Understanding Addiction
Addiction is a brain condition, not a moral failing. Here's what science tells us about how it works and what helps.
How Addiction Works
### The Reward System
Addictive substances hijack the brain's natural reward system[1]. The brain's reward system evolved to reinforce survival behaviors (eating, social bonding), but addictive substances create much stronger signals.
Brain rewardⓘ
Sugar activates reward circuits intensely—in rats, 94% preferred intense sweetness over cocaine[3]. The reward circuits respond intensely to concentrated sweetness, which may partly explain difficulties with sugar and processed food.
### Tolerance and Withdrawal
With repeated use, the brain adapts:
- Tolerance: Need more of the substance to get the same effect
- Dependence: Brain adjusts to expect the substance
- Withdrawal: Unpleasant symptoms when the substance is removed
Withdrawalⓘ
### Craving
Craving is triggered by stress and environmental cues[5].
Environmental triggers include:
- Places associated with use
- People you used with
- Emotional states (stress, boredom, celebration)
- Sensory cues (smells, sounds, visuals)
Behavioral Addictions
Addiction isn't limited to substances. Gaming addiction shows measurable brain changes[6].
Behavioral addictions share key features with substance addictions:
- Compulsive engagement despite negative consequences
- Tolerance (need more to feel the same)
- Withdrawal symptoms when stopped
- Hijacking of reward pathways
Common behavioral addictions:
- Gambling
- Internet/gaming
- Social media
- Shopping
- Pornography
What Helps Recovery
### Social Support
Changing social networks is crucial for recovery[7].
What helps:
- Support groups (AA, NA, SMART Recovery)
- Rebuilding relationships with non-using friends and family
- Making new connections in recovery communities
- Peer support specialists who have lived experience
### Treatment Works
Treatment engagement reduces harm[8].
Effective treatments include:
- Medication: For some addictions (opioids, alcohol, nicotine), medications can reduce cravings and ease withdrawal
- Therapy: CBT, motivational interviewing, contingency management
- Support groups: 12-step programs, SMART Recovery
- Residential treatment: For severe cases or when environment is triggering
### Mindfulness and Attention Training
Mindfulness improves impulse control[9].
Attention training shows promise as add-on treatment[10]
Why mindfulness helps:
- Creates space between craving and action
- Improves emotion regulation
- Reduces stress (a major trigger)
- Increases awareness of automatic patterns
### Recovery Narratives
Recovery stories share common themes[11].
Common elements of successful recovery:
- Turning point: Recognizing the need to change
- New identity: Seeing oneself as a person in recovery
- Purpose: Finding meaning beyond substance use
- Connections: Rebuilding supportive relationships
- Ongoing growth: Viewing recovery as a journey, not a destination
### The Recovery Cascade
Recovery requires multiple supports[12].
Recovery is rarely linear. Most people:
- Try multiple times before achieving lasting recovery
- Benefit from multiple types of support simultaneously
- Need different things at different stages
Myths About Addiction
Reality: Initial use may be a choice, but addiction changes brain circuitry in ways that impair decision-making and impulse control.
Reality: Earlier intervention is more effective. Waiting for catastrophe causes unnecessary harm.
Reality: Relapse is common and doesn't erase progress. Rates are similar to other chronic diseases like diabetes.
Reality: Treatment, support systems, and often medication are far more effective than "just stopping."
Harm Reduction
When abstinence isn't achieved or isn't the goal:
- Needle exchanges: Reduce disease transmission
- Medication-assisted treatment: Reduces overdose deaths
- Drug checking services: Prevent unintended overdoses
- Safe consumption sites: Reduce deaths and connect users to services
Harm reductionⓘ
If You or Someone You Know Needs Help
Recovery is possible at any stage. Key first steps:
1. Talk to a doctor — They can assess, refer, and prescribe medications if appropriate
2. Contact a helpline — Anonymous support and information
3. Try a support group — SMART Recovery, AA/NA, or other mutual aid groups
4. Involve trusted people — Recovery works better with support
Treatment doesn't have to be perfect to help. Partial engagement is still valuable.
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References
- ['Badiani A', 'Belin D', 'Bhutton M', 'Drummond D', 'Robinson T'] (2007). The Mechanistic Classification of Addictive Drugs. PLOS Medicine. [DOI]
- ['Lenoir M', 'Serre F', 'Cantin L', 'Ahmed SH'] (2007). Intense Sweetness Surpasses Cocaine Reward. PLOS ONE. [DOI]
- ['Nakagawa T', 'Kondo S', 'Takebayashi Y'] (2021). A mindfulness-based, stress and coping model of craving in methamphetamine users. PLOS ONE. [DOI]
- ['Yuan K', 'Cheng P', 'Dong T', 'Bi Y', 'Xing L', 'Yu D'] (2012). Cortical Thickness Abnormalities in Late Adolescence with Online Gaming Addiction. PLOS ONE. [DOI]
- ['Kelly JF', 'Stout RL', 'Magill M', 'Tonigan JS', 'Pagano ME'] (2014). Young Adults, Social Networks, and Addiction Recovery: Post Treatment Changes in Social Ties and Their Role as a Mediator of 12-Step Participation. PLOS ONE. [DOI]
- ['Chang Z', 'Lichtenstein P', 'Långström N', 'Larsson H', 'Fazel S'] (2015). Mental Health Services and Public Safety: Substance Abuse Outpatient Visits Were Associated with Reduced Crime Rates in a Swedish Cohort. PLOS ONE. [DOI]
- ['Kianersi S', 'Semnani Y', 'Nazari MA', 'Moulodi F'] (2023). The effect of mindfulness on decision-making, inhibitory control, and impulsivity of substance use disorder in-treatment patients: A randomized clinical trial. PLOS ONE. [DOI]
- ['Boffo M', 'Willemen L', 'Pronk T', 'Wiers RW'] (2021). Effectiveness of attentional bias modification training as add-on to regular treatment in alcohol and cannabis use disorder: A multicenter randomized control trial. PLOS ONE. [DOI]
- ['Parkman T', 'Lloyd C', 'Spilsbury K'] (2022). Characteristics of alcohol recovery narratives: Systematic review and narrative synthesis. PLOS ONE. [DOI]
- ['Williams AR', 'Nunes EV', 'Bisaga A', 'Levin FR', 'Olfson M'] (2019). Defining a recovery-oriented cascade of care for opioid use disorder: A community-driven, statewide cross-sectional assessment. PLOS Medicine. [DOI]