Addiction is a complex disease, but nearly a century of scientific study has helped researchers come to a deeper understanding about how it works.
This research has culminated in an important change in how we talk about addiction: Addiction is now classified as a disease that affects the brain, not a personal failing or choice.
Most people think of substance use when they hear about addiction, but that’s not the only type of addiction.
Today, most experts recognize two types of addiction:
- Chemical addiction. This refers to addiction that involves the use of substances.
- Behavioral addiction. This refers to addiction that involves compulsive behaviors. These are persistent, repeated behaviors that you carry out even if they don’t offer any real benefit.
Before getting into the different types of addiction, it’s helpful to understand a few general elements of addiction.
The reward system
Addiction interferes with normal brain function, particularly in the reward system.
When you do something you find enjoyable, whether that’s hanging out with your best friend, drinking a bottle of wine, or using cocaine, this reward system releases the neurotransmitter dopamine along with other chemicals.
Contrary to popular belief, dopamine doesn’t appear to actually cause feelings of pleasure or euphoria. Instead, it seems to reinforce your brain’s association between certain things and feelings of pleasure, driving you to seek those things out again in the future.
Cravings and tolerance
The desire to experience this euphoria again can trigger cravings for the substance or behavior, especially when you encounter the same cues (like a party where people are drinking, for example). These cravings often serve as the first sign of addiction.
As you continue using a substance or engaging in a behavior, your brain continues to produce larger amounts of dopamine. Eventually, it recognizes that there’s plenty of dopamine in your brain already and starts producing less in response to normal triggers.
There’s one problem, though: Your brain’s reward system still needs the same amount of dopamine to function as it should.
Before long, you need to use more of the substance to make up for what your brain isn’t releasing. This effect is called tolerance.
Disinterest in other activities
As addiction develops, it’s common to lose interest in hobbies and other things you once enjoyed.
This happens because your brain no longer produces much dopamine in response to natural triggers, like having sex or making art.
Even when you want to stop using a substance or engaging in a behavior, you might feel like you still need them in order to feel good about anything.
Loss of control
Addiction usually involves an inability to control substance use or specific behaviors. This can result in job loss, health issues, and relationship concerns, among other things.
In response, you might decide to quit the substance or behavior, only to find that you keep falling short, despite your best efforts.
This is partly why the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recommends using the term “substance use disorder.” This classification includes more diagnostic criteria to help healthcare professionals differentiate between mild, moderate, and severe cases.
Many experts also prefer it because it avoid terms like “abuse,” which can further stigmatize addiction and prevent people from seeking help.
Common symptoms of substance use disorder include:
- cravings intense enough to affect your ability to think about other things
- a need to use more of the substance to experience the same effects
- unease or discomfort if you can’t easily access the substance
- risky substance use, like driving or working while using it
- trouble managing work, school, or household responsibilities because of substance use
- friendship or relationship difficulties related to substance use
- spending less time on activities you used to enjoy
- an inability to stop using the substance
- withdrawal symptoms when you try to quit
Some of the more common addictive substances include:
There’s some disagreement around the concept of behavioral addictions and whether they truly involve addiction. However, the DSM-5 now recognizes two behavioral addictions:
While most medical experts agree certain behavior patterns can become problematic over time, but there’s still some debate around:
- the point when behaviors become addictions
- specific behaviors that can become addictive
For example, some may agree that shopping, sex, and exercise addictions exist but question the idea that people can become addicted to Facebook.
The APA chose not to include these behavior patterns in the DSM-5, citing the lack of scientific, peer-reviewed evidence necessary to develop standard criteria for diagnosis.
As a result, there’s no official diagnostic criteria.
However, general signs of a potential behavioral addiction include:
- spending large amounts of time engaging in the behavior
- urges to engage in the behavior even if it negatively affects daily life, responsibilities, or relationships
- using the behavior to manage unwanted emotions
- hiding the behavior or lying to other people about time spent on it
- difficulty avoiding the behavior
- irritability, restlessness, anxiety, depression, or other withdrawal symptoms when attempting to quit
- feeling compelled to continue the behavior even when it causes distress
Common behavioral addictions people often seek therapy and other professional support to address include:
It’s often extremely difficult to quit or control substance use alone without support from a trained professional.
The first step of treatment for some forms of substance use disorder, including those that involve alcohol, benzodiazepines, and heroin, typically involves medically supervised detoxification. This won’t treat the condition, but it can help people get through the withdrawal process safely.
From there, one (or a combination of) the following is usually recommended.
Rehab, or residential treatment, involves staying at a treatment facility where trained treatment specialists provide medical attention and support. Some programs only last a few weeks, while others might last several months to a year.
Many rehab programs also incorporate elements of the following treatment approaches.
Psychotherapy and addiction counseling can help with recovery, especially if someone started using substances to deal with distressing emotions.
A therapist can help them explore some of the reasons behind their substance use and come up with new coping strategies for dealing with challenges.
In some cases, medication can help people working through addiction have greater success with recovery.
It can be particularly helpful for preventing relapses in people dealing with substance use disorder involving alcohol, nicotine, or opioids. These medications work in different ways, but they generally help reduce cravings for the substance and reduce symptoms of withdrawal.
Treatment providers typically recommend using medication in combination with other treatment approaches, like therapy, to address underlying factors.
Twelve-step programs like Alcoholics Anonymous and Narcotics Anonymous help many people achieve recovery. These programs rely on self-help treatment methods and involve anonymous group support from other people working toward recovery.
Comfort and guidance from others working toward recovery can make a lot of difference. However, these programs typically don’t provide enough support on their own. Plus, the 12-step model doesn’t work for everyone.
Other programs, such as SMART Recovery, may be a better option for people looking for a more scientific approach to group support.
As with chemical addiction, many different factors can contribute to behavioral addictions. Treatment approaches can vary, but therapy is usually the first recommendation.
A type of therapy known as cognitive behavioral therapy (CBT) if often most helpful for behavioral addictions.
CBT focuses on paying attention to the thoughts and emotions that cause distress and learning how to reframe them in the moment. This, combined with more productive coping skills, can reduce the need for addictive behaviors.
Other types of therapy can also help address underlying issues that might play a role in behavioral addiction, like relationships concerns.
Self-help groups and other types of peer support can help with behavioral addiction, especially when used in combination with therapy.
Experts may still have more to learn about how and why addiction happens, but one thing is clear: Addiction is treatable.
The Substance Abuse and Mental Health Services Administration (SAMHSA) website can help you find recovery resources for yourself or a loved one, including information about addiction, a treatment services locator, a free 24-hour informational helpline, and more.
Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues.