Smokers, Shopaholics and Sugar Highs
We’ve probably all met somebody who has been addicted to smoking and perhaps come across alcoholics or people who may be drug dependent. But, of course, addiction isn’t limited to cases that involve addictive substances.
Scientists and healthcare professionals also recognize compulsions that involve many everyday activities that can be taken to extremes. How many people do we know who spend significant proportions of their time online or playing computer games or compulsively engaging in otherwise healthy activities such as exercise?
Experts recognize many forms of addiction that are not related to obvious substance abuse. These include: compulsive shopping, sex addiction, overeating or a compulsion to eat certain items such as sugar, problem gambling, exercise and sport, compulsive or binge travel, and computer addiction. In these instances, the term “addiction” is used to describe a recurring compulsion by an individual to engage in some rewarding activity, despite harmful consequences (as deemed by that individual) to their health, mental state, or social life.
Thus, addiction can encompass any condition that results from a person repeatedly ingesting a substance – such as alcohol or a drug like cocaine or nicotine – that subsequently interferes with ordinary life responsibilities, such as work, relationships or health. Equally, it may refer to activities that can ordinarily be pleasurable but – taken to extreme – interfere with life in a similar way to substance addiction. One significant aspect is that addicts may not be aware that their behavior is out of control and causing problems for themselves and others.
Physical addiction tends to cause the body to adapt to the presence of a drug with increasing tolerance. Then, if that specific drug is discontinued, there tends to be a biological reaction with specific withdrawal symptoms. Another form of physical addiction is the phenomenon of over reaction by the brain to drugs (or to cues associated with certain drugs). For example, an alcoholic walking into a bar will feel increased desire to have a drink because of such cues.
However, physical drug dependence does not necessarily drive many addictions: for example, people may compulsively use drugs, shop or engage in sex in response to being emotionally stressed, irrespective of any physical addiction they may have. This may account for why people frequently switch addictive actions from one drug to a completely different kind of drug, or even to a non-drug behavior.
Experts also argue that, when referring to any kind of addiction, it is important to recognize that its cause is not simply a search for pleasure. Furthermore, addiction has nothing to do with one's morality or strength of character.
According to the American Society of Addiction Medicine (ASAM), addiction is a “primary, chronic disease of brain reward, motivation, memory and related circuitry. It affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviors, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviors.”
It continues: “Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.”
The ASAM adds that the neurobiology of addiction encompasses more than the neurochemistry of reward. It states: “Many neuroscientists believe that developmental morphology is the basis that makes early-life exposure to substances such an important factor.”
Genetic and environmental factors
Genetic factors account for about half of the likelihood that an individual will develop addiction, according to the ASAM. “Environmental factors interact with the person’s biology and affect the extent to which genetic factors exert their influence. Resiliencies the individual acquires (through parenting or later life experiences) can affect the extent to which genetic predispositions lead to the behavioral and other manifestations of addiction. Culture also plays a role in how addiction becomes actualized in persons with biological vulnerabilities to the development of addiction.”
Cost to society
US figures dating back to 2004 suggest that the total cost of drug abuse and addiction relating to tobacco use, alcohol and illegal drugs were estimated at $524 billion a year. Illicit drug use alone accounted for $181 billion in health care, productivity loss, crime, incarceration and drug enforcement costs.
Deaths in the United States resulting from tobacco consumption (18.1%) in 2006 topped those caused by poor diet and lack of physical activity (16.6%); the next biggest killer was alcohol abuse (3.5%). In comparison, motor vehicles were only responsible for 1.8% of deaths.
The American Society of Addiction Medicine defines addiction as:
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.” American Society of Addiction Medicine.
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