Recurrent use of a substance or engagement with an activity leading to impairment or distress, is the sine qua non of an addictive disorder. The diagnosis is based on the presence of at least two of a number of features:
- The substance or activity is used in larger amounts or for a longer period of time than was intended.
- There is a desire to cut down on use or unsuccessful efforts to do so.
- Pursuit of the substance or activity or recovery from its use consumes a significant amount of time.
- There is a craving or strong desire to use the substance or activity.
- Use of the substance or activity disrupts role obligations at work, school, or home.
- Use of the substance or activity continues despite the social or interpersonal problems it causes.
- Participation in important social, work, or recreational activities drops or stops.
- Use occurs in situations where it is physically risky.
- Use continues despite knowing it is causing or exacerbating physical or psychological problems.
- Tolerance occurs, indicated either by need for markedly increased amounts of the substance to achieve the desired effect or markedly diminished effect of the same amount of substance.
- Withdrawal occurs, manifest either in the presence of physiological withdrawal symptoms or the taking of a related substance to block them.
- The severity of the condition is gauged by the number of symptoms present. The presence of two to three symptoms generally indicates a mild condition; four to five symptoms indicate a moderate disorder. When six or more symptoms are present, the condition is considered severe.
Causes of Addiction
Addiction is a multi-faceted condition, arising from the confluence of many elements—including, of course, exposure to an addictive agent. Research makes it clear: There is no way to predict who will develop compulsive substance use or gambling behavior.
Among the factors that contribute to risk are these:
- Estimates vary but scientists find that genetic factors contribute about half the risk for developing a substance use disorder. For example, one factor linked to vulnerability is variation in a gene that determines the makeup of brain receptors for the neurotransmitter dopamine. Another factor appears to be the nature of the body’s hormonal response to stress.
- Physiological factors. Variations in liver enzymes that metabolize substances are known to influence risk of alcohol use disorder.
- Males are more likely to develop substance use disorder than females, although the so-called gender gap may be narrowing for alcohol use disorder and females are more subject to intoxication effects at lower doses of alcohol.
- Personality factors. Both impulsivity and sensation seeking have been linked to substance use and gambling disorders. Impulsivity may be particularly related to the risk of relapse.
- Trauma and abuse. Perhaps by sensitizing brain pathways of alarm/distress, perhaps by adding to the burden of stress, early exposure to significant adverse experience can contribute to the development of substance use disorder by overwhelming the coping ability of an individual.
- Mental health factors. Conditions such as depression, anxiety, attention deficit disorder, and post-traumatic stress disorder (PTSD) increase the risk of addiction. Difficulties managing strong emotions are also linked to substance use.
- Family factors. While strong family relationships have been shown to protect against substance use disorders, several aspects of family functioning or circumstances can contribute to addiction risk. Having a parent or sibling with an addictive disorder raises the risk, as does lack of parental supervision or support. Poor-quality or troubled parent-child relations and family disruptions such as divorce add to risk. Sexual, physical, or emotional abuse also increases risk. Research shows that marriage and taking on child-raising responsibilities mitigate the risk of addiction.
- Accessibility factors. Easy availability of alcohol or other substances in one’s home, at school or work, or in one’s community increases the risk of repeated use.
- Peer group. As profoundly social animals, people are strongly influenced by their peers and, in generally seeking to be liked by them, adopt many of their behaviors, particularly during the adolescent years. Positive social relationships are known to strongly protect against substance use.
- Employment status. Having a job, and developing the skills for employment, exerts pressure for stability and provides financial and psychological rewards that mitigate addiction risk.