What Is Addiction? A Working Definition for Families

As a psychiatrist specializing in addiction, I’m often asked to be a guest speaker for various audiences, including families who want to know how to help a loved one struggling with a substance use disorder (SUD). In these cases, I like to start by answering the misleadingly basic question, “What is addiction?” Because an answer to this question truly is the first step towards recovery. When families have an accurate working definition of addiction, they are better equipped to cope with a loved one’s disease and help that loved one get effective treatment.

On that note, here is a concise working definition of addiction for anyone whose loved one is struggling with drug or alcohol addiction:

1. Addiction is defined by changes to the circuitry of the brain. Dopamine, often called the “pleasure neurotransmitter,” is the language that encodes these changes in the brain. Drugs of abuse work by causing a grossly exaggerated spike in dopamine levels. The accompanying surge in pleasure first hits a small, circular region in the brain known as the “nucleus accumbens,” from there setting off a cascade of neurobiological events affecting the brain’s so-called reward system, including regions like the ventricular tegmental area (VTA) and hippocampus (the seat of memories, emotions and learning).

   Meanwhile, over time, and in the persisting presence of drugs of abuse, the brain reduces its production of dopamine. This is why people new to sobriety will often exhibit a low, negative affect and symptoms of depression. It’s because they don’t have enough dopamine in their brain to feel anything but miserable, during this early phase of recovery.

2. Addiction is not voluntary. Understanding that this disease is not voluntary can help families avoid the trap of explaining their loved one’s behavior merely in terms of a selfish, narcissistic desire to get high. There is also an important distinction to be made between substance abuse and bona fide addiction, based on what we now know about the neurobiology of addiction. In the case of the latter (bona fide addiction), prolonged substance abuse has hijacked the brain’s prefrontal cortex to such an extent that this region of the brain governing cognition and decision making no longer has the freedom to “just say ‘no’” to drugs. In this mode, an addicted person really is incapable of free choice.
3. Addiction is a “neurological insult” (caused by drugs) that your loved one must now learn how to live with. The term “neurological insult” was coined by an expert who studies addiction in the lab, and helps to unpack the truth of the saying, “Once an addict, always an addict.” If an addiction goes untreated and is allowed to progress over a long period of time, the changes to the brain can indeed be permanent. This is why simply taking a new medication, such as an antidepressant, is rarely an effective or permanent treatment solution for people in early sobriety. A comprehensive treatment approach is necessary—with inpatient rehab typically being the best vehicle of delivery. By offering medication-assisted treatment (where appropriate), behavioral therapies and holistic interventions within a highly structured, sober living environment, inpatient rehab can give your loved one the tools and lifestyle supports they need in order to begin successfully living with and managing their disease.

Did anything in particular jump out at you when you read this working definition of addiction? What most surprised you? Please share your reactions below.