Beyond the Myths: A Deep Dive Into Understanding Addiction

Yes, Addiction Is A Mental Health Condition

Addiction is a chronic disease that changes both brain structure and function, currently affecting the lives of nearly 10% of adults in the United States.

Addiction swaps the everyday desires of the brain with those of the drug you are addicted to. You no longer enjoy what other people do as the brain changes. The changes start with recognition of pleasure and end with a drive toward compulsive behavior to fulfill that desire. Sometimes, when you try quitting, the addiction weakens your ability to manage impulses.

Addiction exerts a long and powerful influence on the brain. This influence manifests in three ways:

• Craving for the object of addiction
• Loss of control over its use
• Continuing involvement with it despite problems it causes

With drug and alcohol addiction, substances hijack the brain’s reward system. This could lead to developing a physical dependence on substances.

Some people develop unpleasant and sometimes dangerous physical symptoms when they stop or decrease substance use. These changes result in a weakened ability to control impulses despite the negative consequences.

Substance misuse can lead to serious physical, emotional, and social problems. For example, continued use of drugs or alcohol can lead to job loss, broken relationships, and other failures. These problems often increase stress and anxiety.

Organizations such as the National Institute on Drug Abuse and the American Psychiatric Association consider substance use disorders a mental health condition. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, also recognizes substance use disorders as a mental health condition.

Addiction Rarely Acts Alone

Stress, anxiety, trauma, and depression can also result in the development of substance use disorders, which can create new challenges for your mental health.

Studies show that many of those struggling with other mental health disorders also struggle with addiction to drugs and alcohol. Many individuals with a substance use disorder (SUD) also have other mental health symptoms or disorders. This is known as having a dual diagnosis.

A 2021 national survey highlights the rate of substance use disorders and other coexisting mental health conditions is in adults.

Among adults aged 18 or older in 2021:

• 32.5% of adults had either a substance use disorder or other type of mental health disorder
• 9.7% of adults specifically had a substance use disorder but no other type of mental health disorder
• 7.6% of adults had both a substance use disorder and at least one other type of mental health disorder

The following have been known to co-occur with addiction:

• Bipolar disorder
• Anxiety
• Depression
• Eating disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Post-traumatic stress disorder (PTSD)
• Obsessive compulsive disorder (OCD)
• Personality disorders, like borderline personality disorder
• Schizophrenia and other psychotic disorders

Who Can Develop an Addiction? Anyone

It is possible for people of all ages, backgrounds, and socioeconomic groups to develop addictions to alcohol or drugs. Although some groups are more vulnerable than others, there are several factors that contribute to the onset of addiction.

Genetics

Research suggests that genes contribute to the risk of developing both a substance use disorder and other mental health conditions. Environmental factors, such as stress or trauma, can cause genetic changes. We also know that some genes are passed down in families. These changes may contribute to the development of a substance use disorder or other mental health disorders.

Mental Health Disorders

Research shows that some mental health conditions increase risk for addiction disorders.

For instance, someone struggling with mental health symptoms may get into drugs in an attempt to feel better. Though it may seem to alleviate immediate pain, the use of drugs and alcohol often has devastating, long-term effects. Continued drug use causes the brain to increase the rewarding effects, sometimes resulting in the development of other addictions.

People who struggle with an anxiety or mood disorder, such as depression, panic disorder, or bipolar disorder, are twice as likely to also use drugs or alcohol. Those with attention-deficit hyperactivity disorder (ADHD), antisocial personality disorder and conduct disorder, psychotic disorders—such as schizophrenia and schizoaffective disorder—or OCD are also more likely to misuse substances.

What Causes Addiction?

There is no single cause of addiction. However, a few factors can contribute to whether you may start using or misusing substances.

Peer Pressure

Your friends may encourage you to join them in using drugs. Many people succumb to peer pressure for fear of losing friends or a desire to fit in.

Availability

People may start using drugs or alcohol when they are available at school or home. In some cases, parents introduce their children to drugs. Children raised in a family where others are using drugs or alcohol may be at a higher risk to start using.

Life Events and Trauma

Financial problems, a bad breakup, or the death of a close friend or relative are some of the situations that can push you to seek relief or escape with drugs or alcohol.

Also, people exposed to high levels of stress (for example, a first responder or a member of the armed services) are susceptible to addiction. Research has found that 60-80% of people with PTSD also have substance use issues. People who experience PTSD may use drugs and alcohol to cope with stress or to relieve symptoms such as anxiety, depression, and irritability.

Childhood Experiences

Experiences during childhood can lead to physical and emotional difficulties, including addiction. Physical, sexual, or verbal abuse; neglect; witnessing violence; and parental separation or divorce are factors that can impact your use of substances.

Recognizing Signs of Addiction

People with substance use disorders can experience both a physical dependence on the substance and a psychological dependence. While some of these signs may appear almost immediately, depending on the substance, some are gradual and will appear over time.

Not all of these symptoms will present themselves when someone is struggling with an addiction. Any of these signs, though, may indicate consistent substance use.

If you or someone you know shows these signs and symptoms, it may be a sign of a substance use disorder—and the need for help from a doctor or counselor.

Physical Signs of Substance Use

Substance addiction often leads to noticeable changes in a person’s body and appearance. Watch for physical indicators such as:

• Changes in sleeping patterns
• Fluctuations in weight, either gain or loss, or irregular eating habits or changes in appetite
• Extreme lethargy or extreme hyperactivity
• Poor personal hygiene or decreased grooming habits, including showering, washing hair, or brushing teeth
• Changes in eyes, including constricted pupils or bloodshot eyes
• Changes in skin, including jaundice, acne, paleness, scabs, and bruises
• Tremors or seizures
• Poor physical coordination

Psychological and Emotional Symptoms

Addiction can also affect mental and emotional well-being. Common psychological signs include:

• Changes in personality, typically becoming moodier or experiencing mood swings
• Losing interest in activities and hobbies
• Becoming increasingly withdrawn and secretive
• Depression and hopelessness
• Suicidal thoughts

Behavioral Warning Signs

Beyond physical and emotional changes, addiction often shows through shifts in behavior and daily functioning. Look for patterns like:

• Drunk most of the time
• Actively talking about taking or seeking out drugs
• Taking drugs for fun
• Actions or behaviors that result in frequent collisions with legal authorities
• Poor performance in the workplace
• Financial troubles
• Ignoring or neglecting responsibilities altogether

How Addiction Is Diagnosed and Treated

The good news is that it’s possible to receive both effective and safe treatment for addiction. Both medication and therapy have been very successful in treating substance use disorders.

Treatment not only helps manage addictive behaviors but also helps minimize the chance of relapsing in the future. It’s also never too late to seek treatment—individualized care plans are created for each patient, ensuring that your exact needs are met. No two patients are alike.

To diagnose addiction, a licensed clinician will ask you about the nature of your substance use and learn how substance use is affecting your life. They may ask about other factors, such as your personal and family history as well as identifying any coexisting mental health issues. Honesty and family involvement in this process are crucial to receiving an accurate diagnosis.

Treatment for addiction and co-occurring disorders may include a combination of medications, family therapy, cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), exposure and response prevention therapy, and group therapy approaches. Mindfulness-based therapies are also becoming more commonplace.

Before embarking on any treatment journey, it is important to contact your health care providers to seek help that is best suited for your condition or a loved one.

Treatments vary depending on the type of disorder. Here are some of the more common treatment and support options.

Detox/Inpatient Care

This form of short-term treatment is for people who are physically dependent on drugs or alcohol.

Detox may be necessary for people withdrawing from alcohol, benzodiazepines, and barbiturates, as the withdrawal symptoms can sometimes be fatal without medical supervision. Medical professionals monitor patients to ensure a safe and comfortable withdrawal.

Residential Treatment

This type of treatment involves a 14- to 30-day stay at an addiction treatment center. This type of treatment can be incredibly helpful for people who prefer to be in a structured, drug-free environment, removed from temptations or triggers.

Dual diagnosis programs specialize in helping people who struggle with both addiction and other mental health issues. Treatment may involve group, individual, and family therapy, and medication management.

Partial Hospital or Outpatient Treatment

Outpatient and partial hospital (day) programs offer less structure because patients do not live at the facility. Patients return home each day after treatment is complete.

Treatment may consist of medication, talk therapy, or both. Sessions can occur one or more times per week. Those who are in stable recovery may attend therapy less frequently.

Mutual Help Programs

12-step fellowship programs, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), offer meetings in a supportive and encouraging environment. They are free to join and widely available. Other programs, such as SMART Recovery, also provide tools for recovery and social support.

Treating Coexisting Conditions Together

According to R. Kathryn McHugh, PhD, chief of psychology at McLean Hospital, the traditional care model for co-occurring disorders is perhaps the biggest hurdle to effective treatment.

Historically, mental health and substance use treatments are handled separately by different specialists, each focusing on one area and not always having knowledge about both.

This immediately puts patients at a disadvantage. It can be inefficient and inconvenient. More importantly, patients get care for addiction and the coexisting condition(s) at separate times. The gold standard is to take care of them at the same time.

Often, mental health providers suggest that patients get sober first and then come back to get their other mental health condition(s) treated.

“That isn’t a good idea. Those people often don’t come back,” says McHugh. “They struggle to achieve any extended sobriety, and/or their overall condition worsens because their mood or anxiety disorder isn’t being treated.”

Why Integrated Care Matters

In addition to improving access to care, integrated treatment addresses the complexity and overlap between disorders. McHugh explains that the best programs treat all of a patient’s conditions at the same time and in the same place—ideally with the same provider or care team.

This is important because it’s unrealistic to separate conditions and treat them as entirely distinct issues. “There is a lot of overlap and a lot of intersection between symptoms,” she says.

Coexisting disorders also tend to interact in difficult ways. For example, when one condition improves, symptoms of the other may worsen.

“For some people, it can almost feel like whack-a-mole,” says McHugh. “You get one thing under control, and the other pops back up. If someone’s drinking, that can mask the anxiety. But if you stop drinking, the anxiety comes back up. That’s why it’s so hard to treat one and then the other.”

Promising Treatment Approaches for Co-Occurring Disorders

When addressed together, there are highly effective, evidence-based treatments for dual diagnosis. In addition to behavioral and mindfulness-based therapies, several specialized treatment models have shown success.

Integrated group therapy (IGT), developed by McLean’s Roger D. Weiss, MD, treats substance use and bipolar disorder at the same time. Multiple randomized clinical trials have demonstrated its effectiveness.

Another example is concurrent treatment of PTSD and substance use disorders using prolonged exposure (COPE). This CBT approach combines exposure therapy for PTSD with relapse prevention techniques for addiction.

While these targeted approaches are promising, McHugh emphasizes the need for more flexible, generalizable treatments.

Given the wide range of co-occurring condition pairings, researchers are working to develop transdiagnostic treatments that address shared features common across multiple disorders—such as impulsivity or difficulty regulating emotions. These models not only increase access but also reduce the burden on clinicians who would otherwise need training in many disorder-specific protocols.

Medications also play an important role in treating co-occurring disorders. This may involve targeting both the addiction and the mental health condition—for example, using a combination of antidepressants and medications for alcohol use disorder.

Addiction: How It Affects the Brain

Addiction is fueled by a loss of control over the use of a substance as the brain goes through a series of changes, starting with the recognition of pleasure and ending with a drive toward compulsive behavior.

Understanding the Pleasure Principle

Whether it is a psychoactive drug, sexual experience, or any other form of pleasure, the brain perceives them all in the same way. It stimulates dopamine release from the brain’s pleasure center.

The difference comes in the speed, intensity, and reliability with which the brain releases dopamine. Typically, drugs of abuse stimulate a high dopamine surge. That’s why they will always be so addictive. The high levels create an alternative route to the brain’s reward system, which causes dopamine to flood the brain—and ultimately intensifies addiction.

Overloading the Reward Circuit

Until recently, scientists thought the only cause of addiction was pleasure. But recent studies show that dopamine affects the brain’s learning process and the ability to retain things in memory.

Dopamine takes over the control of the brain’s reward learning process when it interacts with glutamate—like dopamine, another neurotransmitter. This learning process is essential to encouraging necessary body activities, like eating and sex, that are needed for survival.

Again, since the brain’s reward circuit includes the parts that boost motivation, dopamine does the same—but with an overload of motivation.

Continued consumption of the drugs causes the brain to stimulate the body into a deep desire to consume more drugs.

The Brain Develops Tolerance

With time, the brain gets used to the substances, which translates to less pleasure. Naturally, we know pleasure comes after some hard work. But these drugs overwhelm the brain, and in turn, the brain either releases less dopamine or gets rid of its receptors.

That means that dopamine’s effect on the reward center reduces significantly. So, even if you were addicted, you no longer experience the pleasure you were used to. And that can drive someone to consume even more quantities to reach the dopamine “high” levels that can cause significant pleasure.

Relief Is Short-Lived

Most substances only provide fleeting relief. For instance, if you have pain or stress, taking opioids could result in temporary painlessness. If you are experiencing negative moods, anxiety, or sadness, taking stimulants like cocaine also provides short-term fulfillment.

Despite short-term respite, the long-term effects of an addiction are quite detrimental. But even so, the intense urge for that relief can cause you to ignore the risk.

Compulsion Becomes the Driving Force

Even if you hardly experience pleasure from drugs, the memory created from past use compels the desire to recreate that pleasure. This compulsion causes part of your brain—the hippocampus and amygdala—to start developing thoughts about getting the drug again, which grows into intense desire when encountering an environment with those drugs.

This desire to relapse even after years of sobriety, especially when you encounter tempting environments, results from this conditional learning.

Do People Really Experience Withdrawal From Drugs and Alcohol?

When entering treatment, it’s possible for a person to experience withdrawal. Withdrawal is the process of quitting a substance and can vary in severity.

Physical and psychological dependencies can also appear during withdrawal. Your body gets used to drugs and alcohol such that if you don’t use them for a while, physical symptoms begin to show up. You have to take the drugs to maintain your “normal” self. Psychological dependence stems from the mind. You believe you cannot survive without using—for example, it’s impossible to be social or fun without drinking alcohol.

When you have a psychological dependence on drugs or alcohol, you may also come to believe that you need to use the substance all the time. You believe you cannot survive without drugs.

Physical dependence relates to when your body has become used to having drugs, and therefore, you need to take drugs to even feel normal.

For example, if you have an addiction to a depressant like alcohol, you may feel restless, agitated, or have tremors when you do not drink. Some substances, like opioids, can cause sweating or nausea during withdrawal. Withdrawal from cocaine and marijuana often produces emotional symptoms, ranging from irritability to depression.

Withdrawal symptoms can be mild or severe, depending on:

• How long you have been using
• What drug(s) you are taking
• Age
• Physical health
• Psychological characteristics
• Method of withdrawal

Sometimes, withdrawal may be fatal—especially if you are in a critical condition. It’s strongly encouraged to reach out to your health care providers if you are considering withdrawing or seeking treatment for addiction.

The Body’s Reaction to Withdrawal

When going through withdrawal, it’s possible for a variety of responses to occur.

Symptoms vary from one individual to another—depending on the level of addiction and the type of drug. The symptoms are simply how you’d feel when you no longer use them. Withdrawing from cocaine, for instance, will make you feel depressed, agitated, and tired.

Since the brain is used to the drugs, it will always long to have that “normal” state. Sometimes the cravings will be too strong to the point that you have to use them. Therefore, to effectively manage the cravings, you must engage yourself in constructive activities like reading, exercising, learning new skills, and other active engagements.

Withdrawal May Take Longer Than Expected

Even though you will quit within a short period, the effects will, of course, last longer, depending on the factors we mentioned earlier.

Withdrawal involves four main steps:

• Tolerance – The body becomes less responsive to the substance, requiring more to achieve the same effect (Note that tolerance doesn’t imply extreme addiction—it is the body becoming less sensitive to the substance)
• Cessation – The individual stops using the substance
• Acute withdrawal – The initial phase of withdrawal with physical and psychological symptoms lasting a few days, but varying from person to person
• Post-acute withdrawal – A longer-lasting phase with persistent symptoms as the brain readjusts to functioning without the substance

What Is an Intervention?

An intervention can be an effective way to help someone with a substance addiction. Through an intervention, family members and friends come together for the sake of the individual who is struggling with drug or alcohol misuse, pushing for them to get the treatment they need to address their condition.

Interventions can also help family and friends of the person with a substance use disorder. Loved ones can explain how they have been damaged by the individual’s words and actions.

Forcing the person to confront the consequences of their behavior can lead to better outcomes for all involved.

Interventions Can Be Challenging

Despite the benefits, many people hold back from staging an intervention.

The potentially explosive nature of the confrontation prevents people from starting the conversation. Emotions may run high. Secrets can be revealed. Feelings of shame, anger, and hopelessness may rise to the surface.

Some avoid staging an intervention because they are convinced it will not work. They think that only people who are fully motivated will benefit from treatment.

A different but common theme is that they have spoken with their loved one dozens of times, but it hasn’t resulted in change. “They never will accept help, so why try?” they may say.

It’s important to take the hard but needed steps to protect the health and safety of the person with the addiction, and those around them too.

Don’t Wait Until They Hit Rock Bottom

One widely held view is that an intervention is only for those who have hit rock bottom, a point of pain where there is nowhere to go but up.

At this point, some believe, the person will clearly understand the need for treatment and eagerly seek help. An intervention will just confirm and encourage the promising path they have now decided to take.

This belief is not only wrong but also dangerous.

Experts know that rock bottom looks different for everyone struggling with drug or alcohol addiction. In fact, even when someone does reach what seems like the lowest low—maybe following an overdose or a drunk driving accident—they will probably continue to misuse substances and refuse help.

Family members and friends should not wait for the most desperate situation to step in and confront their loved one. Don’t wait until it’s too late to help.

Not Every Intervention Is a Fight

Many avoid holding interventions because they are convinced it will be an angry confrontation, and they do not want the person to feel worse than they already do. That is not surprising, because many people who face interventions say they felt ambushed. They feel emotionally abused, shamed, and insulted.

But an intervention does not have to resemble a firing squad. In fact, the most effective interventions are the ones in which the friends and family members speak to their loved one in calm, clear terms.

Make sure the intervention does not become a negotiation, a trial, or an airing of grievances. Present issues logically and offer serious solutions. Also, be sure to make a distinction between the individual as a person and the addiction.

When an intervention is planned with care and offered with understanding, the individual is more likely to be open to treatment.

The Role of an Interventionist

Families and friends can reach out to professionals for assistance in planning and holding an intervention. In fact, there are trained interventionists who can take you through the process to increase the chance of success.

As an important first step, an interventionist will try to get the family to come to a consensus about the need for a meeting and what the meeting should look like.

“If only part of the family is on board, I will try and intervene with the other part of the family,” explains interventionist Brad Warner, LCSW-R. “Usually they will come along, but if they are immovable, then we will come up with a plan that doesn’t include them.”

Leading up to an intervention, Warner says that he works with individual family members to “get them to change their thinking and perceptions of the problem.”

This work, he explains, “includes a lot of education about addiction, mental health conditions, treatment, and interventions.”

He also holds an extensive pre-intervention meeting the night before the intervention with all the participants. “We discuss all of the information about the person, who often has kept certain people in the dark,” says Warner. This process helps keep the meeting focused and provides insight and comfort for family members.

Including an interventionist in the process can be beneficial for many reasons.

The introduction of an unbiased, helpful person may help convince the person the intervention is for that it should be taken seriously and that their loved ones aren’t overreacting.

In addition, having a professional help plan and hold an intervention can make it more likely to run smoothly and have a positive outcome: getting a loved one the help they need.

Understanding Truths—and Myths—About Addiction

To better understand the condition, it’s important to know what addiction is—and what it isn’t.

Truth: Addiction Is Not Caused by Poor Morals or Willpower

In the 1930s, when researchers first began to investigate what caused addictive behavior, they believed that people who developed addictions were morally flawed or lacking in willpower. “Addicts” were punished. Or they were encouraged to muster the strength to break their habits.

Over the years, we have learned much more, and today, we recognize addiction as a chronic disease that changes both brain structure and function. With addiction, the brain goes through a series of changes—beginning with recognition of pleasure and ending with a drive toward compulsive behavior. These advances in science have improved diagnosis and treatment of substance use disorders (SUDs).

Truth: Addiction Is Not a Choice That Someone Can Just Get Over or Stop Doing

Many have fought back against the notion that people with addiction are deliberately and maliciously engaging in substance misuse. In truth, those with addiction disorders have a health condition.

Misconceptions, stigma, and hurtful language often discourage those who need help from reaching out. As our understanding of SUDs improves, the myths and misconceptions will go away. As a result, more and more individuals will seek treatment.

Truth: Addiction Is Treatable

Several safe, effective, and inexpensive treatments are available for addiction. Treatments vary depending on the type of substance use disorder.

Effective medications are available for alcohol use disorder, opioid use disorder, and nicotine use disorder. Often, psychosocial treatments are combined with medication. Treatment can be beneficial at any point in an addiction and can be tailored to a person’s needs.

Recovery Is Possible—There Is Hope!

In addition to medications and therapy, successful recovery involves rebuilding a meaningful life. This process can be slow and challenging as you rebuild family and social relationships and begin to expand your role in your community. Unfortunately, the process can be difficult for those struggling with homelessness, financial instability, lack of social supports, or limited education.

Moreover, the recovery process can involve investing in new interests and providing meaning to your life. A successful recovery from addiction can include understanding that your problems usually are temporary. Recovery also involves acknowledging that life is not always supposed to be pleasurable.

An important step in recovery is having personal agency. There are many ways to heal by just being part of better things. By diversifying interests and goals, identifying and working through drawbacks, and remembering life has its highs and lows, recovery can be longer-lasting.

Individuals are encouraged to focus on positive behaviors like:

• Creating realistic goals
• Being flexible
• Having a gratitude list
• Assisting people
• Working to transform your mindset for the better

Whether practicing these behaviors alone or with loved ones, positivity can be a powerful—and successful—component of the recovery process.

Facts About Drug and Alcohol Dependence

Substance addiction affects millions of Americans each year, often alongside other mental health conditions. The data below highlights just how widespread—and varied—this issue is across different substances and demographics.

• In 2018, SAMHSA reported that 20.3 million people struggled with SUD between 2017-2018
• In 2011, an estimated 22.1 million Americans (8.9% of those aged 12 or older) met the criteria for SUD
• A 2014 study found that 7.9 million people in the U.S. had both SUD and another mental health condition
• Half of that group were men, though gender differences have narrowed in recent years

Risk of Dependence by Substance

The likelihood of developing dependence varies:

• 8-9% of marijuana users
• 12-13% of alcohol users
• 15-16% of cocaine users
• 67% of nicotine users

Alcohol Use and Misuse

Statistics from the 2018 U.S. National Survey on Drug Use and Health (NSDUH) found that:

• 139.8 million Americans aged 12 or older drank alcohol in the past month
• 67.1 million engaged in binge drinking
• 16.6 million drank heavily
• 14.8 million had an alcohol use disorder

Tobacco and Nicotine Use

• 69.6 million Americans (27.4%) used tobacco in the past 30 days.
• 58.8 million people were current cigarette smokers, according to NSDUH’s 2018 statistics on tobacco consumption
• The CDC’s report in the National Youth Tobacco Survey of 2018 show that among youth, e-cigarette use rose sharply in 2018 with a 78% increase among high school students and a 49% increase among middle school students

Opioids and Heroin

Other 2018 NSDUH statistics show the prevalence of heroin and opioid use in the U.S.:

• 808,000 Americans used heroin between 2017-2018
• About 2 million people had an opioid use disorder

Marijuana Use

NSDUH’s 2018 statistics further show:

• In 2017, 43.5 million Americans (15% of those aged 12 or older) used marijuana
• 4.4 million had at least one marijuana-related SUD
• Reported short-term side effects include hallucinations and slowed reaction time
• Reported long-term side effects include impaired judgment and memory loss

Stimulants: Methamphetamine and Cocaine

Use of other drugs is on the rise, according to NSDUH. In 2018 alone:

• 1.9 million Americans used methamphetamine
• 1.1 million had a meth-related disorder
• Meth use has quadrupled since 2011
• 5.5 million Americans used cocaine
• Cocaine use increased nearly 33% from 2016 to 2017, according to the CDC

Contributors

R. Kathryn McHugh, PhD