The cycle of addiction

Addiction is considered a brain disease in the field of pharmacology. This is because many of its causes are rooted in individual differences. Different genetic architectures mean we all have different baseline levels of neurochemicals and slightly different brain structures. This means that some people are more vulnerable to addiction than others.

Research suggests that addiction risk is about 50-70% genetic, depending on the substance, and the rest is environmental. As well as the pre-existing brain differences that leave a person susceptible to addiction, the brain changes when exposed to a substance repeatedly, meaning much of addiction rests upon the brain and what happens within it.

Addiction and its characteristics

Addiction is a chronic condition. It can manifest differently depending on the substance, but there are similarities across addictions. Addiction involves cravings, loss of control over the usage of the substance, increasing tolerance, withdrawal symptoms when the substance is discontinued, and growing neglect of important tasks, duties and relationships.

Alcohol addiction and drug addiction develop over time and can be broken down into several discrete stages.

The stages of addiction

Depending on the model, addiction can be broken down into anywhere up to seven stages. The simplest model of the stages of addiction has three stages.

Binge/intoxication

Using the drug in increasingly higher amounts. Addiction is unlikely to occur in the first usage, but depending on the drug and the person’s susceptibility, they will find themselves entering this stage more and more frequently.

Withdrawal and negative affect

The appealing effects of the drug are reinforcing, and similarly, the negative effects of withdrawal reinforce addiction. These include mood disturbances, cravings, anxiety, insomnia and sometimes physical effects like headaches, nausea and vomiting.

Preoccupation and anticipation

This could be to stave off withdrawals or to re-experience the positive effects of the drug. The user will become overwhelmed with thoughts of reusing it, and the cycle begins anew.

These stages worsen over time and become more intense. Repeating this cycle causes the brain to alter, both structurally and in terms of neurotransmitter imbalance. Substances become even more associated with pleasure, baseline mood is lower, and withdrawal symptoms and cravings are more intense. This becomes a self-perpetuating and worsening cycle.

Factors associated with addiction

Genetic factors

There is no single genetic change or variation that causes addiction. Many variations likely protect against or increase the risk of developing it. Some genes that may have a role in susceptibility to addiction have been identified. Many of these are from animal studies and do not necessarily translate to human addiction – but they do raise some interesting questions about the genetic basis of addiction.

Hypodopaminergia

Variations in genes that code for dopamine are theorised to affect susceptibility to addiction. This has been named Reward Deficiency Syndrome (RDS) or hypodopaminergia – too little dopamine activity.

RDS is a deficiency in the brain’s reward system that diminishes the ability to experience pleasure and reward in everyday activities. This drives highly reward-seeking behaviour to make up for this deficiency – drug and alcohol use, overeating and behavioural addictions. People with certain genetic profiles are more prone to developing RDS. It’s caused by lower dopamine metabolism and function, and fewer D2 dopamine receptors in the brain: 30-40% fewer receptors at birth.

Genes that increase vulnerability to certain substance addictions

Hypodopaminergia results in an increased susceptibility to all addictions, but some genes are related to individual substances.

Some people process alcohol differently than others. People who have a gene that codes for a variation of the alcohol dehydrogenase two gene, a protein that breaks down alcohol, are actually protected against alcohol addiction – because they are worse at effectively breaking down alcohol. Drinking causes them to feel flushed and nauseous and experience headaches and rapid heart rate, which makes drinking less enjoyable. On the other hand, people with a genetic variation that lets them break down alcohol more effectively than others are at an increased risk of addiction.

Genetic variations can cause higher levels of baseline stress, differences in serotonin transportation, increased pain-stress response, lower pain thresholds and many, many more individual variations that science is only just beginning to map out. These can affect addiction risk in many ways – how well we metabolise substances, how good we feel when sober, how much stress affects us, how much affinity certain substances have with our neurobiological makeup and more.

Environmental factors

Having more exposure to drugs and alcohol or living in an environment that normalises addiction and substance misuse increases the risk of addiction. Early exposure to drugs and alcohol is especially risky. Early initiation into drug and alcohol usage, particularly before the age of 14, increases the risk of alcoholism and drug addiction.

Socioeconomic deprivation and poverty are also linked to an increase in substance use and drug and alcohol-related mortality. This link gets much stronger over time, with economic deprivation strongly associated with drug and alcohol-related harms as a person ages.

Psychological factors

A pre-existing mental health condition increases the risk of addiction, and in turn, addiction exacerbates underlying mental health conditions. This is deeply interwoven with genetic causes, as mental health conditions have a similar balance of genetic and environmental basis. Self-medication is a common driver of substance use.

Social factors

Social factors overlap with psychological factors. Adverse childhood experiences increase the risk of addiction in later life – and also increase the risk of developing mental health problems like PTSD, which in turn have an impact on susceptibility to addiction.

Adverse childhood events are stressful or traumatic events that happen before the age of 18 – domestic violence, sexual abuse, neglect, suicide or having an addicted person in the household. The risk of addiction increases in proportion to the number of traumatic events experienced.

Events do not need to be categorised as severely traumatic to impact addiction. Low-grade stress, such as work, difficult relationships or certain family dynamics, can increase addiction, especially if a person is already vulnerable to stress.

Breaking the cycle

Alcoholism treatment or drug addiction treatment is multifaceted, and professional help and a strong support system will give you the best chance of beating your addiction.

If your addiction has become sufficiently severe that you think you will struggle to deal with it alone, rehab treatment is an excellent option. It brings together as many treatment modalities as possible, helping you fight your addiction on several fronts.

This can include medically assisted detox, if appropriate, to get through severe withdrawals and long-term support and advice on how to stop drinking or using drugs after detox. You will be offered behavioural therapies and counselling to both treat your addiction and its underlying causes, along with holistic treatments that aim to heal both body and mind. Group therapy, family therapy and support groups will help you to reduce the isolation of recovery and build new and supportive relationships. You will also have support and monitoring to prevent relapse and will be given the tools to develop a healthier lifestyle.

Some people are more vulnerable to addiction than others – but no one is predestined to become addicted, and anyone can beat their addiction with the right tools and support.