17.1.1 What is Addiction?

• Addiction is the physical and/or psychological dependence on the use of drugs or other substances e.g. alcohol, or dependence on activities or behaviours e.g. gambling, shopping
• Examples of addiction include but are not limited to, smoking, opiate addiction, alcohol addiction and gambling addiction
• Physical dependence is the physiological state of adaptation to a substance resulting in tolerance , the absence of which produces withdrawal
• Psychological dependence is the compulsion to use a substance for its pleasurable effect which can also lead to anxiety, memory issues, mood swings and an obsession with the substance
• Physical and psychological dependence overlap, with key behaviours being over-use, taking the substance even when you know it is bad for you, problems maintaining everyday activities and inability to stop
• Tolerance can be explained by the idea of homeostasis - the brain tries to maintain its ‘balance’ but if large amounts of an addictive substance are consumed regularly, then it disrupts this balance and eventually the brain readjusts by rebalancing at the new level
• There are two types of tolerance:
  • Metabolic tolerance is when the substance is metabolised quicker and therefore leaves the body quicker
  • Cellular tolerance is when there are changes in the responsiveness of the neurons as the brain tries to rebalance at a new level
• Both types of tolerance result in more and more of the substance being needed to produce the same level of effect

Tolerance results in more substance needed to achieve the same effect.

• Withdrawal syndrome occurs when the individual stops taking the addictive substance, or consumes a smaller dose, and experiences symptoms which are opposite to those induced by the drug
• Withdrawal syndrome symptoms are often very unpleasant, providing a strong motivation to continue the addictive behaviour
• Withdrawal symptoms vary depending on the individual and the substance, including the amount consumed and how regularly it was consumed:
  • Alcohol - intense symptoms for 1-3 days which may include nausea, sweating and in some cases delirium tremens (DTs) causing confusion, agitation and aggression
• Nicotine - intense symptoms start at 24 - 48 hours, can last for many weeks and can include irritability, loss of sleep and weight gain
  • Psychostimulants (e.g. cocaine) - symptoms generally last up to two weeks and may include depression, anxiety and disturbed sleep

Addictions can start in the teenage years.

 Research which investigates addiction

• Marks et al. (1997) found that people dependent on alcohol were more likely to have a higher nicotine dependence which may ultimately result in them experiencing greater discomfort from nicotine withdrawal showing that symptom overlap can affect the severity of withdrawal
• Oliver and Foulds (2021) analysed an existing data set collected by the National Institutes of Health and found that almost two-thirds of those smoking only one to four cigarettes per day and a quarter of those smoking less than weekly were addicted to nicotine, demonstrating that even light smokers may need treatment to successfully quit smoking

Evaluation of research investigating addiction

Strengths

• A better understanding of the interaction between physical and psychological dependence has meant treatment has improved from single efforts at detoxification to following this with longer-term rehabilitation
• Knowledge that there is a physical as well as a psychological component to addiction, which is identified as Substance use disorder in the DSM-5 (2013),  has removed some of the stigma surrounding addiction

Weaknesses

• Research investigating addiction cannot explain individual differences in the amount of a substance or the regularity of consumption needed to become dependent as it cannot take all environmental and motivational factors into account, like home situation, economic worries, loneliness
• Tolerance and withdrawal are difficult to research as they tend to use self-report measures which affect the validity of the data due to issues such as social desirability bias

Link to Issues & Debates: 

The explanations of dependence, tolerance and withdrawal tend to be biologically deterministic, as they focus on the chemical reasons for addiction and do not allow for the consideration of free will as a component in motivation for withdrawal and difficulties with it.

The explanations also are biologically reductionist, as they explain tolerance through the brain’s efforts at homeostasis and do not consider environmental reasons for an increase in consumption. A more holistic approach would investigate the increase further by asking about friends, family, employment and personal lifestyle. There may be environmental reasons such as a change of friendship group as an individual begins to associate with people who have easier access to drugs or increasing poverty and depression. Each of these could be seen as explaining increasing consumption.