John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH).
An addiction is a disorder characterized by the compulsive use of a rewarding substance or activity despite experiencing adverse consequences. This complex condition is influenced by a person’s genes and their environment and is often considered a brain disease.
In the past, addiction was thought to only encompass substance abuse, but the definition has been expanded to include activities like gambling as well as gaming and shopping. It’s also important to note that addiction is about the underlying neurology of the brain and not about the outward behaviors. With appropriate treatment, people with addictions can go on to live happy, healthy lives.
Addiction is a treatable, chronic disease that affects the brain’s reward, motivation, memory, and related circuitry. Once the brain’s reward system has been impacted by the addictive substance or activity, it can trigger a behavioral and biological response that promotes repeated engagement in the addictive behavior despite harmful consequences.
People engage in potentially addictive activities to feel pleasure, and over time, the reinforcing effect of these activities may change brain chemistry to create an unconscious drive to continue the behavior. Multiple factors influence this process, including genetics, diet, mental health, past traumas, pain, stress, and stage of life.
The first step in overcoming addiction is to desire change and avoid the people, places and things which promote the addiction. Support groups, mentors, and 12 step programs provide help, while counselors, recovery centers, and physicians provide expertise and medication to treat cravings and the effects of withdrawal. Eating healthy and getting exercise also play an important role in recovery.
A person's genetics account for about half of their risk for developing an addiction. The impact of genetics is influenced by an interaction between a person's environment, diet, and biology. Alcoholism, like other addictions, tends to run in families, and members of those families are at increased risk for developing alcoholism.
Substance use disorders are psychiatric conditions that involve the compulsion to use a drug or alcohol despite the development of adverse consequences. A substance abuse disorder diagnosis can be categorized as mild, moderate, or severe, depending on the number of diagnostic symptoms or criteria a person exhibits.
A behavioral addiction occurs when a pleasurable activity changes the brain and drives a person to engage compulsively in the activity despite harmful consequences. People can become addicted to activities like gambling, gaming, shopping, pornography, and even exercise. In some cases, people can experience withdrawal when they stop the behavior.
An intervention is one of several strategies used to persuade an addicted person to get help for their addiction. Interventions are an organized attempt by family members or friends to confront a loved one about how their addictive behavior has affected them. Although commonly used, data on their effectiveness is lacking.
Comorbidity refers to the presence of more than one distinct condition in an individual. A common example is when someone with a mental illness also has a substance use disorder. Neither condition causes the other, and successful treatment will often address both conditions at the same time. Comorbidity is associated with worse health outcomes and complex clinical management.
National Institute on Drug Addiction. Understanding drug use and addiction. Updated June 2018.