brain’s pleasure and reward systems, as described above, certainly contribute to the potential that the person’s tendencies toward drug abuse will be activated. To continue our example above, most well-known substances of abuse interact with the dopamine system, as described in an article from Big Think.
This potential to interact with the dopamine system can include all drug categories, including:
- Nervous system depressants like alcohol, opiates, or benzodiazepines (benzos)
- Nervous system stimulants like cocaine or methamphetamine
- Hallucinogens like LSD or PCP
- Marijuana, bath salts, and a wide range of other drug types
Depending on the drug, it may interact with brain chemistry regulating memory, sensory perception, pain perception, and other areas that can be altered by the drug and affect the individual’s potential to become addicted.
Along with these first two aspects, the next aspects that determine the development of addiction are considered to be the four stages of drug abuse that lead to developing addiction. As described by the mental health website HelpGuide, this can almost be described as a “learning process” through which the brain becomes dependent on a substance.
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For the most part, the first time an individual uses a drug does not lead directly to addiction. However, it sets the stage for the chemical reactions in the brain that can lead to the later steps. There are exceptions to this rule, such as methamphetamine, which can create a severe response in the brain on first use, leading to the cravings and chemical dependency that characterize addiction.
Often, this experimentation stage starts in adolescence. As described by the National Institute on Drug Abuse (NIDA), there are many reasons that people might experiment with drugs as teenagers, including:
- Peer pressure or perceived social acceptance
- Increased athletic or intellectual performance
- Self-medication for depression, anxiety, and other mental health disorders
The adolescent brain is particularly susceptible to addiction because it is still developing and drugs can have a more profound effect. Still, sometimes adults will experiment with drugs for similar reasons, along with others, and develop addiction as well.
4. Regular Use
Some people who have a low risk of addiction may not proceed to this stage; however, many people, once they have experienced drug-induced euphoria for the first time, want to try it again. Perhaps the drugs come out every time they get together with certain friends. Or maybe continued struggles in school or on the team lead to repeated use of drugs taken for performance enhancement. Whatever the reason, the individual begins taking the substance more regularly, creating a repeated response in the brain.
As the drugs bind to the chemical receptors in the brain, something else starts to happen: The brain begins to get used to having the substance provided and may begin to signal the body to produce less of the substance naturally. The brain may even decrease the number of receptors that are able to take in that substance. As a result, the body responds by craving more intake of the drug, as described by Merck Manual.
This reaction is referred to as “tolerance.” The basic definition of tolerance is the point at which more of the drug is needed in order to create the same physical response that was previously achieved with less. Tolerance is a major turning point in the development of addiction.
Again, some people are able to develop tolerance without developing addiction. However, tolerance quite often leads to the person responding to the body’s call for more of the substance by increasing the dosage taken or taking the drug more often.
As described by Addict Science, this behavior creates a feedback loop; the person takes more of the substance, which increases tolerance, so the person takes more again, increasing tolerance further. At a certain point, the cravings are also counterbalanced by withdrawal symptoms whenever the person tries to stop using the drug, a result of physical or psychological dependence. Because the body isn’t producing enough of the natural chemical and the receptors aren’t reacting as well, if drug use is stopped, extreme discomfort can occur that counters the pleasure and comfort that the drug brings. The individual then discovers a need to take the drug, not just for the original desire to feel good, but to avoid feeling bad.
Before the person is aware, chemical dependency and compulsive drug use have begun, creating the downward spiral to addiction.
6. Dependency and Addiction
Addiction leads the individual to have a physical and psychological dependence on the drug to feel good or to be able to function normally. As explained by the American Society of Addiction Medicine, addiction itself is chronic disorder of the brain’s reward, memory, and motivation systems that changes an individual’s behaviors to focus around seeking and using drugs.
Addiction is characterized mainly by the person’s changes in behavior that focus on drug use, even when the negative effects of use are creating consequences in the person’s life. These include:
- Problems in relationships
- Trouble keeping up at work or school
- Financial difficulties
- Problems with the law
- Physical injury due to drug use or risk-taking behaviors during drug use
Because the person can’t stop using the drugs even in the face of these problems, help is needed to enable the person to learn how to stop using the drugs.
As mentioned above, addiction is a chronic condition like asthma, which, once developed, must be managed throughout a person’s life. However, also like asthma, addiction can be treated, and various therapies can help a person recover from addiction and lead a healthier, more productive life. With motivation, support, and hope, work with an accredited rehab facility that uses research-based treatments can create these conditions for a person struggling with addiction, making it possible to get control again and enjoy a healthier future.