For a behavioral health condition that affects millions of Americans, their families and communities, addiction to alcohol or other drugs is widely misunderstood and stigmatized. Simply put, addiction is a disease. The behavioral aspects of the disease are characterized by the continued use of alcohol or other drugs even when that use causes harm or interferes with achieving goals in life.
You might also hear addiction described as "a disease of the mind, body and spirit." That’s because the condition involves a physical and psychological craving or compulsion to use mood-altering substances, and because recovery from addiction involves physical, psychological and emotional healing.
The American Society of Addiction Medicine describes addiction as "a primary, chronic disease of brain reward, motivation, memory and related circuitry." Classification as a "primary disease" means addiction is not the result of some other situation, problem or health issue. For example, addiction is not caused by a bad marriage, financial hardship, a difficult childhood or other co-occurring mental health disorders.
In fact, the number one risk factor for substance use disorder—the medical term for addiction—is genetics. Individuals who have a family history of the disease are at a much greater risk than the general public of developing a substance use disorder.
Like other chronic diseases such as diabetes, asthma and hypertension, addiction often involves cycles of relapse (recurrence of symptoms) and remission. Other criteria used by the medical community in classifying substance use disorder as a disease include:
Observable symptoms and signs
Responsive to treatment
Here are three critical facts you need to know about drug addiction if you’re concerned about yourself or a loved one:
It's progressive—if unaddressed, it will get worse
It's chronic—there is no cure, but it can be successfully managed
It's potentially fatal
The behavioral health field has struggled for decades to debunk the myths and misconceptions about the nature of drug and alcohol addiction. People with a substance use disorder were thought to be morally flawed and lacking in willpower rather than seen as suffering from a disease. Labels and terms such as "addict" and "alcoholic"—even substance "abuse" and "drug abuse"—persist today and further stigmatize the disease and individuals who have the condition. This language and these views shape society's responses to substance use disorder, treating the condition as a moral failing rather than a complex behavioral health issue, which leads to an emphasis on punishment rather than disease prevention and treatment.
Today, thanks to science and advocacy, our understanding of substance use disorders and addictive behaviors has come a long way, and parity in health care insurance coverage has provided more people with access to effective treatment.
Despite these advances, misconceptions about why people become addicted or a lack of understanding about how drug use changes the brain persist. Watch the video to learn more about addictive substances and the science of addiction.
Scientific research has identified how brain circuitry and brain chemistry are affected by long-term use of alcohol and other addictive substances. Simply put, sustained drug use alters brain function. Drug use increases the release of a powerful chemical called dopamine. Over time, if dopamine is routinely in abundance because of substance use, the brain attempts to balance things out by producing less dopamine. At that point, the brain relies on substances to trigger the release of dopamine. And that is when individuals start to use alcohol and other drugs just to feel "normal."
Different sources will say different things about the stages of addiction. Some will claim there are three stages while others attest to seven (and everything in between).
Although the stages and the language used to describe them can vary from source to source, the general timeline usually remains the same:
Recreational or experimental use: a person tries a drug for the first time.
Social or regular use: a person uses in social settings, on a more regular basis.
Problem or risky use: a person uses outside of socially accepted settings or in situations that put themselves at greater risk of negative consequences.
Dependence and addiction: a person uses frequently, experiences cravings and compulsions, and continues to use despite adverse outcomes.
When dependence forms, another process continually transpires: a person cycles between use, withdrawal and preoccupation—a constant negative feedback loop.
First, you should understand that addiction doesn't happen overnight. Dependence involves a progressive, complex process that takes place in an area of the brain known as the "reward center"—the same place that regulates and reinforces natural rewards vital to our existence, such as food and sex. That is why the addicted brain pursues alcohol and other drugs as if these substances are needed for our very survival. And it's why people with active addiction place the pursuit of alcohol or other drugs above almost any other priority.
Scientists have also identified a variety of social, psychological, genetic and other factors that make some people more vulnerable than others to developing drug addiction. What's important to understand in all cases is that no one chooses to develop the disease. Two people may start out using alcohol or other drugs similarly, with one person's use progressing into a substance use disorder while the other person doesn't develop symptoms.
Keep in mind, too, that individuals who become addicted are never able to use alcohol or other addictive drugs without potentially imperiling their health. Their brain chemistry has changed in a way that can be brought back into balance through rehab, but that balance will always remain vulnerable to resumed use.
Specific medical, psychological and behavioral screenings and assessments are designed to detect substance use disorder. In general, symptoms of addictive behaviors involve:
Loss of control
Needing to use the drug regularly
Cravings and intense urges to use
Needing to take more of the drug to get the same effects
Persistent use despite adverse consequences
Inability to stop using the drug despite repeated attempts
Engaging in risky behavior while intoxicated or to obtain a drug
Families are profoundly affected by the harmful consequences of addiction. To cope with the chaos of a loved one's addictive behaviors, families tend to keep secrets, find scapegoats and adopt unhealthy behaviors such as denial, blame or preoccupation. So families need help in their own right to recognize and address addictive behaviors and establish healthy boundaries and relationships.
Like other chronic diseases, addiction to alcohol or other drugs can be managed successfully so that you can live a full and rewarding life. Most people who go to treatment programs not only stop using alcohol or other drugs but they also improve their occupational, social and psychological functioning.
Those who have a moderate to severe substance use disorder will likely be recommended for inpatient treatment programs.
Those who have a mild substance use disorder or have already completed in-patient treatment may only require outpatient services.
And those who have co-occurring mental health disorders, like depression, anxiety or post-traumatic stress disorder, would benefit from mental health services.
Millions of people around the world are proof that recovery is stronger than addiction. And they are proof that treatment works, families heal and life gets better.