What does it mean to be addicted to a substance? When we talk about addiction, we usually think of drugs. However, “drug” is not a strictly scientific term—it belongs more to social, and probably legal, vocabulary. It defines a group of substances that are capable of causing addiction or whose possession and distribution are prohibited by law. But how do we approach the issue from a clinical perspective? Let me explain it in my own words.
The diagnostic manual (DSM-5) does not speak of “drugs” but rather of substances. Such substances can cause disorders. Here are the 10 classes of substances considered in the manual:
- Alcohol
- Caffeine
- Cannabis (e.g., marijuana)
- Hallucinogens
- Inhalants
- Opioids (e.g., morphine, oxycodone, heroin)
- Sedative, hypnotics, anxiolytics
- Stimulants (e.g., amphetamines, cocaine)
- Tobacco
- Other substances.
As we can see from the list above, not all substances fall under the common image of “drugs.” For example, alcohol, caffeine, and tobacco are generally not labeled as such. So we may ask: what do these substances have in common that makes them worthy of attention in the diagnostic manual? The answer is: they all activate the reward circuit.
The reward circuit might sound like a complex concept—let’s simplify it. We know that brain cells (neurons) are connected to each other, and these connections can form actual circuits dedicated to specific functions. There is a circuit dedicated to the function of reward. But what is a reward? In simple terms, being rewarded means receiving something pleasant after performing an action. And once we are rewarded, we want to repeat the behavior to get another reward.
Even with this simplification, that is how things work in our brain when we take one of the listed substances. They generate a feeling of pleasure (sometimes called a “high”), which we want to experience again. It’s clear that pleasure has a cost. Some people might recall a personal experience to understand that consuming too much of a substance has unpleasant effects. Imagine going to a party, drinking too much alcohol, having fun during the night—but afterward experiencing problems such as a headache, stomach pain, nausea, etc.
The problem is that in situations of poor self-control, people are unable to regulate the balance between costs and benefits. They keep consuming the substance despite being aware of the future consequences. The reward circuit keeps doing its job, making us crave the substance more and more—until a state of dependency is created.
At this point, we may wonder: why do we even have this reward circuit? From an evolutionary standpoint, the traits a species develops should “advantage” it, that is, allow both survival and reproduction. Indeed, the reward circuit makes activities like eating (survival) and sexual behavior (reproduction) pleasurable. The reward circuit is excellent at its job—what happened over time is that we found ways to “trick” it.
Addictions are not only substance-related; they can also be behavioral addictions. One can become addicted to sex, shopping, or even exercise. However, the diagnostic manual recognizes only one behavioral addiction: gambling disorder. This is because, for other behaviors, there is not yet enough scientific literature to establish a clear clinical framework.
Sources:
- American Psychiatric Association (2013) – Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
- Bernhill, J. W. (2014) – DSM-5 Clinical Cases
Recommended videos:
- https://www.youtube.com/watch?v=jZHtIb2ZMcA
- https://www.youtube.com/watch?v=0rehK3Mkyf4
- https://www.youtube.com/watch?v=kSgvhB23060
- https://www.youtube.com/watch?v=3tfRcpcMXMk
- https://www.youtube.com/watch?v=6rwsm6MXZ80
If you’d like me to describe another psychology topic in my own words, write it in the comments.
No comments:
Post a Comment