Addiction, now often referred to as a substance use disorder (SUD), is a disease that involves the continued use of one or more substances even though there may be serious health and social consequences. Addiction interferes with parts of the brain that are responsible for reward, motivation, learning, judgment and memory.
The disease model of addiction
Addiction is defined as a disease by most medical associations, including the American Medical Association and the American Society of Addiction Medicine.
Like diabetes, cancer and heart disease, addiction is caused by a combination of factors. These include behavioral, psychological, environmental and biological factors. The genes passed on by parents may also play a key role. They can be responsible for about half of a person’s risk of developing a substance use disorder.
When untreated, it can often cause other physical and mental health issues. Over time, addiction can become more severe, disabling and life-threatening.
Treatment & Recovery
There is no one-size-fits-all approach. Getting the right treatment for your child is a process, and navigating the current system requires determination and careful review.
Realizing that your teen or young adult child needs help for their substance use can be frightening and overwhelming. We can help you navigate the steps along the way.
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How substance use changes the brain
People feel pleasure when basic needs, such as hunger and thirst, are satisfied. In most cases, these feelings of pleasure are caused by the release of certain chemicals in the brain. These chemicals reward the individual, making them repeat the behaviors that produce those feelings (like eating and drinking).
Substance use can cause the brain to release high levels of these same chemicals that cause feelings of pleasure. Constant substance use causes these chemicals to release more, which results in changes in the brain’s reward and motivation systems as well as memory.
As a person continues to use substances, the brain tries to get back to a balanced state by reacting less to those rewarding chemicals. As a result, a person may need to use more of the substance just to feel the same way they felt with lower amounts. This is called tolerance.
People may have strong desires or urges to use the substance even if there are harmful or dangerous consequences. They may strain or ruin relationships with people who are concerned about their use. Often people won’t do what they are supposed to do at home, school or work as substance use gets in the way. In addition, with some substances including heroin, fentanyl and other opioids, a person may continue to use to avoid feeling sick (known as experiencing withdrawal symptoms). They may also lose interest in normal life activities, hobbies and interests.
It takes time for the brain to heal from a substance use disorder. Because of this, those with a substance use disorder may be more at risk of returning to use due to triggers. Triggers include people, places and things associated with substance use. Examples include places where a person used substances such as a bedroom, a car, or a bar. Even an ATM can be triggering if a person used it to get money to buy substances. Certain people can trigger a desire to use substances or seeing substance use in a movie or on the street can result in urges to use.
Is substance use a choice?
Early decisions to use substances are based in large part on a person’s own choice, though this is often affected by their culture and environment. However, some people are more at risk of developing a SUD than others. This is caused by certain factors, such as:
- A family history of addiction
- Trauma
- Untreated treated mental health disorders such as depression and anxiety
- Family conflict
When substance use progresses to the point of addiction, a person no longer chooses to use; they are now dependent on substances. A key sign of addiction is a loss of control over substance use.
Are people with addiction responsible for their actions?
A person doesn’t choose how their brain and body respond to substances. This is why some people can control their use and others can’t. People with a substance use disorder can still reduce their use or abstain — it’s just much harder than it is for others. Just like any other disease people need to be able to get quality, evidence-based treatment and care.
With the help and support of family, friends and peers to access help and stay in treatment, people struggling with a substance use disorder can increase their chances of recovery and survival. They can lead truly rewarding and fulfilling lives.
Addiction is a chronic disease
A chronic disease is a long-lasting condition that can be controlled but not cured.
Most people who engage in substance use do not develop addiction, and many young people tend to reduce their use once they take on more adult responsibilities. Still, about 25-50% of people with a substance use problem develop a severe, chronic disorder. For them, addiction is a disease that requires intensive treatments and continuing aftercare, monitoring and family or peer support to manage their recovery.
The good news is that even the most severe, chronic form of SUD can be manageable, usually with long-term treatment and continued recovery supports.
Why do some people say addiction is not a disease?
Some people think addiction cannot be a disease because it is caused by the individual’s choice to use substances. While the first use (or early use) may be by choice, once the brain has been changed by addiction, most experts believe that the person loses control of their behavior.
Choice does not determine whether something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.
Others argue that addiction is not a disease because some people with addiction get better without treatment. People with a mild SUD may recover with little or no treatment. People with the most serious form of SUD usually need intensive treatment followed by lifelong management of the disease. However, some people experiencing addiction stop drinking or using other substances without treatment. Others achieve recovery by attending self-help meetings without receiving much, if any, professional treatment.
In all cases, professional treatment and a range of recovery supports should be available and accessible to anybody who develops a substance use disorder. Addiction is a treatable disease.
Harm reduction
The ultimate goal for someone with an SUD may be to stop them from using substances entirely. However, it is important to take whatever steps you can to reduce the risks associated with substance use.
What makes some people more vulnerable to addiction?
Certain conditions and circumstances make some people more vulnerable to addiction than others. These risk factors do not determine one’s destiny — rather, they are useful in gauging the potential for a problem to develop.
Preventing and delaying substance use for as long as possible, along with addressing any underlying risk factors, are important to reducing the likelihood of problem substance use. Fostering your child’s coping skills, mental health and relationships, along with keeping them safe, can also serve as protective factors.
Family history of addiction
If there is a history of addiction in your family, you should discuss it with your child. These conversations can take place in the same way you would discuss a family history of diabetes or other medical conditions, and should happen no later than the early teen years
Mental health concerns
Mental health conditions like depression, anxiety, conduct disorder or attention deficit hyperactivity disorder (ADHD) create a greater risk for problematic substance use and addiction. As a parent, it’s important to be on the lookout for whether your child may be using substances to cope with their condition.
It’s a good idea to talk with health care providers about the connection between mental health and substance use. Managing and treating underlying mental health conditions, or understanding how emotional and behavioral problems can trigger or escalate substance use, is important for reducing risk and preventing co-occurring disorders (that is, when mental health and substance use problems occur at the same time).
Behavioral or impulse control problems
Children who frequently take risks and have difficulty controlling impulses or following rules are at higher risk for substance use problems. While most teens understand the dangers of taking risks, some have particular difficulty resisting impulses to engage in risky behavior. The term “addictive personality” is often used to describe the characteristics of people with this set of behavior traits.
Exposure to trauma
Children who have had a history of trauma (such as witnessing or experiencing violence or abuse) have been shown to be at higher risk for substance use and addiction later in life. It’s important for parents and caregivers to recognize the possible impact of trauma on a child and get appropriate help.
Environmental factors
Substance use or addiction in the family or among peers; easy access to nicotine, alcohol or drugs; and more frequent exposure to popular culture and advertising that encourage substance use can all contribute to an increased risk.
Age of first use
Starting alcohol, nicotine or other substance use at an early age is one of the strongest and most consistent predictors of an increased risk of addiction.
Changes to risk over time
As people move into adulthood, risk factors for substance use and addiction begin to change. At each new stage of life, new and different circumstances can create stress and added pressure, increasing vulnerability to substance use and addiction.