| Addiction and dependence glossary[1][2][3] | |
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An addictive behavior is a behavior, or a stimulus related to a behavior (e.g., sex or food), that is both rewarding and reinforcing, and is associated with the development of an addiction. There are two main forms of addiction: substance use disorders (including alcohol, tobacco, drugs and cannabis) and behavioral addiction (including sex, gambling, eating and shoplifting).[4] The parallels and distinctions between behavioral addictions and other compulsive behavior disorders like bulimia nervosa and obsessive-compulsive disorder (OCD) are still being researched by behavioral scientists.[5]
Defining addictive behavior presents a challenge, as the concept encompasses diverse behaviors, and therefore its usage has been contentious. Although, central to the definition is excessive dependence on a specific substance or activity, derived from the Latin term ‘to enslave.[6] Furthermore, addictive behavior describes patterns characterized by a loss of control and a compulsion to accept a reward despite severe consequences. This often manifests in compulsive engagement, prioritizing short-term gratification over long-term consequences, and a transition from impulsivity to compulsivity.[7] Consequently, addictive behaviors create a spectrum of activities that entrap individuals in repetitive patterns, despite the adverse consequences, echoing the enslavement inherent in the notion of addiction.[8]
Developments in research continue to reshape our understanding of addiction. Traditionally, addiction was largely associated with substance-use disorders, including alcohol and heroin, and therefore “non-substance-related (behavioral) addiction” was not listed in the two internationally used diagnostic manuals for mental disorders. However, contemporary research suggests that any stimulus capable of producing pleasure can lead to addiction. This shift broadens the scope of addiction to include excessive shopping, internet usage, computer gaming, gambling, and sex.[9][10] Addictive behaviors, whether substance-related or behavioral, often involve deficiencies in inhibitory control, emotion regulation, and decision-making.[6] There are significant overlaps in diagnostic symptoms between substance use and behavioral addiction, including dominance over one’s life, euphoric experiences, withdrawal symptoms, interpersonal conflicts, and the risk of relapse despite negative outcomes.[11]
From a neurobiological perspective, behavioral addiction may affect brain neurotransmitter systems similarly to pharmacological substances, such as the dopamine system.[12] These behaviors often follow a three-step cycle consisting of preoccupation (anticipation), binge intoxication, and withdrawal effect, with reinforcement playing a central role in each stage. Reinforcement occurs through positive experiences during the initial engagement, negative reinforcement to alleviate withdrawal symptoms, and conditioned reinforcement where cues associated with behavior or drugs trigger intense cravings, perpetuating the addiction.[13]
Addiction is classified as a chronic brain disorder by the American Society of Addiction Medicine (ASAM).[5] There are several reasons why people develop an addiction. A predisposition to the addictive qualities of substances may be inherited by some people, making it a genetic circumstance. Another cause for addictions could be the environment. Whether or not someone develops substance use problems can be influenced by their home and neighborhood, as well as the attitudes of their peers, family, and culture on substance use.[5] Another cause of developing an addiction could be related to mental health issues: over 50% of individuals with substance use disorders have experienced mental health issues at some point in their lives. Even moderate substance usage might exacerbate mental health issues in individuals.[5] The other view is from the moral standpoint which regards addictive behavior as an intentional choice was freely made by the addict.[14]
Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.41 ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.
Substance-use disorder: A diagnostic term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) referring to recurrent use of alcohol or other drugs that causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Depending on the level of severity, this disorder is classified as mild, moderate, or severe.
Addiction: A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicated by compulsive drug taking despite the desire to stop taking the drug. In the DSM-5, the term addiction is synonymous with the classification of severe substance-use disorder.