Understanding Addiction
A relapsing-brain disorder; a moral failure; a personal choice; a lack of willpower; an excess of bile; a response to intergenerational trauma.
Addiction has been conceptualized and reconceptualized since the beginning of recorded human history. Loss of control surrounding the consumption of a substance was introduced in the 17th century, with evidence of some individuals being unable to control themselves around alcohol. Since that time, our understanding of addiction has moved from a moralistic framework to a biopsychosocial approach. Despite our movement into modern times, there is still excessive stigma surrounding alcohol, drugs, gaming and internet addictions.
Introduction
There are multiple definitions of addiction, but first let’s lay out some terminology to ensure we fully understand everything at stake. A psychoactive substance is any substance that when taken, affects people’s cognitive and emotional processes. Recently, there has also been evidence that some behavioral activities, such as gambling, internet use, and videogames, can also be considered psychoactive, as these activities have a similar effect on people’s moods and thoughts.
People’s use of substances lies on a spectrum. As well, each substance a person uses has its own spectrum.
People generally start using the non-problematic route: they start experimenting with drugs or behavioural activities, but there are no harms or issues with it. Some people may progress into casual or social use of the substance, so may not. Others still may move from casual/recreational use into a problematic realm: this is where consequences start to build up due to the drug or activity. Some people have problematic use of substances and are able to reign in their use and transition back to non-problematic or non-use. Others may move into a full “addiction” where someone may meet the full criteria for a disorder. At this point, people are generally physically and psychologically dependent on a substance or activity. They may go into withdrawals, experience extreme irritability, mood and personality changes, cravings, and inability to stop despite negative consequences.
Addiction is seen all around the world, across cultures and different contexts. Our human fascination with intoxication starts from a young age, where the feeling of being dizzy is fun and interesting. Even animals have learned to eat rotting fruit in order to enjoy the intoxicating effects of fermented sugar, also known as alcohol. The difference between regular usage and dependence, lies in the amount, duration, and frequency of harms associated with its use.
Identifying Addiction
As we talked about earlier, addiction can be to substances or behaviours. Some people explain that “I am addicted to MORE.” If they could get more alcohol, they would. More exercise, they would. More cocaine, they would. More gambling, they would.
We notice addiction because people start to act differently around their drug or activity of choice.
People may need more of the substance to achieve the same high (this means a person has developed a higher tolerance). They may also change how the substance is administered, in order to feel the effects differently (going from orally taking pills to crushing and snorting pills). People who are in an addicted state may not see the harms associated with their use, can become hyperfocused on obtaining their next drink or drug, and start isolating themselves from others. People also start to experience cravings for the substance or activity. When you ask someone what a craving feels like, many state it is like needing air. Lastly, many people who are dependent on drugs/alcohol/behaviours have a loss of control. They may try to only have one beer, but end up consuming enough until they black out. Another person may intend to only buy a lottery ticket, but end up spending more than they agreed to. This loss of control is a hallmark of addictive disorders and part of the hopelessness that people feel when they realize their addiction is having a negative impact on their life.
Causes
There are many pathways to develop addiction. Some people who experience addictive behaviours have an untreated mental health disorder and their addiction is a way to medicate their symptoms. Others may have no mental health disorders, but start drinking and using drugs due to environmental influences and develop a habit that turns into an addiction.
Using a biopsychosocial framework, we tend to see overlapping factors involved in the development of addiction: biologically there can be a predisposition due to genetics or family history. Psychologically, there may be some personality traits that make people less risk aversive and more likely to try certain drugs. Socially, a person can only be addicted to something they are able to try. How available a drug is, how acceptable it is, if it is legal or illegal: these all influence how likely it is for someone to access a drug.
Treating addiction as a mental health concern has advantages because psychotherapists and mental health workers can view their problem through a larger lens. Rather than just try to treat the problem from one angle, a therapist can examine a person holistically and create a robust treatment plan.
Treatments
The world has come a long way in treating addictive disorders. In the past, alcoholism was treated by sending intoxicated people to 
inebriate wards and asylums. These asylums were specifically created for people with drug and alcohol problems, and they included non-medical detoxification, isolating patients from drinking, moral reframing and inclusion in sobriety fellowships. These were closed due to ethical abuse, economic depression, and criminalization of drug and alcohol problems. After this, alcoholics were sent to drunk tanks, hospitals and insane asylums. In the 1900s, therapy psychological and spiritual interventions became more commonplace and substance abuse hospitals started opening again. These treatments were expensive: one hospital charged 350 dollars a day for treatment of alcoholism with a belladonna elixir…this cost would translate to almost 6000 dollars a day in 2022.
During this time in the early to mid 1900’s, Alcoholics Anonymous was founded. Morphine clinics were opened, and Narcotics farms were formed. One Narco farm, Lexington, was a center for drug treatment and federal research center. Patients were given free treatment for their addictions, but the farm was really a prison where research on humans was conducted.
Alcoholics and those considered mentally ill are also impacted by US laws that called for their sterilization. Medical doctors and supervisors were allowed to “asexualize” their patients if it was thought it might help their moral physical, mental, or moral condition.
Since the mid 1900’s, treatment of alcoholism and addiction has become more evidence-based, as well as ethically and morally sound. Options for treatment are either inpatient or outpatient, and there are a variety of evidence-based practices at a person’s disposal. Cognitive-behavioural therapy, family therapy, 12-step therapy, community reinforcement interventions and contingency management are all approaches with some efficacy in addressing substance abuse.
CBT was used in addiction psychotherapy to reduce and prevent relapses. A CBT therapist would look at the role that learning has played in a person’s drinking career, and devise ways to recognize and cope differently.
There are more options than ever in finding sobriety or limiting your intake of drugs, alcohol, and addictive behaviours.
Now, we know that recovery is possible.
Conclusion
Addiction is best described as a relapsing brain disorder that involves cravings, loss of control, continued use despite negative consequences, and changes in personality and mood. Everyone’s use of substances and addictive behavious falls on a spectrum, ranging from casual use to problematic use to dependence/addiction.
Regardless of where you are on the spectrum, if you feel like you might be developing a problem with a behaviour or substance, reach out for help. ConnexOntario is an excellent place to start exploring your options. https://www.connexontario.ca/en-ca/
As well, reach out to one of our addiction specialists at CMAP Health.
About the Author
Victoria Howarth is one of our qualifying registered psychotherapists {RP (Q)} and a therapist under supervision at CMAP Health. She has a Master’s Degree in Counselling Psychology at Yorkville University and a Master’s Certificate in Addictions and Mental Health from Durham College. She has experience coaching and counselling adults with substance use disorders with an emphasis on harm reduction. To find out more about Victoria you can view her profile.
