An addiction is a recurring compulsion by an individual to engage in some specific activity. The term is often reserved for drug addictions  & alcoholism but it is sometimes applied to other compulsions, such as problem gambling, compulsive overeating, pornography, and hyper religiosity Factors that have been suggested as causes of addiction include genetic, biological/pharmacological and social factors.

Not all doctors agree on what addiction or dependency is. Traditionally, addiction has been defined as being possible only to a psychoactive substance (for example alcohol, tobacco and other drugs) which ingested cross the blood-brain barrier, altering the natural chemical behaviour of the brain temporarily. However, "Studies on phenomenology, family history, and response to treatment suggest that intermittent explosive disorder, kleptomania, pathological gambling and pyromania may be related to mood disorders, alcohol and psychoactive substance abuse, and anxiety disorders (especially obsessive-compulsive disorder)

It is generally accepted that addiction is a disease, a state of physiological or psychological dependence or devotion to something manifesting as a condition in which medically significant symptoms liable to have a damaging effect are present

Many people, both psychology professionals and laypersons, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, cutting, shopping, and religion so that these behaviours count as diseases as well and don't cause guilt, shame, fear, hopelessness, failure, rejection, anxiety, or humiliation symptoms associated with, among other medical conditions, depression, epilepsy, and hyper religiosity. In depression related to religious addiction "The religious addict seeks to avoid pain and overcome shame by becoming involved in a belief system which offers security through its rigidity and its absolute values. However, religion can also be a source of pain, guilt and exclusion, and religious themes may also play a negative role in psychopathology. Understanding of neural science, the brain, the nervous system, human behaviour and affective disorders has revealed "the impact of molecular biology in the mechanisms underlying developmental processes and in the pathogenesis of disease

The use of thyroid hormones as an effective adjunct treatment for affective disorders has been studied over the past three decades and has been confirmed repeatedly.

In the contemporary view, the trend is to acknowledge the possibility that the hypothalamus creates peptides in the brain that equal and/or exceed the effect of externally applied chemicals (alcohol, nicotine etc.) when addictive activities take place. For example, when an addicted gambler or shopper is satisfying their craving, chemicals called endorphins are produced and released within the brain, reinforcing the individual's positive associations with their behaviour.

Physical dependency

Physical dependence on a substance is defined by the appearance of characteristic withdrawal symptoms when the substance or behaviour is suddenly discontinued. While opioids, benzodiazepines, barbiturates, alcohol and nicotine are all well known for their ability to induce physical dependence, the categories of substances share this property and are not considered addictive: cortisone, beta-blockers and most antidepressants are examples. So, while physical dependency can be a major factor in the psychology of addiction and most often becomes a primary motivator in the continuation of an addiction, the initial primary attribute of an addictive substance is usually its ability to induce pleasure, although with continued use the goal is not so much to induce pleasure as it is to relieve the anxiety caused by the absence of a given addictive substance, causing it to become used compulsively. An example of this is nicotine. Users report that a cigarette can be pleasurable, but there is a medical consensus that the user is fulfilling his/her physical addiction and, therefore, is achieving pleasurable feelings relative to his/her previous state of physical withdrawal. Further, the physical dependency of the nicotine addict on the substance itself becomes an overwhelming factor in the continuation of use. Although 35 million smokers make an attempt to quit every year, fewer than 7% achieve even one year of abstinence (from the NIDA research report on nicotine addiction).

Some substances induce physical dependence or physiological tolerance - but not addiction - for example many laxatives, which are not psychoactive; nasal decongestants, which can cause rebound congestion if used for more than a few days in a row; and some antidepressants, most notably venlafaxine, paroxetine and sertraline, as they have quite short half-lives, so stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressants. Many non-addictive prescription drugs should not be suddenly stopped, so a doctor should be consulted before abruptly discontinuing them.

The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, the intensity of pleasure or euphoria, and the individual's genetic and psychological susceptibility. Some alcoholics report they exhibited alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Studies have demonstrated that opioid dependent individuals have different responses to even low doses of opioids than the majority of people, although this may be due to a variety of other factors, as opioid use heavily stimulates pleasure-inducing neurotransmitters in the brain. The vast majority of medical professionals and scientists agree that if one uses strong opioids on a regular basis for even just a short period of time, one will most likely become physically dependent. Nonetheless, because of these variations, in addition to the adoption and twin studies that have been well replicated, much of the medical community is satisfied that addiction is in part genetically moderated. That is, one's genetic makeup may regulate how susceptible one is to a substance and how easily one may become psychologically attached to a pleasurable routine.

Eating disorders are complicated pathological mental illnesses and thus are not the same as addictions described in this article. Eating disorders, which some argue are not addictions at all, are driven by a multitude of factors, most of which are highly different than the factors behind addictions described in this article.

Psychological dependency

Psychological dependency is a dependency of the mind, and leads to psychological withdrawal symptoms (such as cravings, irritability, insomnia, depression, anorexia etc). Addiction can in theory be derived from any rewarding behaviour, and is believed to be strongly associated with the dopaminergic system of the brain's reward system (as in the case of cocaine and amphetamines). Some claim that it is a habitual means to avoid undesired activity, but typically it is only so to a clinical level in individuals who have emotional, social, or psychological dysfunctions (psychological addiction is defined as such), replacing normal positive stimuli not otherwise attained.

It is considered possible to be both psychologically and physically dependent at the same time. Some doctors make little distinction between the two types of addiction, since the result, substance abuse, is the same. However, the cause and characteristics of each of the two types of addiction is quite different, as is the type of treatment preferred.

Psychological dependence does not have to be limited only to substances; even activities and behavioural patterns can be considered addictions, if they are harmful, e.g. gambling, Internet use, usage of computers, sex / pornography, eating, self-harm, vandalism or work.

Addiction and drug control legislation

Most countries have legislation which brings various drugs and drug-like substances under the control of licensing systems. Typically this legislation covers any or all of the opiates, methamphetamines, cannabinoids, cocaine, barbiturates, hallucinogens (tryptamines, LSD, phencyclidine(PCP), psilocybin) and a variety of more modern synthetic drugs, and unlicensed production, supply or possession may be a criminal offence.

Usually, however, drug classification under such legislation is not related simply to addictiveness. The substances covered often have very different addictive properties. Some are highly prone to cause physical dependency, whilst others rarely cause any form of compulsive need whatsoever. Typically nicotine (in the form of tobacco) is regulated extremely loosely, if at all, although it is well-known as one of the most addictive substances ever discovered.

Also, although the legislation may be justifiable on moral grounds to some, it can make addiction or dependency a much more serious issue for the individual. Reliable supplies of a drug become difficult to secure as illegally produced substances may have contaminants. Withdrawal from the substances or associated contaminants can cause additional health issues and the individual becomes vulnerable to both criminal abuse and legal punishment. Criminal elements that can be involved in the profitable trade of such substances can also cause physical harm to users.

Methods of care

Early editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) described addiction as a physical dependency to a substance that resulted in withdrawal symptoms in its absence. Recent editions, including DSM-IV, have moved toward a diagnostic instrument that classifies such conditions as dependency, rather than addiction. The American Society of Addiction Medicine recommends treatment for people with chemical dependency based on patient placement criteria (currently listed in PPC-2), which attempt to match levels of care according to clinical assessments in six areas, including:

• Acute intoxication and/or withdrawal potential
• Biomedical conditions or complications
• Emotional/behavioural conditions or complications
• Treatment acceptance/resistance
• Relapse potential
• Recovery environment

While addiction or dependency is related to seemingly uncontrollable urges, and arguably could have roots in genetic predispositions, treatment of dependency is conducted by a wide range of medical and allied professionals, including Addiction Medicine specialists, psychiatrists, and appropriately trained nurses, social workers, and counsellors. Early treatment of acute withdrawal often includes medical detoxification, which can include doses of anxiolytics or narcotics to reduce symptoms of withdrawal. An experimental drug, ibogaine, is also proposed to treat withdrawal and craving. Alternatives to medical detoxification include acupuncture detoxification. In chronic opiate addiction, a surrogate drug such as methadone is sometimes offered as a form of opiate replacement therapy. But treatment approaches universal focus on the individual's ultimate choice to pursue an alternate course of action.

Therapists often classify patients with chemical dependencies as either interested or not interested in changing. Treatments usually involve planning for specific ways to avoid the addictive stimulus, and therapeutic interventions intended to help a client learn healthier ways to find satisfaction. Clinical leaders in recent years have attempted to tailor intervention approaches to specific influences that affect addictive behaviour, using therapeutic interviews in an effort to discover factors that led a person to embrace unhealthy, addictive sources of pleasure or relief from pain.

The cultural model recognises that the influence of culture is a strong determinant of whether or not individuals fall prey to certain addictions. For example, alcoholism is rare among Saudi Arabians, where obtaining alcohol is difficult and using alcohol is prohibited. In North America, on the other hand, the incidence of gambling addictions soared in the last two decades of the 20th century, mirroring the growth of the gaming industry. Half of all patients diagnosed as alcoholic are born into families where alcohol is used heavily, suggesting that familiar influence, genetic factors, or more likely both, play a role in the development of addiction. What also needs to be noted is that when people don't gain a sense of moderation through their development they can be just as likely, if not more, to abuse substances than people born into alcoholic families.

The moral model states that addictions are the result of human weakness, and are defects of character. Those who advance this model do not accept that there is any biological basis for addiction. They often have scant sympathy for people with serious addictions, believing either that a person with greater moral strength could have the force of will to break an addiction, or that the addict demonstrated a great moral failure in the first place by starting the addiction. The moral model is widely applied to dependency on illegal substances, perhaps purely for social or political reasons, but is no longer widely considered to have any therapeutic value. Elements of the moral model, especially a focus on individual choices, have found enduring roles in other approaches to the treatment of dependencies.

The blended model attempts to consider elements of all other models in developing a therapeutic approach to dependency. It holds that the mechanism of dependency is different for different individuals, and that each case must be considered on its own merits.

Adapted from  Wikipedia, encyclopedia