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Addiction or substance abuse is a complex brain disease. A person with an addiction experiences cravings that persist even in the face of extremely negative consequences. During a craving, a person with an addiction misses the habit-forming drug terribly, and often he or she experiences symptoms of withdrawal.
Evidence strongly suggests that genetic susceptibilities and biological traits play a role in addictions; however, the development of an addiction is also shaped by a person's environment (for example, a person with alcoholism cannot become addicted without access to alcohol). The "addictiveness" of a drug is related to how strongly the drug activates the reward circuits in the brain. For instance, when the methamphetamine found on the street is purer (meaning that it stimulates the dopamine reward circuits more), then the number of first-time drug users who become drug abusers is higher.
Addictive substances or behaviors change the reward circuits in the brain. In other words, the brain responds to the addictive substance in the same way that it responds to very pleasurable experiences. This explains, in a general sense, why people with addictions sometimes forsake all other life activities and obligations and even their own health in pursuit of the addictive substance.
According to the Diagnostic and Statistical Manual of Mental Disorders, substance use is considered abusive or addictive if the person has experienced three or more of the following signs during a 12-month period:
Drug abuse can occur with or without tolerance or withdrawal. Tolerance and withdrawal indicate physical dependence. A key issue in evaluating addiction is if a person is unable to stop using the harmful substance (loss of control). Often people who are addicted to a drug do not have insight into their inability to stop drug use and falsely believe they could stop if they "wanted to." This is called denial.
No single event or criterion is indicative of an addictive disorder; drug use becomes addiction (drug abuse) only after a pattern of behavior that takes place over time. In many ways, current definitions of addiction are limited and mostly incorporate behavioral symptoms in the definition.
Medically Reviewed by a Doctor on 1/4/2016
Maureen C Nash, MD, MS
Jessica B Johnson
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