Robert J. Middleton, MD
What is Addiction?
Addiction represents a pattern of thinking and feeling that drives behavior with progressively worsening consequences over time and the decreased ability to regulate that behavior. Addictions can be categorized as "substance" (alcohol, opioids, nicotine, etc.) and "process" (gambling, sex, pornography, relationships, etc.). Often, substance addictions are also associated with a powerful physical component, which is the withdrawal syndrome characteristic for that substance, when the amount present in our body is not enough to prevent it. This is why detoxification is often the first stage of treatment.
The vulnerability to develop an addiction is quite unique to each person and determined by a complex interaction of genetics and multiple environmental factors. The single greatest risk factor however, is a family history of addiction.
In people who are vulnerable to developing an addiction, it is the repeated alteration of brain chemistry through the reinforcing effects of substances and behaviors that may eventually produce changes in the "reward" areas of the brain. Some of these are permanent, while others are reversible over time with abstention from the behavior.
Addictions are recognized as diseases because they are inheritable, progressively worsening, primary (can occur by themselves) and have a predictable natural history of their evolution and effects.
In psychiatry, the academic term "substance use disorder", with varying levels of severity, is currently in fashion to describe the continuum of substance use, abuse, dependence and addiction.
I believe simpler terminology can be used more effectively to describe these different states. Abuse is inapproriate use for whatever reason. Dependence means a withdrawal syndrome can occur if the amount in our body is not sufficient to prevent it. Addiction is characterized by a loss of control over the behavior and its negative consequences, craving to resume the behavior and, when actually engaged in the behavior, the compulsion to continue it. Substance addiction is usually, but not always, associated with dependence as well.
Recovery from addiction is also characterized by a vulnerability to "relapse", a re-igniting of the active form of the disease with the resumption of harmful behaviors.
Relapse behavior is used to seek relief from our thinking and feeling when other methods are not utilized by the person with the addiction. In my experience, relapse represents a dramatic underestimation of the tremendous power of addiction thinking and its effects on the behavior of each individual.
Therefore, abstinence from the behavior and learning to recognize addiction thinking and not fall prey to it are the cornerstones of successful recovery.