Addiction (Substance Dependence)

What is Addiction?

Addiction is an illness in which there is a pattern of misuse of a drug, problems with social life or work, and/or evidence of tolerance (gradually needing a higher dose to get the same effect) or withdrawal (having certain dangerous physical symptoms if you stop the drug suddenly). People with addiction suffer from an irresistible need to use a drug at higher doses and more often, despite knowing the serious physical or emotional results and despite extreme disruption of the their lives. The official psychiatric term for addiction is Substance Dependence.

What are the symptoms of addiction?

The three main symptoms of addiction are:

  • denial that there is a problem
  • the feeling of needing the drug to function normally
  • the misuse of and dependence on a drug (alcohol, food, tobacco or some other drug)

Other symptoms may include tolerance and withdrawal, problems with relationships, impulsiveness, immaturity, dependent behavior, and decreased coping ability.

What causes addiction?

Many people inherit a predisposition to addiction, but anyone can become addicted, whether or not addiction problems run in the family. There is no evidence that there is such a thing as an "addictive personality," nor is there evidence that childhood traumas or life stresses cause addiction. There is evidence that a high level of stress can bring out or worsen the symptoms of this illness in susceptible people.

What happens to people with addictions?

Addiction is a lifelong illness. It cannot be cured, but it can be controlled. Without treatment, the patient has persistent symptoms that increase in frequency and intensity, and become more damaging. The symptoms of addiction continue without stop and get worse over time. The person's life becomes focused on the drug and social functioning declines. As the illness progresses, the person does whatever is necessary to obtain drugs. Criminal behavior may occur and there is total alienation from the non-drug culture. The person's physical health declines and continued drug use leads to death. With treatment, dysfunctional behaviors improve and health can be restored in most or all aspects of living.

How is addiction treated?

Treatment is available in residential, ambulatory, and inpatient settings. Treatment always involves total abstinence from the drug that was abused and from all other drugs of addiction. If there is physical dependence, treatment begins with detoxification (that is, gradual withdrawal of the drug). Other treatment methods include individual, group and/or family therapy, counseling, education and behavior modification. Self-help and support groups are an important part of treatment and often become lifelong aftercare for the person in recovery. Learning about addiction and finding ways to cope with the emotional and social results of addiction are important goals of treatment.

What can I do to deal with my addiction?

There are a number of problems that are likely to occur during the first few months of abstinence. They are:

  • feeling too confident about recovery
  • depression
  • insomnia
  • fear and anxiety
  • changes in relationships with other people
  • changes in self-esteem
  • trouble with time planning
  • trouble fitting back into the family
  • the urge to use
  • feeling overwhelmed or unable to cope

Some of the things a person can do to make the fullest possible recovery are:

  • Keep away from street drugs and alcohol.
  • Attend 12 step meetings daily for the first 90 days of abstinence.
  • Get a sponsor in a 12-step program.
  • Plan your leisure time in ways that avoid contact with drugs.
  • Use community supports.
  • Attend an outpatient program.
  • Avoid fatigue.
  • Exercise regularly and vigorously.
  • Eat a well-balanced diet.
  • Set realistic long-term and short-term goals.
  • Avoid testing yourself by using drugs.
  • Know the warning signs of relapse.

How can I tell if I'm at risk for a relapse?

Common signs of relapse include:

  • denying fears or anxieties about sobriety
  • deciding that the only thing needed to remain sober is abstinence
  • being too confident about recovery
  • avoiding talking about painful issues
  • overworking
  • overeating
  • overreacting to stress and change
  • isolating oneself
  • expecting too much of oneself
  • depression
  • mood swings
  • viewing problems as unsolvable
  • avoiding fun
  • blaming others
  • becoming overtired
  • eating poorly
  • letting go of daily routines
  • avoiding counseling or AA
  • feeling hopeless
  • rejecting help from others
  • having fantasies and dreams about drinking or using drugs
  • lying
  • rationalizing that drug use would make life better
  • looking up old using friends
  • starting to use
  • denying that using is a problem

Where can I get more information and support?

There are many good books about addiction. Some of them are:

Alcoholics Anonymous (also known as "The Big Book"). Alcoholics Anonymous World Services, 1986.

Katherine Ketcham, et. al. Beyond the Influence: Understanding and Defeating Alcoholism. Bantam Books, 2000.

Jean Kinney. Loosening the Grip: A Handbook of Alcohol Information. McGraw-Hill, 1999.

Narcotics Anonymous Worldwide (editor). Narcotics Anonymous.Hazelden, 1991.

The following organizations can provide help, information and support:

Alanon, Alateen and Adult Children of Alcoholics. Mutual support and information for friends and relatives of alcoholics. Reach them online at

AA (Alcoholics Anonymous) A fellowship of recovering alcoholics. Reach them online at

Cocaine Anonymous. A fellowship of recovering cocaine addicts. Reach them online at

Double Trouble in Recovery. A 12-step program for people recovering from both addiction and mental illness. Reach them online at

Narcotics Anonymous. A fellowship of people recovering from narcotics abuse. Reach them online at

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