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What Is Addiction?

By Elizabeth Hartney, BSc., MSc., MA, PhD  Medically reviewed by John C. Umhau, MD, MPH, CPE Updated on July 28, 2020

What is Addiction?

Addiction is a complex, chronic brain condition influenced by genes and the environment that is characterized by substance use or compulsive actions that continue despite harmful consequences.1

For a long time, addiction meant an uncontrollable habit of using alcohol or other drugs. More recently, the concept of addiction has expanded to include behaviors, such as gambling, as well as substances, and even ordinary and necessary activities, such as exercise and eating.


While addiction to substances has often appeared clear-cut, there’s some controversy about what substances are truly addictive. Current guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic tool used to diagnose different types of mental health conditions, indicate that most psychoactive substances, including medications, have the potential to be addictive.

Addictions vs. Substance Use Disorders

The term addiction is used to describe compulsive drug-seeking behaviors that continue in spite of negative outcomes, but it is important to note that addiction is not considered an official diagnosis in the DSM-5.2

Rather than using the term “addiction,” the DSM-5 classifies substance use disorders. While the diagnostic criteria vary for each type, the DSM-5 describes these disorders as a problematic pattern of use of intoxicating substances that leads to significant impairment and distress. These symptoms can result in impaired control, social impairment, risky use, and tolerance/withdrawal. 

While these conditions might be informally referred to as addictions, your doctor will officially diagnose you with some form of substance use disorder or one of the two behavioral addiction disorders that are officially recognized by the American Psychiatric Association (APA).

Substance Use Disorders

There are different substance use disorders found in the DSM-5:3

  • Alcohol-related disorders
  • Caffeine-related disorders
  • Cannabis-related disorders
  • Hallucinogen-related disorders
  • Opioid-related disorders
  • Sedative-, hypnotic-, or anxiolytic-related disorders
  • Stimulant-related disorders
  • Tobacco-related disorders

Behavioral Addictions

The DSM-5 also recognizes two types of behavioral addiction:

  • Gambling addiction
  • Internet gaming disorder

There is still much debate about whether many behavioral addictions are “true” addictions. More research is needed to clarify this issue. While shopping addictionsex addiction, and exercise addiction are often noted as behavioral addictions, the DSM-5 does not officially recognize these as distinct disorders.


The signs and symptoms vary from one addiction type to another, but some common symptoms of addiction include:

  • An inability to stop
  • Changes in mood, appetite, and sleep
  • Continuing despite negative consequences
  • Denial
  • Engaging in risky behaviors
  • Feeling preoccupied with the substance or behavior
  • Legal and financial problems
  • Losing interest in other things you used to enjoy
  • Putting the substance or behavior ahead of other parts of life including family, work, and other responsibilities
  • Secrecy
  • Using increasingly larger amounts of a substance
  • Taking more of the substance than you intended
  • Withdrawal symptoms

Defining Features of Addiction

Two aspects that all addictions have in common:

  • The addictive behavior is maladaptive. The behavior causes problems for the individual or those around them. So instead of helping the person cope with situations or overcome problems, it tends to undermine these abilities.
  • The behavior is persistent. When people are addicted, they will continue to engage in the addictive behavior despite the trouble it causes. So an occasional weekend of self-indulgence is not an addiction, although it may cause different kinds of problems. Addiction is characterized by frequent engagement in the behavior.

Addiction vs. Dependence

It is important to distinguish between dependence and addiction. When people become dependent on a substance, it means that they experience drug tolerance and drug withdrawal:

  • Tolerance means that the body has adapted to the presence of the drug so that it takes more of the drug to produce the same effects.
  • Withdrawal occurs when people experience certain physical and psychological symptoms if the use of the substance is suddenly decreased or halted.

A person can become dependent on a drug without being addicted, although the two often occur together. Addiction occurs when people continue to compulsively use a drug despite harmful consequences.4


Addiction diagnosis usually requires recognizing that there is a problem and seeking help. Substance use is not always an indication of addiction, although drug use carries numerous health and social risks in addition to the risk of addiction.

Once a person has decided that they have a problem and need help, the next step is an examination by a healthcare professional. This involves questions about behaviors or substance use, an examination to assess overall health, and the development of a treatment plan that works best for the individual’s specific addiction. 

The exact diagnosis a person receives will depend on the nature of their addiction. Commonly misused substances that can lead to addiction include:

  • Alcohol
  • Cocaine
  • Hallucinogens
  • Inhalants
  • Marijuana
  • MDMA and other club drugs
  • Methamphetamine
  • Opioids5
  • Prescription drugs
  • Steroids
  • Tobacco/nicotine

Because some substances have the potential to cause dangerous withdrawal symptoms, it is important to receive an appropriate diagnosis in order to get the best treatment.

If You Think You Might Have an Addiction

It is common, if not normal, to go through a stage of engaging in substance use or an addictive behavior without believing you are addicted. This is so common, in fact, that it has a name, the pre-contemplation stage.

If you are starting to think you might have an addiction, you have probably moved into the contemplation stage. This is a great time to find out more about the substance or behavior that you have been engaging in and to reflect honestly on whether you are experiencing any signs or symptoms of addiction.

Many people then decide to make changes. For some people, this is easy and manageable. For many others, quitting can lead to unpleasant withdrawal symptoms, even with behaviors, and can open up uncomfortable feelings that were being soothed or suppressed by the addictive behavior.

If this happens, or if you have been drinking or using drugs, such as opioids—illicit or prescribed, other prescription medications, stimulants, cocaine, or meth—you should seek medical help immediately.

Stopping some drugs then relapsing can heighten your risk of overdose, mental health problems, or other life-threatening medical complications, and should be done under medical supervision.


Substances and behaviors can create a physical and psychological high. Over time, people develop a tolerance, meaning it takes more of something to achieve those same initial effects. Some of the factors that can contribute to addiction include:

  • The brain: Addiction leads to changes in the brain’s reward circuits over time.
  • Family history: You may be more likely to become addicted if you have family members who also have addictions.
  • Genetics: Research suggests that genetics increases the likelihood of developing an addiction.6
  • Environment: Exposure to addictive substances, social pressure, lack of social support, and poor coping skills can also contribute to the development of addictions.

Addictions take time to develop. It is unlikely that a person will become addicted after using a substance once, although it is possible to develop a mental health problem or to die of an overdose or another complication after one use of some substances.

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