Addiction is a state of severe physical and psychological dependence on certain substances. People living with addiction may have brain differences and often require treatment, but stigma can prevent this from happening.
Addiction is a complex but treatable disease. Addiction is the most severe form of substance use disorder (SUD).
Both mental illness and SUD can contribute to one another. For example, a person may use alcohol or drugs to cope with mental health conditions such as anxiety or depression. In turn, such substances can affect the chemicals in the brain that regulate mood, such as serotonin and dopamine.
Many factors can contribute to SUD, including genetics, how your body reads genetic information, stress, trauma, and environmental influences.
This article explains whether addiction is a mental illness, gives an overview of SUD, how addiction changes your brain, who is at risk, and how we can reduce the stigma of addiction in society.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) lists addiction as a mental illness under the clinical name “substance use disorder (SUD).”
There are several categories of substance addictions that activate the brain’s reward system,
- hallucinogens, such as LSD
- opioids, such as fentanyl
- anxiolytics, such as Valium or Xanax
Recently, the DSM-5-TR included gambling use disorder. People with gambling use disorder report urges or cravings before gambling, similar to those urges experienced with the above substances.
How do organizations define addiction?
The National Institute on Drug Abuse (NIDA) defines addiction as a chronic relapsing disorder with compulsive behaviors despite negative consequences. The NIDA considers it a brain disorder because it involves changes to the reward, self-control, and stress part of the brain.
The American Psychiatric Association (APA) defines addiction as physiological or psychological dependence on substances, such as alcohol or drugs, or certain behaviors, such as gambling.
Many prominent healthcare associations now define addiction as a disease. This change in definition is important in reducing the stigma toward addiction and SUDs.
Substance use disorder (SUD) is the repeated use of a substance despite negative effects. SUDs can be mild, moderate, or severe.
The Centers for Disease Control and Prevention (CDC) states that
The DSM-5-TR presents an 11-point list of symptoms to help mental health care professionals diagnose SUD. These symptoms
- social or interpersonal problems linked to substance use
- psychological or physiological issues linked to substance use
- hazardous or dangerous use
- neglecting roles in life
- using large amounts for a long time
- trying to quit repeatedly
- spending a lot of time using
- giving up hobbies or activities to use
Having an SUD does not mean a person is not “strong” or “determined enough” to stop using a substance, nor does it mean they want to continue using. It means their brain works differently than that of someone without an SUD.
Removing the stigma about addiction being tied to a person’s values and morals is a vital step toward helping people get treatment.
The NIDA states that alcohol and drugs can alter how the brain works. Brain cells communicate through neurons, which send and receive information via neurotransmitters. Drugs can interfere with how the neurons communicate, causing changes in how the brain processes and relays information.
Although it still is not as well understood, the “high” from drugs may come from surges of chemical signaling compounds such as endorphins. Some drugs cause much greater surges than those naturally produced from nondrug rewards, such as eating or listening to music.
Areas of the brain affected by drug use include:
- Basal ganglia: This area plays a role in positive motivation, such as sex and eating, forming an area known as the “reward circuit.” Repeated substance use over-activates this circuit, making it adapt to the drug over time. A person can lose the ability to feel pleasure from anything else besides the substance.
- Extended amygdala: This area plays a role in negative emotions, such as anxiety and irritability, which usually come with withdrawal. To overcome such feelings, the circuit requires more of the substance for temporary relief rather than getting high for pleasure.
- Prefrontal cortex: This area plays a role in planning, thinking, problem-solving, decisions, and self-control.
Other parts of the brain that substances affect are areas that regulate heart rate, breathing, and sleeping.
Many factors can make a person more inclined to substance misuse and addiction. According to the NIDA, 40–60% of a person’s risk of SUD stems from epigenetics. Epigenetics is how our environment and behavior can change our genes.
Risk factors include:
- behavioral issues stemming from childhood
- drug experimentation
- lack of community resources
- lack of parental supervision
- parents who partake in drug use themselves
- friends and peers who partake in drug use themselves
Other factors include:
- the age at which a person takes a substance, as the brain is still developing during the teen years
- how a person takes a substance, such as smoking or injecting, as some ways of consumption produce a faster brain response
Stigma is negative beliefs and thoughts about something.
There is a lot of stigma surrounding mental health conditions, including addiction. This stigma harms people with the condition.
- leave a person feeling embarrassed and judged, stopping them from going to get the medical help and treatment they need
- lead a person to hide their use from friends and family
- affect the friends and family of the person with addiction
- affect people who provide support and a safe space for people with addiction, such as nonprofits and other organizations
Limited education about addiction is one reason for its stigma. When people understand that addiction can stem from things outside a person’s control, such as genetics and environmental factors, they can then view it as a treatable disease rather than as something to feel ashamed of.
Some organizations that help people with addiction include:
- SMART Recovery
- Faces & Voices of Recovery
- Amy Winehouse Foundation
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- Crisis Text Line
- National Drug Helpline
- Partnership to End Addiction
Ways to reduce stigma can include:
- providing correct education about addiction
- providing a safe space for people with addiction, such as through organizations
- educating healthcare professionals to treat people living with addiction without bias
- reframing addiction as a mental health condition in the media
- countering misinformation and disinformation about addiction
- encouraging others to treat people with addiction with respect and compassion
- being mindful of the language used when speaking about addiction
Many healthcare organizations categorize addiction as a mental illness.
Addiction is also known as severe substance use disorder. Addiction can mean a person’s brain works differently from people without addiction. A person may find it harder to control or quit their substance use.
We must reframe the language and thinking around addiction to reduce its stigma. Reducing the stigma and negative beliefs around addiction are key steps for helping people get the medical treatment they need.