What comes to mind when I say “addiction”? Perhaps you picture a sad looking disheveled addict as you might see pictured in a “say no to drugs” campaign or perhaps you picture the Starbucks® logo, but regardless of what comes to mind, chances are either yourself or someone you love is addicted to something. The Merriam-Webster dictionary defines addiction as a “compulsive need for and use of a habit-forming substance (such as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly : persistent compulsive use of a substance known by the user to be harmful.” Under its definition of being addicted it also includes the definition “strongly inclined or compelled to do, use, or indulge in something repeatedly.” Levels of addiction and seriousness differ. The American Society of Addiction Medicine (ASAM) gives the following as a short definition of addiction:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
This definition, as we see defines addiction not as just something we say or joke about like “I’m addicted to chocolate” or “I’m not myself until after my first cup of coffee 1 ”, but as a disease which is related to a literal rewiring of the brain.
First, let’s look at a few general numbers related to addiction; then we will go slightly more in depth in terms of how addiction literally rewires the brain.
Adults (18+) 15.1 million adults (6.2%) have Alcohol Use Disorder (AUD)
Youth (12-17) 623,000 youth have (AUD)
~88,000 people die annually from alcohol-related causes making it the third leading preventable cause of death in the US.
In 2010, alcohol misuse cost the US $249,000,000,000 (249 billion)
In 2014, the World Health Organization reported that alcohol contributed to more than 200 diseases and injury-related health conditions.
~50 million people in US are addicted to tobacco products
41,000 of these deaths result from secondhand smoke exposure.
1 in 5 deaths in the US is the result of tobacco. Including 87% of lung cancer, and 30% of all cancer deaths annually.
US societal costs of nicotine addiction are ~$193,000,000,000 (193 billion) per year.
As of 2015, 2 million substance use disorders involving prescription pain relievers, 591,000 heroin addictions.
42,249 people died of opioid overdose in 2016.
4 of 5 heroin users began by abusing prescription pain killers.
$504,000,000,000 (504 billion) in economic costs.
The surgeon general is advising people to get naloxone and learn how to use it to save lives in what is being called the “Opioid Epidemic.”
2015, 4 million people in US met criteria for marijuana use disorder.
Potency (THC level) is increasing.
Most commonly used illicit drug in the US, with decreasing numbers of young people thinking that it is risky to use.
Other illicit drugs
2012, ~440,000 regular users of methamphetamines in US
2014, ~913,000 people addicted to cocaine, around 505,224 visits to the emergency department for misuse/abuse
Pornography addiction is not formally recognized (in DSM-V) as a condition.
The average age of first exposure is 11.
Pornography use increases the marital infidelity rate by more than 300%.
56% of divorce cases involved one person having an obsessive interest in porn.
~2,000,000 people are addicted to gambling (technology makes gambling easier)
~$6,000,000,000 (6 billion) per year cost of compulsive gambling behaviors
Pathological gambling is a recognized DSM-V condition
Other types of addictions/dependencies2
As shown above, there are numerous types of addictions/ dependencies that can negatively affect our lives and the lives of people we love. What do addictions have in common? They all are related to the limbic circuitry (emotional neural circuits) within our brains. Specifically dopamine neurons which are involved in our reward circuitry, as well as in classical conditioning, are usually hijacked in cases of addiction. Maladaptation can lead to various cellular and molecular changes (increases in CREB, upregulation of GluR1, increases in ΔFosB, changes in dopamine receptor expression, upregulation of cAMP-PKA signaling pathways, etc.)3 Our brains are designed to give us feedback and learn and adapt, as well as to inform us when things are pleasurable, but addiction is a chronic disease of brain reward, motivation, memory, and related circuitry. There are many factors that contribute to addiction. The prevalence of alcohol and drug use, as well as the percentage of people who gamble or participate in potentially addictive activities is much higher than the numbers that we see of people who are actually addicted. There are several factors that can go into whether or not a behavior becomes an addiction. Genetics as well as other factors such as environment3 are critical for determining the outcome. These two factors are related as environment can affect genetics and gene expression. For instance, returning veterans who were heroin addicts in Vietnam typically lost their addiction upon returning to the United States.3
This month, the Ending Pretending blog will be focusing on addiction. As Christians, we have hope for ourselves and our loved ones, as Romans 8:37 says, “Yet in all these things we are more than conquerors through Him who loved us” NKJV. And as the familiar verse Philippians 4:13 says, “I can do all things through Christ who strengthens me” NKJV. We are hoping that as you read these upcoming posts you might see the hope that Scripture offers for those who are in the throes of addiction, and look unto Christ who said, “These things I have spoken to you, that in Me you may have peace. In the world you will have tribulation; but be of good cheer, I have overcome the world.” John 16:33 NKJV.
Blog post by Berquin Feese, PhD. He is one of the primary editors of the Ending Pretending blog and also a professor of chemistry and neurobiology.
1. The author is in no way condoning the use of caffeine or any addictive substance, and does not believe this to be a joking matter. However, he has heard many people joke about their more minor addictions/ dependencies.
2. Caffeine, for instance, is defined as a dependency, not addiction, by the national institute on drug abuse. The difference is that although people will undergo a withdrawal, and experience symptoms such as tiredness, headaches, insomnia, irritability etc. going without caffeine does not lead to destructive or self-destructive behavior.
3. Purves, D., Augustine, G.J., Fitzpatrick, D., Hall, W.C., LaMantia, A-S., White, L.E. (Eds.). (2012). Neuroscience (5th ed.). Sunderland, MA: Sinauer Associates, Inc.