Addictive behavior

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Addiction and dependence glossary [1] [2] [3]
  • addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences
  • addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems
  • dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)
  • drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose
  • drug withdrawal – symptoms that occur upon cessation of repeated drug use
  • physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens)
  • psychological dependence – dependence socially seen as being extremely mild compared to physical dependence (e.g., with enough willpower it could be overcome)
  • reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them
  • rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach
  • sensitization – an amplified response to a stimulus resulting from repeated exposure to it
  • substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress
  • tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

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]

Contents

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 the human's 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]

How addiction affects the brain

Brain imaging techniques have assisted in mapping neural circuits involved in addictive behaviors, such as reward responses, cravings, cue conditioning, and withdrawal symptoms. This has provided key insights on the underlying mechanisms of addiction, including substance use and non-substance (behavioral) addictions. [15]

Addiction hijacks the brain’s reward system, which normally encourages individuals to engage in survival-related activities such as socializing, eating, or achieving goals. Substances or specific behavioral activities create an intense “high” by flooding the reward system with dopamine, a chemical commonly known as “a feel-good chemical". Over time, the brain adapts to this surge by dampening its dopamine production and sensitivity to rewards. Consequently, the addicted individual may experience feelings of sluggishness and lack of motivation unless they consume the substance or engage in an activity to attain a sense of normalcy. This cycle of intense pleasure is followed by withdrawal symptoms and cravings, which fuel addiction. [16] [15]

Despite the traditional distinction between substance-use addictions and behavioral addictions, research reveals noteworthy similarities in their neurochemical mechanisms. [17] Brain imaging studies demonstrates that both types of addiction activate similar regions in the mesolimbic reward pathway, a network linked to motivation and pleasure. [18] Moreover, both involve changes in neurotransmitters, such as dopamine and serotonin, which are responsible for regulating mood, impulse control and reward processing. These convergent neurochemical features suggest that substance dependence and non-substance addictions follow similar fundamental stages. [17]

The key stages of addiction are as follows:

Intoxication: Addictive substances induce dopamine surges in the mesolimbic reward system during intoxication, reinforcing a pleasurable high and establishing associations between drug-related cues and the anticipation of rewards

Adaptation: Individuals with addiction exhibit reduced dopamine production, leading to diminished sensitivity with repeated use. Besides dopamine, other neurotransmitters, such as serotonin and opioids, contribute to initial pleasurable effects (euphoria) and are also impacted by the brain's adaptation to repeated use.

Withdrawal: Upon cessation of the behavior or the drug effect wearing off, individuals experience negative mood states, including anxiety and anhedonia, due to the dampened reward system. Withdrawal processes are mediated by basal forebrain areas and neurotransmitters such as corticotropin-releasing factor (CRF) and norepinephrine.

Cravings: Conditioned cues (sight, smell, and emotions) drive cravings, prompting individuals to seek a re-experience of euphoria. Prefrontal circuits involved in highlighting the substance or addictive behavior’s importance are activated, while the limbic region triggers an automatic response encouraging the pursuit of the activity or substance. Dusyfuntioning in prefrontal cortical regions impairs executive functions, making it difficult to resist craving despite adverse consequences. [15]

These overlapping neurochemical features support the growing understanding of addiction as a border phenomenon, impacting substance-use and behavioral addictions. [17]

Compulsion vs addiction

Compulsions are the basis of addictions. Reward is one major distinction between compulsion in addicts and compulsion as it is experienced in obsessive-compulsive disorder. An addiction is, by definition, a form of compulsion, and involves operant reinforcement. For example, dopamine is released in the brain's reward system and is a motive for behaviour (i.e. the compulsions in addiction development through positive reinforcement). [19]

There are two main differences between compulsion and addiction. Compulsion is the need and desire to do something or carry out a task repetitively or persistently. Whereas addiction is defined by the following step after compulsion where an individual takes action on a compulsion to feel pleasure and satisfaction (the action is known as compulsive behavior). Notably, for addicts, compulsive behavior can lead to “persistent changes in the brain structures and functions” which creates a cycle of motivation for their behavior that is absent in OCD. [14]

Compulsions (and compulsive behavior) do not necessarily include pleasure for the individual but addictive behavior does. In contrast, someone who experiences a compulsion as part of obsessive-compulsive disorder may not perceive anything rewarding from acting on the compulsion. Often, it is a way of dealing with the obsessive part of the disorder, resulting in a feeling of relief (i.e., compulsions may also arise through negative reinforcement). [20]

Correlation between different personality traits and addictive behaviors online

For over a decade, scientists have emphasized that contact with digital technology can potentially lead to addiction. People of all ages utilize digital devices, and their numbers are growing annually. Accordingly, excessive internet use can result in unhealthy internet use, also known as internet addiction. [21]

It's been proven that the big five personality traits and internet addiction are associated. A recent study aimed to examine the relationships between the big five personality traits and internet addiction within this framework. [22] As such, the researchers employed the meta-analysis method. In accordance with the study's goal, twelve papers were included in the meta-analysis, and thirteen effect sizes were derived from these investigations. [22] In this case, it was shown that agreeableness, conscientiousness, extraversion, and openness to new experiences were inversely correlated with internet addiction, while neuroticism was positively correlated with it. As a result, it's thought that the big five personality traits play a significant role in the development of an internet addiction. [22]

Another study focuses on neuroticism, which has been frequently proven to be a risk factor for internet addiction. The following categories were used to summarize the concepts related to neuroticism and internet addiction: internalizing problems, externalizing problems, coping style, and other factors. [23] The most significant finding from the study is that, with rare exceptions, internet addiction has been primarily included as an outcome and all other ideas as predictors. [23] Internalizing problems comprise the most consistent subset of the topics in the study. In addition to having a positive correlation, neuroticism and internalizing problems were independent predictors of internet, smartphone, and social media addiction. Regarding externalizing problems—which were often the subject of less research—the same picture became apparent. [23] The review's findings also demonstrated that, similar to neurotic people's difficulties with emotion regulation, the internet provides them with a special setting in which to deal with unpleasant emotions. Furthermore, having poor-quality social relationships increases the risk of developing internet addiction and other digital addictions, particularly in those with high levels of neuroticism. [23]

Development of addictive behaviors in adolescents

Given the similarities between substance use addictions and behavioral addictions, the risk factors for susceptibility appear similar, with age of onset (adolescence) being a key factor. [24] Adolescence is a period of time characterized by significant changes of physical, cognitive and emotional nature. [25] Adolescents are discovering their individuality and struggle to balance their independence with peer conformity. [25] During this transitional period, adolescents are therefore vulnerable to developing addictive behaviors.

Epidemiological studies reveal that recreational users differentiate from those with substance use disorders. Research suggests a correlation between individuals who initiate substance use during adolescence and developing a substance use addiction, progressing rapidly from trial to the adverse consequences of addiction. Substance usage increases in late adolescence and young adulthood, with alcohol, marijuana, and tobacco being the most widely consumed substances. [24]

Brain maturation during adolescence is more susceptible to developing addictive behaviors as it further promotes risk-taking behaviors and subsequently early addiction decisions. [26] This has been corroborated by animal studies, revealing that biological factors may desensitize adolescents to the sedative effects of chemical substances, such as alcohol, leading to increased consumption during the teenage years, [27] In fact, drug or alcohol-induced addictive behaviors in adolescents have been linked to models discussing a stronger sensitization of the appetitive response and disrupted inhibitory control. [28] Moreover, the susceptibility of adolescents is heightened as they tend to weigh the rewarding effects of the activity or stimulus more heavily than the negative effects, while also being less sensitive to withdrawal effects. In early adolescence, individuals lack the motivation to control appetitive motivational tendencies. [28] The presence of positive and negative reinforcers seem to increase alcohol consumption, portraying a positive correlation between motives and alcohol consumption. [28] After initiating drinking, there seems to be an increase in appetitive motivation to drink and a negative effect on controlled regulatory processes. [28] The imbalance between these factors lead to increased substance use. [28]  Although there have been declines in adolescent substance use rates, trends of rising e-cigarette (vape) usage highlight the ongoing health care concern regarding adolescent substance use and its effects on neurodevelopment processes during this crucial developmental stage. [29]

In addition to the environmental influences, there seems to be a genetic role in adolescent addictive behaviors. Addiction risk alleles can increase the risk of addictive behaviors in teens. [30]   Furthermore, the prefrontal cortex, the region responsible for decision making and executive function, is still developing during adolescence. [31] This creates a vulnerability and the initiation of addictive behavior during this developmental stage can thus affect long-term functioning. [31]

Therapy for addictions

Therapy for addictions is not a cure, but a way of managing addictive behaviors. [32] It is a treatment tailored to the specific triggers and root causes affecting each patient (such as trauma, stress, or anxiety), [33] and that "enables people to counteract addiction's disruptive effects on their brain and behavior and regain control of their lives." [32]

Various therapeutic approaches exist to assist individuals in modifying addictive behaviors (i.e.: such as yoga therapy, which can “treat or prevent addiction”),. [34] However, individuals seeking therapy for addictive behaviors may benefit significantly from consulting with a therapist recognized by medical institutions for their expertise in addiction or compulsion. [33]

While medical interventions may be necessary for physical detoxification in certain cases, “addiction therapy or addiction counseling is focused on treating psychological addiction”. [35] For instance, individuals may engage in addictive behaviors to cope with “historical trauma”, necessitating a therapist to use trauma focused cognitive behavioral therapy or exposure therapy to address past issues. [35] Alternatively, for those using addictive behaviors to cope with current events, therapy addiction may focus on “learning stress management techniques and emotional regulation skills”, including cognitive behavioral therapy or acceptance and commitment therapy. [35] In other cases, when addiction is intertwined with mental health issues, therapists employ an integrated approach, addressing conditions (i.e.: depression, anxiety, or bipolar disorder) alongside the addiction through procedures such as dialectical behavior therapy or hypnotherapy. [35]

The use of these treatments is increasing in the medical field, as “a shift is occurring to mainstream the delivery of early intervention and treatment services into general health care practice”. [36]

See also

Related Research Articles

Motivational salience is a cognitive process and a form of attention that motivates or propels an individual's behavior towards or away from a particular object, perceived event or outcome. Motivational salience regulates the intensity of behaviors that facilitate the attainment of a particular goal, the amount of time and energy that an individual is willing to expend to attain a particular goal, and the amount of risk that an individual is willing to accept while working to attain a particular goal.

In internal medicine, relapse or recidivism is a recurrence of a past condition. For example, multiple sclerosis and malaria often exhibit peaks of activity and sometimes very long periods of dormancy, followed by relapse or recrudescence.

Impulse-control disorder (ICD) is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, an urge, or an impulse; or having the inability to not speak on a thought. Many psychiatric disorders feature impulsivity, including substance-related disorders, behavioral addictions, attention deficit hyperactivity disorder, autism spectrum disorder, fetal alcohol spectrum disorders, antisocial personality disorder, borderline personality disorder, conduct disorder and some mood disorders.

Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.

Sexual addiction is a state characterized by compulsive participation or engagement in sexual activity, particularly sexual intercourse, despite negative consequences. The concept is contentious; as of 2023, sexual addiction is not a clinical diagnosis in either the DSM or ICD medical classifications of diseases and medical disorders, which instead categorize such behaviors under labels such as compulsive sexual behavior.

<span class="mw-page-title-main">Caffeine dependence</span> Medical condition

Caffeine dependence is a condition characterized by a set of criteria, including tolerance, withdrawal symptoms, persistent desire or unsuccessful efforts to control use, and continued use despite knowledge of adverse consequences attributed to caffeine. It can appear in physical dependence or psychological dependence, or both. Caffeine is one of the most common additives in many consumer products, including pills and beverages such as caffeinated alcoholic beverages, energy drinks, pain reliever medications, and colas. Caffeine is found naturally in various plants such as coffee and tea. Studies have found that 89 percent of adults in the U.S. consume on average 200 mg of caffeine daily. One area of concern that has been presented is the relationship between pregnancy and caffeine consumption. Repeated caffeine doses of 100 mg appeared to result in smaller size at birth in newborns. When looking at birth weight however, caffeine consumption did not appear to make an impact.

Sensitization is a non-associative learning process in which repeated administration of a stimulus results in the progressive amplification of a response. Sensitization often is characterized by an enhancement of response to a whole class of stimuli in addition to the one that is repeated. For example, repetition of a painful stimulus may make one more responsive to a loud noise.

Psychological dependence is a cognitive disorder and a form of dependence that is characterized by emotional–motivational withdrawal symptoms upon cessation of prolonged drug use or certain repetitive behaviors. Consistent and frequent exposure to particular substances or behaviors is responsible for inducing psychological dependence, requiring ongoing engagement to prevent the onset of an unpleasant withdrawal syndrome driven by negative reinforcement. Neuronal counter-adaptation is believed to contribute to the generation of withdrawal symptoms through changes in neurotransmitter activity or altered receptor expression. Environmental enrichment and physical activity have been shown to attenuate withdrawal symptoms.

<span class="mw-page-title-main">Internet addiction disorder</span> Excessive internet usage that causes psychological disorders

Internet addiction "disorder" (IAD), also known as problematic internet use, or pathological internet use, is a problematic compulsive use of the internet, particularly on social media, that impairs an individual's function over a prolonged period of time. Young people are at particular risk of developing internet addiction disorder, with case studies highlighting students whose academic performance declines as they spend more time online. Some experience health consequences from loss of sleep as they stay up to continue scrolling, chatting, and gaming.

Behavioral addiction, process addiction, or non-substance-related disorder is a form of addiction that involves a compulsion to engage in a rewarding non-substance-related behavior – sometimes called a natural reward – despite any negative consequences to the person's physical, mental, social or financial well-being. In the brain's reward system, a gene transcription factor known as ΔFosB has been identified as a necessary common factor involved in both behavioral and drug addictions, which are associated with the same set of neural adaptations.

<span class="mw-page-title-main">Dopamine dysregulation syndrome</span> Neuralogical disorder caused by long-term use of dopaminergic drugs

Dopamine dysregulation syndrome (DDS) is a dysfunction of the reward system observed in some individuals taking dopaminergic medications for an extended length of time. It is characterized by severely disinhibited patterns of behavior, leading to problems such as addiction to the offending medication, gambling addiction, or compulsive sexual behavior, along with a general orientation towards immediate gratification. It typically occurs in people with Parkinson's disease or restless legs syndrome (RLS) who have taken dopamine agonist medications for an extended period of time.

<span class="mw-page-title-main">Substance use disorder</span> Continual use of drugs (including alcohol) despite detrimental consequences

Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences to self and others. Related terms include substance use problems and problematic drug or alcohol use.

An addictive personality refers to a hypothesized set of personality traits that make an individual predisposed to developing addictions. This hypothesis states that there may be common personality traits observable in people suffering from addiction; however, the lack of a universally agreed upon definition has marked the research surrounding addictive personality. Addiction is a fairly broad term; it is most often associated with substance use disorders, but it can also be extended to cover a number of other compulsive behaviors, including sex, internet, television, gambling, food, and shopping. Within these categories of addiction a common diagnostic scale involves tolerance, withdrawal, and cravings. This is a fairly contentious topic, with many experts suggesting the term be retired due to a lack of cumulative evidence supporting the existence of addictive personality. It has been claimed that characteristics of personality attributed to addictive personality do not predict addiction, but rather can be the result of addiction. However, different personality traits have been linked to various types of addictive behaviors, suggesting that individual addictions may be associated with different personality profiles. The strongest consensus is that genetic factors play the largest role in determining a predisposition for addictive behaviors. Even then, however, genes play different roles in different types of addictions. Forty to seventy percent of the population variance in the expression of addictions can be explained by genetic factors.

<span class="mw-page-title-main">Addiction</span> Disorder resulting in compulsive behaviours

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in the development of addiction.

Exercise addiction is a state characterized by a compulsive engagement in any form of physical exercise, despite negative consequences. While regular exercise is generally a healthy activity, exercise addiction generally involves performing excessive amounts of exercise to the detriment of physical health, spending too much time exercising to the detriment of personal and professional life, and exercising regardless of physical injury. It may also involve a state of dependence upon regular exercise which involves the occurrence of severe withdrawal symptoms when the individual is unable to exercise. Differentiating between addictive and healthy exercise behaviors is difficult but there are key factors in determining which category a person may fall into. Exercise addiction shows a high comorbidity with eating disorders.

About 1 in 7 Americans reportedly suffered from active addiction to a particular substance. Addiction can cause physical, emotional and psychological harm to those affected by it. The American Society of Addiction Medicine defines addiction as "a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences."

Addiction vulnerability is an individual's risk of developing an addiction during their lifetime. There are a range of genetic and environmental risk factors for developing an addiction that vary across the population. Genetic and environmental risk factors each account for roughly half of an individual's risk for developing an addiction; the contribution from epigenetic risk factors to the total risk is unknown. Even in individuals with a relatively low genetic risk, exposure to sufficiently high doses of an addictive drug for a long period of time can result in an addiction. In other words, anyone can become an individual with a substance use disorder under particular circumstances. Research is working toward establishing a comprehensive picture of the neurobiology of addiction vulnerability, including all factors at work in propensity for addiction.

Personality theories of addiction are psychological models that associate personality traits or modes of thinking with an individual's proclivity for developing an addiction. Models of addiction risk that have been proposed in psychology literature include an affect dysregulation model of positive and negative psychological affects, the reinforcement sensitivity theory model of impulsiveness and behavioral inhibition, and an impulsivity model of reward sensitization and impulsiveness.

Evolutionary models of drug use seek to explain human drug usage from the perspective of evolutionary fitness. Plants for instance, may provide fitness benefits by relieving pain. Proponents of this model of drug use suggest that the consumption of pharmacological substances for medicinal purposes evolved in the backdrop of human-plant coevolution as a means of self-medication. Humans thus learned to ignore the cues of plant toxicity because ingesting the bioactive compounds of plants in small amounts was therapeutic.

Treatment and management of addiction encompass the range of approaches aimed at helping individuals overcome addiction, most commonly in the form of substance use disorders and behavioral addictions. Effective treatment often includes a combination of medical, psychological, and social interventions tailored to the specific needs of the individual. Common practices to this end include detoxification, counseling, behavioral therapy, medication-assisted treatment, and support groups. The goal of addiction treatment is to reduce dependence, improve quality of life, and ultimately support long-term recovery. Comprehensive management addresses both the physical and psychological aspects of addiction, recognizing it as a chronic but treatable condition.

References

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