Addiction

Addiction Definition

Addiction is when an individual cannot stop engaging in an activity they find pleasurable, and involves tolerance and withdrawal symptoms alongside dependence (both physical and psychological). There are many types of addiction, but at its core, it is when a person is unable to stop engaging in their addiction even though it is causing them and others harm; they have become dependent on the object of their addiction.

There are some concepts within the topic of addiction that we will clarify below, including kinds of dependence, tolerance, withdrawal syndrome and some risk factors for addiction.

Addiction can form as a psychological dependence and/or a physical dependence on a substance or behaviour.

Tolerance

A person becomes tolerant of something when they are physically dependent on it to achieve a sense of normality. They engage in the object of addiction so often that it no longer has the same effect. As a result, they increase their 'dosage' to achieve the same effect.

Withdrawal Syndrome

Withdrawal symptoms refer to the physical symptoms that someone experiences when they either reduce or stop partaking in the object of their addiction. They include but are not limited to, anxiety, insomnia, nausea and body aches. Withdrawal symptoms differ depending on the drug or behaviour.

Risk Factors for Addiction

Risk factors are things that might make someone more vulnerable to developing an addiction. They could be lone factors, but often addiction results in a combination of several. Risk factors for addiction could include:

• Stress - Continually using substances as a form of stress relief could lead to an addiction, and stressful situations are a risk factor.
• Genetic factors - Addictive behaviour tendencies can possibly be inherited in family genes.
• Family influences - Growing up in an environment that normalises heavy substance use or addictive behaviour.
• Peer group influences - Including peer pressure to engage in risky behaviours that could lead to addiction.

Fig. 2 - Family and peer influence can be a risk factor for addiction.

Types of Addiction

There are multiple types of addiction. In this section, we will look at two specific types of addiction, however: nicotine addiction and gambling addiction. We will look at how different approaches explain these addictions and how we can treat them.

How can we Define and Explain Nicotine Addiction?

Nicotine addiction is when someone is addicted to nicotine, through smoking cigarettes or chewing tobacco. Specifically, the DSM 5 defines nicotine addiction as:

1. Unsuccessful efforts to quit or reduce intake of tobacco
2. Cravings for Tobacco
3. Failure to attend to responsibilities and obligations due to tobacco use
4. Continued use despite adverse social or interpersonal consequences

Biological Explanations for Nicotine Addictions

Biological explanations of addiction centre around the brain's mesolimbic system, or reward system. The components of this system that influence addiction are:

• The prefrontal cortex
• The ventral tegmental area
• The nucleus accumbens
• Dopamine (mesolimbic dopamine pathway)
• The opioid system
• Neuroadaptation

Specifically, these systems regulate desensitisation, conditioning (reward systems), tolerance and changes within the brain which can all contribute to addiction. Notably, serotonin is also involved in the control of impulsiveness (control lowers impulses to engage in risky behaviours).

The Learning Theory Explanation for Nicotine Addictions

Learning theory explains nicotine addiction through conditioning. A person with nicotine addiction is not only rewarded with the pleasure of smoking a cigarette but may develop cue-reactivity, wherein objects associated with smoking trigger their addiction, e.g. a lighter.

Fig. 3 - Smoking can lead to nicotine addiction.

How can we Define and Explain Gambling Addiction?

Gambling addiction is when someone is addicted to gambling. DSM 5 considers gambling to be a problematic disorder, leading to significant distress characterised by:

1. A preoccupation with gambling behaviour.
2. Repeated and unsuccessful attempts to stop.
3. Continuing the habit despite losses and other costs.

Gambling addiction could take many forms, from betting on sporting events to playing poker and slot machines. When someone is addicted to gambling there are a few approaches that could explain their behaviour, but in this section, we will explore learning theory, the cognitive approach and cognitive bias.

Learning Theory in Gambling

Learning theory explains gambling in terms of operant and classical conditioning. When the gambler wins they are rewarded, reinforcing their gambling behaviour. Although it is true that gambling is not reinforced every time someone gambles, the thrill and risk of placing a bet are, therefore, this uncertainty reinforces addiction.

Cognitive Theory in Gambling

The cognitive theory explains gambling in terms of irrational thoughts, including reasoning and cognitive bias such as illusions of control (a belief that the gambler can influence the outcome of their bet) and gambler’s fallacy (a belief that after a losing streak, a win is certain). Gambling can also be seen as a coping mechanism and distraction.

Cognitive Bias in Gambling

Cognitive bias is a thinking error that affects people's judgement, it occurs when people try to justify bad decisions in order to carry on repeating the behaviour. In gambling addiction this can include instances of focusing on nearly winning or only winning (rather than all the times lost), making people believe that they are more likely to win if they carry on gambling because they have won before.

Drug Addiction

The DSM 5 criteria for drug addiction is listed as 'substance-related and addictive disorders', including drugs such as alcohol, nicotine, caffeine, opioids, hallucinogenic, stimulants and cannabis. Drug addiction is categorised as:

There are multiple ways to treat drug addictions, and this is seen through addressing the biological and psychological needs of the individual.

Biological Treatments for Drug Addiction

Biological treatments for drug addiction usually involve drug therapy. There are three main types of drugs that might be used:

1. Aversive: drugs that create a negative reaction to the object of addiction e.g., vomiting after using a substance.
2. Agonist: a less harmful replacement for the object of addiction. These allow the sufferer to slowly withdraw from their addiction.
3. Antagonist: these block the effects of the object of addiction e.g., you won’t get a pleasurable feeling after using a substance.

Fig. 4 - Drug therapy can help in the treatment of addiction.

Behavioural Treatment for Drug Addiction

The common behavioural treatment for addiction is aversion therapy. Aversion therapy involves replacing the positive association the sufferer has with their addiction with a negative or aversive association.

Covert sensitisation is an alternative behavioural treatment for addiction. Covert sensitisation involves the same process as aversion therapy but the sufferer simply imagines the association rather than experiencing the aversive stimulus.

Cognitive Treatment for Drug Addiction

Cognitive behavioural therapy (CBT) is used as a cognitive treatment for addiction. It is based on the idea that addiction is caused by faulty thought processes, so if someone changes the way they think about their addiction, they can also break their addictive behaviour. The therapy (CBT) aims to allow people to recognise situations in which they turn to their addiction to replace their addiction with positive behaviour.

Alcohol Addiction

Alcohol addiction is categorised in the DSM 5 within the substance-related and addictive disorders, with the compulsive behaviour and related treatment being related to alcohol and personalised towards the individual seeking help. This again can include a mix of biological, behavioural and cognitive treatment.

Biological Treatment for Alcohol Addiction

Drug therapy treatments for alcohol addiction can include any of the same treatments listed in the drug addiction section (aversive, agonist, antagonist).

An example of an antagonist drug usually used in the treatment of alcohol addiction is naltrexone, which blocks the pleasurable effects of drinking alcohol, potentially making it easier to stop drinking as there are no positive effects felt anymore.

Behavioural Treatment for Alcohol Addiction

Drug therapy can overlap with behavioural treatment for alcohol addiction. Aversive drugs taken when drinking alcohol can cause severe nausea and sickness, which creates negative associations with the substance. This is a form of aversion therapy.

Cognitive Treatment for Alcohol Addiction

Cognitive Behavioural Therapy (CBT) is also recommended during the alcohol addiction treatment process. CBT is effective for the treatment of anxiety and depression, which are disorders and symptoms which may co-exist in someone with alcohol addiction.

CBT and other psychological treatments/talking therapies allow safe spaces for people to explore their harmful thoughts, beliefs and behaviours without judgement. This can aid in an individual's recovery and prevent relapse.

Addictive Personality

As mentioned when discussing risk factors for addiction, there are several things that can influence the development of addictive behaviour. Not necessarily having an addictive personality type, but genetic and environmental vulnerabilities or stressors that risky or pleasurable behaviour is used as a coping mechanism to manage.

There are a few theories on how to manage addictive behaviour that are not initially tailored towards a specific substance or behaviour and can be adapted based on the needs of the individual.

Theory of Planned Behaviour

This theory was a development of Ajzen and Fienbein's (1970) theory of reasoned action. Ajzen (1989) proposed that behaviour is controlled by intentions which are influenced by various factors:

• The individual’s subjective norms (how they think others would view their behaviour)
• Perceived behavioural concerns (how much they think they can perform the behaviour)
• Personal attitudes (a person’s own attitudes towards their addiction)

The theory states that behaviour can be changed by creating different attitudes towards addiction. This is achieved by showing the sufferer data about how many people engage in risky behaviour. This will give the sufferer the willpower to change their behaviour.

Prochaska (1997)’s Six-stage Model of Behaviour Change

This model describes the six stages of behavioural change which can help a person overcome addiction. They are as follows:

1. The pre-contemplation stage - no intentions of changing.
2. The contemplation stage - aware of problematic behaviour but won't change.
3. The preparation stage - willing to make small changes.
4. The action stage - makes active changes.
5. The maintenance stage - working to stay in recovery and not relapse.
6. The relapse stage - engagement with addictive behaviours again after successfully not engaging with behaviours.