Addiction to drugs represents the most severe manifestation of what is clinically now referred to as a substance use disorder. In the United States, all of the major mental health organizations follow the lead of the American Psychiatric Association (APA) when referring to and discussing the identification and diagnoses of many types of mental health disorders (forms of mental illness).
A substance use disorder occurs when a person’s continued use of drugs or alcohol results in them experiencing significant stress, a failure to meet personal obligations, and/or significant impairment in functioning.
Substance use disorders range from mild to severe with mild forms representing what once used to be referred to as drug (or alcohol) abuse and more severe forms representing what used to be referred to as addiction. Addictions represent severe manifestations of drug abuse that have significant, detrimental effects.
According to the APA, physical dependence on drugs or alcohol occurs after a person engages in prolonged use of some substance. The person will experience changes in their metabolism, brain functioning, and other areas that result in developing a tolerance for the substance.
Tolerance occurs when the person needs more and more of a drug to get the effects they once achieved at a much lower dose. As time goes on, the changes in the person’s physical system result in it being thrown out of balance when there is not a specific level of the drug or alcohol in their tissues.
The person’s metabolism will break down and eliminate drugs and alcohol, and if the person does not continually use the substance, its levels will decline, resulting in a state of imbalance. This leads to the person experiencing withdrawal symptoms. When a person develops withdrawal symptoms, they have developed a physical dependence on the substance.
No. According to the diagnostic criteria put forth by APA, the development of physical dependence is neither necessary nor sufficient to be diagnosed with any level or type of substance use disorder. Many people who use medications to treat specific illnesses or problems may develop a level of physical dependence on the medication, but they would not be diagnosed with a substance use disorder. Likewise, many individuals diagnosed with substance use disorders, even at the highest level of severity, may not display significant withdrawal symptoms.
According to the book The ASAM Principles of Addiction Medicine published by the American Society of Addiction Medicine (ASAM), the preferred term for the process that is still referred to by some as medical detox is withdrawal management. The process is the same no matter how it is labeled.
It consists of the prescription and administration of medications by an addiction medicine physician to alleviate withdrawal symptoms that occur from many different types of drugs or from alcohol. The medications used in this process may actually be medications that are in the same class as the drug that the individual has abused.
For example, the drug Suboxone is an opiate drug that is used for the treatment of opiate withdrawal. Conversely, it may be medications that are designed to treat specific symptoms.
The use of these drugs alleviates many of the symptoms that occur from withdrawal, including nausea, anxiety, confusion, and even seizures. Other medications may address specific symptoms, such as a headache, insomnia, or lethargy.
When the medication used in the withdrawal management process is one that also can produce physical dependence, the physician will begin with a dosage that controls the person’s withdrawal symptoms. Over time, they will slowly reduce the dosage to allow the person to habituate to lower amounts of the drug in their system. Eventually, the drug can be discontinued without any adverse effects.
It is important to be aware that simply getting through the withdrawal process does not constitute recovery from a substance use disorder.
There is no specific answer to this question. According to the book Addiction and Change: How Addictions Develop and Addicted People Recover, whether or not a person develops a substance use disorder and how fast it develops in any person depends on factors such as:
There is no way of determining how fast any individual will develop a substance use disorder. Some people say they were addicted when they first began using a substance, whereas others claim it took years for their problem to develop.
Certainly, some individuals do demonstrate significant signs of substance abuse rather quickly, whereas others who engage in very similar types of behaviors may never display the types of symptoms associated with a substance use disorder. The speed at which any substance abuse issue develops varies from person to person.
This is a very complex question, and the answer is no less complex. According to numerous sources, including research studies such as the one reported in the journal Psychological Medicine, genetic factors play a significant role in the development of any form of substance use disorder.
The APA reports that a significant risk factor for the development of any substance use disorder (or any form of mental illness) is having a family history of a substance use disorder. The risk is increased for those who have first-degree relatives (parents or siblings) who had been diagnosed with a substance use disorder.
However, other risk factors also increase the possibility that a person will develop a substance use disorder. It is generally considered that the interaction of numerous factors leads to any single person developing any type of addiction.
When many people ask this question, they are actually asking if someone is destined to become addicted to drugs or alcohol if they have a certain type of genetic makeup. The answer to that question is “no.” Simply having a family history of a substance use disorder does not guarantee that anyone will absolutely develop an addiction themselves. Addictive behaviors are complex and consist of numerous interacting factors.
The only way to definitely tell if a person has a substance use disorder is to have that person formally evaluated by a licensed mental health clinician. According to the APA and ASAM, signs may indicate a person has a potential substance abuse issue.
Unfortunately, the above signs could also be due to numerous other causes. Substance use disorders will typically result in the person having problems in their personal relationships, at work, at school, and in other important areas of life. Even though any of these above observations might signal the potential for some type of substance abuse issue, only a professional evaluation can determine the presence and severity of a substance abuse issue.
No, there is no cure for addiction. The notion that someone can actually be “cured” of their substance use disorder is not accepted among the major organizations involved in the diagnosis and treatment of mental illness.
This does not mean there is no hope for people who struggle with substance use disorders. According to the National Institute on Drug Abuse (NIDA), people with substance use disorders can be treated, their behavior can improve, and if the treatment program follows a set of general principles, the outcome is very often positive.
However, the notion that a person is cured of a substance use disorder as a result of their treatment is not accepted by any major mental health care organization. Individuals in recovery have to work hard and maintain their participation in treatment for many years to sustain their recovery.
The psychological term personality refers to an individual’s unique and enduring pattern of behaving, feeling, and thinking. Despite the popular notion that someone can have an addictive personality, research studies have never been able to identify such a construct in individuals who have all types of addictions.
Nonetheless, sources like APA, ASAM, and NIDA have reported research studies that indicate that certain types of traits may result in an individual being at an increased risk to develop a substance abuse problem.
Individuals with these traits are not guaranteed to develop issues with substance abuse, but they may be at a greater risk to engage in substance abuse. However, some of these traits, such as nonconformity, thrill-seeking, or a tendency to be impulsive at times, have also been associated with being successful in certain types of activities. The research on personality and addiction has never been able to fully describe any personality type or characteristics that can predict later substance abuse.
(November 2013). Classification and definition of misuse, abuse, and related events in clinical trials: ACTTION systematic review and recommendations. Pain. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460151/
(April 2015). The Heritability of Alcohol Use Disorders: A Meta-Analysis of Twin and Adoption Studies. Psychological Medicine. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345133/
(January 2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse. Retrieved December 2018 from https://www.google.com/search?q=NIDA+prinicpples+of+effective+treatment&rlz=1C1EJFA_enUS679US679&oq=NIDA+prinicpples+of+effective+treatment+&aqs=chrome..69i57j69i60.8023j0j7&sourceid=chrome&ie=UTF-8