Addiction & The Brain
We will examine some of the key factors driving addiction and how it affects the brain. Specifically, we will discuss what addiction is, the environmental risk factors, the biological risk factors, how it progresses, and the way substance abuse affects the brain at a primal level.
What is Addiction?
Drug addiction is a mental health disorder characterized by a compulsion to find and use a drug, lack of control over its use, increasing usage over time, and continued use despite negative consequences, whatever they may be.
Frequency of Addiction
Because of the nature of addiction and the negative societal connotations associated with it, it is difficult to determine the true number of individuals suffering from addiction across the global population. According to a 2017 status report, about 18% of adults globally are chronic alcohol users, 3.8% are chronic marijuana users, and around 1%-1.5% are users of other illicit substances. This amounts to over a hundred million people worldwide suffering from some form of substance use disorder. It is difficult to track accurate numbers, as many people go undiagnosed or deny having present issues.
Addiction As A Moral Failing
For a long time, society considered addiction a moral failing that could be addressed simply by deciding not to use illicit substances. A commonly cited example of this type of thinking is in the 1980s "Just say no" campaign spearheaded by first lady Nancy Regan. While not using a substance does, in fact, ultimately mean just "saying no," there's a lot of underlying mental work that has to be done before a person has the power to say no. The Just Say No campaign, and the entire "war on drugs" it was a part of, ultimately proved ineffective, for reasons that may now seem obvious. If curing addiction was as simple as just saying no, there would be far fewer active addicts.
Although still widely stigmatized, many people now understand that addiction is a severe but treatable mental health condition. It manifests itself in many ways and affects people regardless of socioeconomic status. It is believed that there is a combination of environmental and biological or genetic attributes that factor into a person's chance of becoming an addict.
Addiction Defined Clinically
The Diagnostic and Statistical Manual for Mental Health Disorders, Fifth Edition (DSM-V), published by the American Psychological Association (APA) in 2013, distinctly covers 10 different substance use disorders. Individually, there's Alcohol Use Disorder, Opioid Use Disorder, Stimulant Use Disorder, and Hallucinogen Use Disorder, to name a few. Their diagnostic features are all very much the same, and the way they affect the brain's rewards system is similar. The major difference between each disorder is the individual effects induced by each drug. The addiction part is the same across all of them. The DSM-V states that "the essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems".
There are eleven diagnostic criteria that are common across all the substance use disorders. A few of them only have ten criteria, but it's basically the same. Rather than listing them all individually, here is a summarized version for them all. If you'd like to read the individual criteria, get a copy of the DSM-V. At least two or more of the following should be present to indicate a type of substance use disorder.
- Taking the substance in larger amounts or over a longer period of time than intended
- A constant desire to quit using the substance, or trying to cut back and failing (losing control over substance use)
- Spending a lot of time obtaining a substance, using it, or recovering from its effects
- Cravings or strong desires to use the substance
- Failing to fulfill obligations to work, school, or family as a result of use
- Continuing to use despite problems caused by using
- Giving up or reducing time spent on work, family, fun activities in favor of using
- Repeatedly using in situations where it's physically dangerous (while driving, for example)
- Continuing to use even after becoming aware of the physical and psychological problems resulting from use
- Tolerance - The need to use increasing amounts of the substance and/or use it more frequently. Diminished effect with continued use (having to take more to get the same high)
- Withdrawal - Becoming physically or psychologically sick when the substance is removed
Stages of Addiction
Addiction doesn't happen all at once. There are various stages and models of these stages. Some models have four stages, others have seven, but they all basically start and end in the same place. It usually takes several months or years before addiction fully takes over, but some progress through these stages much more quickly. When people return to drugs after a stint of sobriety, they usually skip past the first stage.
Experimentation & Social Use
Addiction begins with experimentation. Some people experiment with drugs, find they don't like them, and never touch them again. Others may enjoy them, but can use them socially. Examples might include people who have one or two drinks socially at parties, but rarely or never drink to excess. Or people who smoke weed with their friends a few times a month or less, but not every day.
Addiction manifests itself when people use drugs increasingly, such as individuals who binge drink every weekend or start smoking weed every day after work. They may find that they enjoy using the substance more than other people, and are using it to cope with the stressors in their life. Everything just seems better with their substance of choice.
- During this stage, the individual's social circles may start to change.
- They may begin gravitating towards others who also use substances on a more frequent basis, and away from their previous friend groups.
- They may notice that they need to consume more of the substance to get the same effects as before. Their tolerance is building up.
Through increasing use, the user will eventually reach a point where they become physically and/or psychologically dependent on the drug. Their body has adjusted to the substance, and expects it to always be there.
They may need to administer the drug on a frequent, continuous basis in order to just feel normal. Life without the substance becomes almost unimaginable, and the bulk of their time is spent finding and using the substance.
- The user may fail to fulfill work, personal, and family obligations in favor of using.
- They may begin isolating and using by themselves, when they used to only use with others.
- They may surround themselves only with other addicts, to normalize their behavior.
- They no longer have time for the normal or "casual" drug users, as time with them detracts from time that could be spent using.
Through repeated use, the user has conditioned their brain to value the drug as something essential to survival. Substance use may outweigh all other needs, including even family, food, water, and shelter.
Withdrawal symptoms occur when the user goes for a short time without the substance. They can begin as soon as a few hours after the last use. Withdrawal symptoms vary depending on the substance used and how high the user's tolerance is. It usually starts with cravings, or an incessant compulsion to use the drug, which then leads to anxiety and stress. Feeling these early symptoms, many people in active addiction will seek out the drug again to make them go away.
The longer a regular drug user goes without the substance, the more severe the withdrawal symptoms become. For some drugs, like stimulants, the severe withdrawal might look like extreme anxiety and paranoia or hallucinations. For other drugs, like opiates, the withdrawal looks like getting a sudden severe sickness. With alcohol or benzodiazepine withdrawal, severe symptoms include delusions, seizures, and death. These physical withdrawals occurring immediately after cessation of a substance are referred to as acute withdrawal.
When people try to quit on will power alone, they often find they cannot, as the withdrawal symptoms prove too much for them to handle. Therefore, it may be more effective for addicted drug users to go through medical detox, where they can recover from the withdrawal in a safe, controlled environment.
After months or years of active using, it makes sense that it takes a long time for people's brains to recover fully. Protracted withdrawal, also known as post-acute withdrawal, are symptoms which occur for weeks and months after heavy drug users quit their substance of choice. Rome wasn't built in a day, and neither is recovery. Long after the drugs are out of the addict's systems, they may still experience cravings, anxiety, depression, fatigue, mood swings, sleep disturbances, and more. It is estimated that protracted withdrawal can last anywhere from six months to two years as the brain adjusts to a life without drugs.
Different drugs have different protracted withdrawal symptoms. Cravings may come and go, but occasionally can be very severe.
Triggers are anything that reminds the addict of drug use and cause cravings. It could be a person, place, thing, time, season, event, or even the weather. Triggers can cause symptoms similar to PTSD. Some people report having flashbacks to times they were using upon being triggered. Others report going into disassociative states, where their body almost appears to act on its own, seeking the drug, and they're just along for the ride.
While in recovery, it's essential that the recovering addict gets support they need to stay sober, or they may find themself relapsing, or returning to their substance of choice.
Recovery occurs when a person commits to staying sober for a sustained amount of time, well past the acute withdrawal phase. There are support many options available, including therapy, support groups, medication, spiritual programs, and more.
The start of most recovery journeys (at least in developed nations) occurs when individuals check themselves into detoxes, rehabs, hospitals, or psych wards. Sometimes it starts when a person's sentenced to jail or prison time. Every recovery journey is unique and there is no one-size-fits-all solution to addiction. The chances of relapse are high, especially in early recovery, and the statistics on relapse rates are pretty abysmal looking. The chances of relapse are highest in the first weeks of sobriety. Then, the chance of relapse decreases and levels off for a couple of years. Finally, the chance of relapse drops to very low after a person stays in sustained recovery for multiple years.
Although relapse rates are high, most people that seriously attempt recovery are successful after several tries if they survive the relapses. The average is 5 attempts before people get it, but this is largely skewed by the individuals that relapse dozens of times. Half of people who attempt recovery get it in two tries or less (the mean is 5 and the median is 2) .
The Disease Model
The idea of addiction being a disease is not new. Before the term alcoholic came to be, doctors referred to alcoholism as inebriety (being inebriated). Records show some doctors considered inebriety to be a disease as early as 1803, over a century before Alcoholics Anonymous came onto the scene in the 1930s and further propagated the disease concept.
It should be noted that the APA's DSM-V never states that addiction is a disease. It refers to different drug addictions collectively as substance use disorders. However, other articles published by the APA, various doctors, and other psychological organizations, affirm that addiction is, in fact, a disease. So which is it, a disease or a disorder? What's the difference and does it even matter?
What's A Disease?
We all have some idea of what a disease is. Cancer, alzheimers, and diabetes are examples of well-known diseases. It's some type of medical condition or sickness that's not the result of a physical injury, such as breaking your ankle.
In 2007, Dorland's Medical dictionary defined a disease as:
a definite pathological process having a characteristic set of signs and symptoms. It may affect the whole body or any of its parts, and its etiology, pathology, and prognosis may be known or unknown.Dorland's Medical Dictionary
Addiction certainly fits this definition of a disease - it has characteristic signs and symptoms, known etiology, pathology, and prognosis. In other words, we have a decent understanding of why it happens, how it happens, and how it progresses.
Now let's look at a more another definition. According to the APA's dictionary, a disease is:
a definite pathological process with organic origins, marked by a characteristic set of symptoms that may affect the entire body or a part of the body and that impairs functioning.Disease Definition, APA
This definition also seems to fit for addiction. Addiction is a pathological pursuit of drugs with characteristic symptoms which affects the body and the brain. It certainly impairs functioning.
What's A Disorder?
A disorder is more generalized than a disease. A disorder is anything that impairs physical or mental functioning. The APA's definition of a disorder is:
a group of symptoms involving abnormal behaviors or physiological conditions, persistent or intense distress, or a disruption of physiological functioning.Disorder Definition, APA
Addiction certainly fits this description as well. Addiction has known symptoms which result in distress and a disruption of functioning.
What's The Difference
The key difference between the definitions for disease and disorder seems to lie in the part regarding definite pathological processes with organic origins. Disorders are groups of symptoms, but not the disease themselves. A disease is more specific than a disorder. With most diseases, like cancer, we know the origins of the disease, or the science behind why it happens. The first definition of a disease from Dorland's medical dictionary says the etiology may be known or unknown, suggesting that we don't need to understand the reasons behind it for it to be considered a disease. In fact, there's even a term for diseases of unknown origin - idiopathic diseases.
That said, in most modern medical literature, illnesses with unknown origins are largely referred to as syndromes or disorders, not diseases. Take fibromyalgia, for instance. According to the Mayo Clinic, it's a disorder characterized by musculoskeletal pain, fatigue, and a number of other issues. We know its symptoms, but not its origin. It appears much like a disease, but we don't call it such.
Acne is considered being a skin disorder or condition, but not a disease. Acne might be a symptom of a disease, but not everyone with acne has a disease. A doctor can't just look at a patient with acne and jump to the conclusion that they have skin cancer. We know acne occurs because hair follicles are clogging up with oil, but there are several things that can cause oily skin. So we call it a condition or a disorder rather than a disease.
The key takeaway here is that most illnesses we refer to as diseases have a known, specific, scientifically proven origins and disorders are just clusters of symptoms. The requirement for scientific proof of origin seems to be at the center of the debate on addiction being viewed as a disease. For the rest of this guide, we'll work under the assumption that an illness must have scientifically proven origins to be a disease.
The Disease Case For Addiction
The scientific community didn't largely begin accepting addiction as a disease until the 1980s and 1990s. Until this point, addiction as a disease was more of a theory, since the cause of the "disease" of addiction was not exactly known. During this time, advances in brain imaging with MRIs allowed researchers to compare the brain structures of addicts with non addicts.
Specifically, researchers noticed differences in the prefrontal cortex, limbic system, and nucleus accumbens. The prefrontal cortex is associated with behavior control, higher-level thinking, and decision making. The limbic system is associated with emotions and survival mechanisms and the nucleus accumbens releases dopamine and is associated with rewards.
They noticed that there was less grey matter in the prefrontal cortex in the brains of addicts than non addicts. This shows the neural connections involved with rational decision making were weaker in addicts, which makes sense considering addicts aren't well known for their rational decision-making skills. These findings correspond with later studies, such as a 1998 MRI study which found less volume in the prefrontal lobe of polysubstance abusers, and a 2013 study which found decreases in grey matter with increasing years of substance use.
A Brain Disease?
Brain Disease: any degenerative, metabolic, and infectious disease that leads to brain damageBrain Disease, APA Dictionary
These differences in brain structure led scientists to conclude that addiction is, in fact, a brain disease caused by using drugs. It's a self-reenforcing cycle in which the use of drugs causes significant degenerative structural changes in the brain. These changes cause more drug seeking behavior, and the brain structure changes further with more drug use.
Addiction is looking very much like a brain disease at this point.
This diagram represents the three stages of addiction cycle.
- Binge/Intoxication - The individual uses their substance of choice and experiences rewarding effects
- Withdrawal/Negative Affect - The individual experiences negative emotions due to the absence of substance of choice
- Preoccupation/Anticipation - Individual seeks the drug again
The more the individual continues to use, the more this cycle happens, the more the brain changes, and the more the disease progresses. It's a downward spiral.
Genetic Research Supporting The Disease Model
Doctors and researchers have long theorized there's a genetic component to addiction, as it seems to run in families. This could be attributed to environmental factors, as people who grow up in addicted households have greater access to drugs growing up, and are therefore more likely to try drugs themselves. Classical genetic studies, like family, twin, and adoption studies, suggest addiction has a genetic component. So it's not all environmental.
More recently, since the 2000s, advances in DNA studies have allowed researchers to identify several genetic markers that seem to be linked to addiction. Not everyone with these genetic markers becomes addicts, and there's no single gene that's been identified for addiction. These genetic markers could be related to differences in how people metabolize drugs, differences in how much reward people get from using drugs, and differences in how susceptible individuals with addiction are to other commonly co-occurring mental health conditions. For example, people who are genetically susceptible to stress and depression are also more likely to use drugs as coping mechanisms for these other cooccurring conditions.
Genetic markers may be substance specific, and some genetic markers may point to more or less susceptibility to a certain substance.
In short, it's complicated. These studies show that there's likely some genetic component to addiction, but do not definitively prove so. There have been issues with replicability in many of these studies.
As far as the disease model goes, the brain imaging studies are more concrete than the genetic studies. We're not at a point where we can say something like "this gene on chromosome x causes addiction" with certainty.
Addiction Not a Disease?
Not everyone considers addiction to be a disease. Even amongst people with doctorates in their fields, there is debate. One widely cited researcher is neuroscientist Marc Lewis, who has helped author many publications on addiction. This includes his book titled The Biology of Desire: Why Addiction is Not a Disease (2016). Before we can understand why he doesn't think addiction is a disease, we must first understand something about the brain.
The Brain is Neuroplastic
The brain is neuroplastic. Neuroplasticity is the brain's ability to form and restructure neural connections in response to learning and experience. In other words, the structure of your brain is always changing, based on what you're doing with it. Dr. Lewis often cites falling in love as an example of these changes. They say that often love begins with lust, and this is exactly what's happening. When a person falls in love, their brain's pleasure center starts releasing dopamine, not dissimilar from an addict using drugs. When the person they love is gone, the individual will seek out that person again to experience the same dopamine reward. Therefore, at the start of relationships, many people seem fixated on their partner, only thinking about their good qualities and ignoring most of the bad. They get excited every time they get a phone call or a text message from them, and every time they're around them.
Over time, as the relationship progresses, these feelings level out. They may still be there to some extent, but the feelings weren't as strong as in the beginning. They may begin noticing things they don't like in their partner. This is when, after a few weeks or months, many relationships fall apart. People may ask themselves if this is their soul mate or if this is just a fling. This is quite like in addiction when your tolerance is building up. In the same way addicts' brains change when they're on drugs for an extended period of time, the brains of people falling in love change over periods of time.
The Case Against Disease
Dr. Lewis does not argue the facts about structural changes in the brain related to addiction. In fact, he completely agrees with them. His case boils down to the disease concept and the natural learning elements involved in brain changes with neuroplasticity. If using drugs causes brain changes from learned experiences, why is it a disease? Everyone's brain is changing all the time. If someone falls in love and their brain changes as a result, does that make falling in love a disease? If learned behaviors cause the structure of the brain to change, is learning itself a disease? Dr. Lewis argues that addiction is not a disease, but a symptom of prolonged drug use. It can be corrected over time the same way a quarreling husband and wife might benefit over time from couples' therapy - by learning and repeating new behaviors to change the brain.
Detriments To The Disease Model
So now we know the case for and against addiction being a disease. Why does it even matter what we call it? No matter where you fall on the spectrum of the disease or not-disease debate, I hope we can agree that addiction is a terrible mental health issue that people need to address.
The issue with calling it a disease comes down to a few simple things.
- If people who are addicts believe they have a disease, they may blame their problems on the disease, rather than working on fixing their brains. In the same way some people with late-stage lung cancer keep smoking after their diagnosis because they feel there's nothing they can do about it, people with other drug addictions may think consciously or subconsciously that they have a disease, it can't be fixed, so they might as well keep using until they die. The disease itself can become an irrational excuse to continue using drugs.
- Since the brain is neuroplastic, an addict calling themselves an addict for the rest of their lives is counterintuitive if they want to get better. The less people think like addicts, the more their brain changes from the new learned behavior, and the higher their chances of sustaining long-term recovery. There's certainly a "once an addict, always an addict" mentality that needs to stop. In order for people to recover from addiction, the first step is to stop calling people in recovery "addicts." People who used to have acne, a skin disorder, in high school, don't go around saying they have acne for the rest of their lives. That would be ridiculous. People with substance use disorder shouldn't go around saying they're an addict when they're in long-term recovery. It only serves to feed into negative emotions and thought patterns. I'm not saying people in recovery should forget they had a substance problem, but they should be able to live a productive life without continuing to identify as an addict.
Further Reading: Never call someone an "Alcoholic" or "Addict" - A. Jaffe Ph.D. Also check out Dr. Lewis's lecture on this topic.
Final Thoughts On The Disease Debate
After researching the information for this article, I'm still not entirely sure if addiction is a disease or not. I'm still hung up on the definition of a disease, as I could not find a definitive answer on how generalized or specific a disease has to be. Like I said earlier, most of the definitions I came across require a disease to have a specific scientifically proven cause, but not all. Take Covid for example. Covid is often compared to the flu because its symptoms are similar. However, Covid is a disease and the flu is an illness. We don't call the flu or covid a "disorder" like we do with addiction, and addiction itself is sometimes referred to as a mental illness... It's all quite confusing and I'm not qualified to answer these questions. There's too much semantics going on.
Ultimately, I prefer the term disorder to illness, and the term illness to disease as far as characterizing addiction is concerned. Disorder just sounds nicer to me. A disorder seems like something I can fix more easily than a disease. Ultimately, I would define addiction as a mental health issue with various environmental and genetic components that negatively affects the structure of the brain and people's behavior over time through continued nearly uncontrollable substance abuse. Or, much more simply, addiction is when bad stuff happens because people can't stop using drugs. I think that pretty much sums it up.
Early Addiction & Risk Factors
Now that we've established what addiction is and have a basic understanding of what it does to the brain, let's take a look at the early signs of addiction and environmental risk factors.
Experimentation and Peer Pressure
Addiction starts with experimentation. Take marijuana for instance. Nearly half of Americans are estimated to have tried marijuana at some point in their life. Multiple surveys, including a 2017 study on college students, show that the lifetime use rate is around 50% (in this study it was 53% among the 8141 college students surveyed). According to that study, 1 in 10 marijuana users reported no consequences from using marijuana, and 1 in 10 marijuana users reported a lot of consequences (19 plus) from marijuana use. The other 8 in 10 fell somewhere in between.
Most people that try marijuana in their lives do so in their teenage or college years. Usually this is due to peer pressure. A 25 year follow up study on 53 drug addicts found that "curiosity and peer pressure were the main reasons for starting drug use." Because of its prevalence, I cited marijuana for the first example. However, similar reports of peer pressure and curiosity indicate that this is almost always the start to early addiction, regardless of whether the drug is marijuana, heroin, alcohol, or anything else.
In short, what starts out as a fun thing to do with friends may eventually turn into full-blown drug dependence. This does not by any means indicate that everyone who experiments with drugs will become a drug addict. In fact, most people who try drugs do not go on to develop addictions. Only a subset of the population with other combined risk factors will develop an addiction.
Abusing Prescribed Medication
In some cases, people are prescribed drugs by doctors for medicinal purposes and go on to develop an addiction. The most commonly prescribed addictive substances include opiates (pain killers), stimulants (for ADHD and such), and benzodiazepines (things like Xanax for anxiety).
People may start by visiting the doctor for their medical condition, get the prescription, and realize they enjoy the drug either for its euphoric or pain-relieving effects. It becomes a coping mechanism and they take more medication than prescribed. Once they run out, to get their "fix" they may turn to street drugs such as heroin, cocaine, and other illicit substances.
Rx Opiate Abuse
Individuals suffering from chronic pain may become even more tempted to abuse substances as their pain worsens or their tolerance builds. Other times, people report being in accidents or sustaining severe injuries, where the best course of pain treatment was opiates. In some cases, high risk individuals may go on to abuse these opiates, even if they didn't have an addiction problem before the accident or injury.
Rx Stimulant Abuse
Many individuals suffering from attention deficit disorders are prescribed stimulants as a treatment. While stimulants are helpful in maintaining focus, they are also highly addictive. One of the characteristics of ADHD is impulsivity. When we combine impulsivity with easy access to addictive substances, it's no surprise that there is a high correlation between ADHD and addiction. This does not mean everyone with ADHD taking stimulants will develop an addiction. Stimulants help many people. There are safer, non-addictive medications such as Strattera , that can help with symptoms of ADHD.
Rx Benzodiazepine Abuse
Benzodiazepines, commonly called Benzos, are a class of sedative drugs that depress the central nervous system (much like alcohol). They are known for their instant, anxiety-reducing effects and are often prescribed for people experiencing severe anxiety, panic attacks, and extreme short term life stressors. Examples include Xanax and Valium. While they are incredibly effective at reducing anxiety, they are also highly addictive.
Possible Progression To Street Drugs
It is not uncommon for people to sell their prescription drugs illegally. Prescription drugs are much harder to access than street drugs and therefore have a higher value. People can stretch their supplies much further and get higher longer if they convert money obtained from selling their prescription medications into street drugs.
Warning signs that someone may be abusing their prescriptions include: running out of the drug before the prescription is scheduled to be refilled, accidentally "losing" the prescription repeatedly, and making up false or exaggerated symptoms to get a higher dose than is medically necessary. It was once a common practice to go "doctor shopping" where addicts would fake symptoms at multiple prescribers, get multiple scripts for the same types of medications from these different doctors, and have them filled at different pharmacies. National and state databases have been established to reduce this behavior.
Family & Environmental Risk Factors
Many studies have already established that there is a likely link between genetics and addiction. Individuals with blood relatives suffering from addiction are highly likely to also suffer from addiction. Classical genetic studies, twin studies, etc. have proven a likely genetic component exists.
People who grow up in an environment where alcohol or drug use is prevalent are also much more likely to become addicts themselves. This can be attributed to several factors, including the normalization of the addicted behaviors, modeling poor behaviors, and easy access to the substances. It makes sense that a child growing up surrounded by alcohol would have more easy access to alcohol, and therefore be more likely to try it at an early age than someone who did not grow up in such an environment. The same could be said for any other substance.
People growing up in homes with addicts are more likely to be subject to adverse childhood events. This could be parents divorcing, physical violence, poverty, or any other type of trauma related to being in a poor environment. These negative childhood experiences stick with people for the rest of their lives and can lead to further mental health issues. To cope with these mental health problems onset in childhood, many people may turn to drugs and alcohol.
Psychological Risk Factors
For a huge number of reasons, people may suffer from mental illness. It is estimated that as much as 26% of the adult population in the US could be diagnosed with some form of mental illness over the course of any given year. Some diagnoses could be temporary. For example, it's normal to be depressed after the death of a loved one. It's normal to feel anxious when you start a new job or go to a new school. When mental health impairs an individual's normal functioning for an extended period, it could be a sign of an ongoing mental health issue.
Only a psychiatrist or psychologist can diagnose people with mental health conditions. These conditions may go away over time, get better on their own, or require treatment in the form of therapy, medication, or lifestyle changes. Mental health diagnoses are very subjective, since they're usually based entirely on the reports from the individual. It's very possible for people to see a psychologist and get a diagnosis, and then see another psychologist and receive an entirely different diagnosis.
People suffering from mental health conditions often turn to drugs to self medicate their problems. Rather than seeing a psychiatrist and addressing their core issues, it's much easier and instantly rewarding to reach for illicit substances or a bottle of booze. When people suffer from addiction in addition to other mental health issues, it's said that they have co-occurring conditions or diagnoses. It's estimated that nearly half of all addicts have co-occurring mental health conditions.
With co-occurring mental health issues, it's hard to determine which came first. We have a chicken or the egg situation. Did the person develop severe anxiety because they're an alcoholic? Or did the person develop alcoholism to cope with their severe anxiety? It varies from person to person, and the exact order of causes can be difficult for some to pin down. Regardless, treating underlying mental health issues is key to recovery. Many recovering addicts find when they treat their underlying mental health issues, they no longer have a strong desire to use substances.
- The DSM-V has 11 total criteria for substance use disorders. This is a generalization of them all. (DSM V, APA, SUD section, pp. 483,585)
- Global statistics on alcohol, tobacco, and illicit drug use. (SSA, 2017, A. Peacock, J. Leung, et. al)
- Risky Substance Use Environments and Addiction (J. Mennis, G. Stahler, M. Mason, Environmental Justice Research, 2016)
- Genetic approaches to addiction: genes and alcohol (Ducci, Goldman, 2008, Addiction vol. 103)
- Substance Use Disorders, DSM-V, APA, 2013, page 483.
- How Many Recovery Attempts Does it Take to Successfully Resolve an Alcohol or Drug Problem? (J. Kelly et. al, Alcohol Clin Exp Res. 2019 Jul)
- 1891 Quarterly Journal of Inebriety states that Dr. Rush of Philadelphia has been calling inebriety a disease since the early 1800s, and that Dr. Valentine Mott of NY agreed
- Role of the limbic system in dependence on drugs (Rodríguez de Fonseca, Miguel Navarro, Annals of Medicine, 30:4, 1998)
- Smaller volume of prefrontal lobe in polysubstance abusers (X Liu, et. al, Neuropsychopharmacology. April 18, 1998)
- Dissociated Grey Matter Changes with Prolonged Addiction and Extended Abstinence in Cocaine Users (C Connolly et. al, 2013, PLOS ONE, CCA)
- Addiction science and its genetics (David Ball, 2007, KCL)
- Molecular genetic underpinnings of human substance abuse vulnerability (George R. Uhl, Molecular Neurobiology Branch, Baltimore MD)
- Neuroplasticity (Moheb Costandi, MIT Press, 2016)
- College student marijuana involvement... (M. Pearson, et. al., 2017, Addictive Behaviors)
- Risk factors for drug addiction and its outcome (Susanne Gjeruldsen, et. al. 2009, Nordic Journal of Psychiatry)
- Genetic and environmental influences on cannabis use initiation and problematic use (Addiction, 2010)