The process of addiction is complex and figuring out exactly where it begins requires understanding the circumstances under which is often develops. Just like any other illness, particularly one caused ostensibly by one’s lifestyle, the development of an addiction is often determined by factors both within a person’s control, and outside of their control. The way addiction takes a hold of a person both physically and mentally depends on their genetics, and their life.
But regardless of when or by what mechanism addiction begins, it always starts with one thing: the substance itself. To understand how addiction takes a hold over someone, we need to understand what makes certain substances addictive, and why these substances differ from other similar substances.
Addiction is Uncontrollable
It’s important to start by divorcing addiction from dependence, tolerance, and withdrawal. While these are related concepts, tolerance and withdrawal are concepts that exist in non-addictive medication, and dependence and addiction are not always the same thing. First, most definitions of addiction make a distinction between heavy drug use and addictive drug use based on the person’s own efforts to stop using. If a person tries to quit, but can’t, they’re likely addicted.
But dependence is something else. It’s a physical process by which the body adapts to the drug. This occurs with other substances as well, meaning, substances that aren’t classically addictive. When a drug enters the body and begins interacting with it, the body begins to change in accordance to the effects of the drug (and this differs from person to person). Dependence occurs when it’s clear that quitting would lead to negative effects (withdrawal). These do not necessarily equate to addiction. A person can develop a dependence on medication, experience withdrawal when quitting their medication, and still not feel the need to use (i.e., no cravings). This is why it is important to taper off certain medication.
Addiction is Mental and Physical
Addictive drugs have since been identified to largely interact with certain parts of the brain that are responsible for deep-seated emotions and systems regarding motivation, reward, and self-control. The very core of what drives us to do things is affected by the ingestion and use of addictive drugs, and the more we use these drugs, the more the body (and mind, as an extension of the brain) begins to adapt to, and change, in order to fuel the need to keep using.
The drug begins to overshadow anything else. One common factor among addictive drugs is the way the drug either empowers or increases the production or recipience of dopamine. This is a naturally occurring neurotransmitter that plays a critical role in many different processes, including motivation and reward. Other, non-addictive drugs that interact with similar neurotransmitters haven’t had the same addictive effect on the mind (including drugs such as SSRIs, which solely target the reuptake of serotonin).
All this goes to demonstrate that the process by which a person becomes addicted separates itself from the way the body and brain react to other drugs by way of how addictive drugs affect a very specific portion of the mind, one intrinsically linked to how we motivate ourselves, and to how we naturally crave for certain things (whether it’s entertainment, sex, or food cravings outside of hunger). Yet because addictive drugs act on these systems at a magnitude far beyond what they are usually equipped to handle, the long-term effect is a disproportionate craving for the addictive drug, and a growing lack of passion for previous interests.
Addiction is Genetic and Environmental
The manner in which this process unfolds is entirely subjective. Some people develop addiction much faster than others, for specific substances. There is plenty of evidence to suggest that addictiveness is hereditary, in the sense that someone with a long history of alcoholism in the family is much more likely to become an alcoholic if exposed to heavy drinking, and so on.
Aside from genetic factors, environmental factors and life experience heavily inform addiction. Teens are more likely to develop an addiction if they start using drugs early on, because the effects are much more pronounced on a developing brain. High levels of stress usually coincide with addiction, because the stress reinforces the behavior of using drugs to self-medicate, to address a bad mood, to escape reality, or to conform to the external pressure to use drugs.
Poor mental health or mental instability caused by hereditary conditions or the results of trauma (PTSD) or bullying and shaming (especially among LGBTQ+) are also more likely to lead to an addiction, as these individuals are more likely to turn to drugs as a way to cope, which further puts them at risk for developing a mental and a physical dependence on the substance, and a true substance use disorder.
Addiction is Chronic and Treatable
An addiction is supported by continued drug use. It’s simply nearly impossible to treat someone who continues to use a substance that contributes to the biological changes that affect their behavior. If the ultimate problem with an addiction is the fact that it leads to self-destructive and uncontrollable behavior, then eliminating the root of that addiction is the first step to overcoming it.
But it isn’t that simple. It’s not as easy as just turning off a tap and waiting for the sink to drain. While the first step of helping someone get better should be to separate them from their drug(s) of choice, a lot of patience is required for the following countless steps. There are different approaches, some of which involve therapy, some of which require psychiatric help and medication, and some of which involve other treatments such as the 12 Step Method, but the gist of addiction treatment is understanding that many cases of addiction are chronic, and feature a long period mired by powerful cravings, potential relapses, and the psychological and physical stress of withdrawal and post-acute withdrawal.
As the body and brain readjust to sobriety, a recovering addict is often faced with a series of difficult choices and responsibilities as part of their reintroduction to society. It takes a lot of support to help soften the initial blows of early recovery and make the path towards long-term sobriety as smooth as possible. Because an addiction comes with constant reminders and memories of drug use, a big part of becoming sober is overcoming the need to use again.
That can be difficult, because life often is difficult, and all have our ways of coping with it. For an addict, there can be only one real choice. Helping them identify and rely on other, healthier choices is both important, and hard. That is where support becomes critical, both in the form of professional help (through sober living homes, continued therapy, and group meetings), as well as friends and family. Addiction may be chronic, but it is treatable over time.