Pathways to Addiction

Addiction can be defined as compulsive drug use despite wanting to stop. The unwilling addict wants the drug but also wants not to want it.

From the outside, drug use looks like a choice but it is not. Addiction undermines the capacity for decision-making and self-control, making the individual powerless to resist addictive impulses.

The followings describe the motivation in the different stages of addiction. In the beginning, choices are often naïve — the user is unaware of the health risk. In the later stages, the user is vulnerable to irrational forces.

1. Getting hooked. Addiction begins with the discovery of a source of pleasure and reward. As the person repeatedly indulges the behavior and enjoys the resulting pleasure, desires to indulge increase. A desire for something that is followed by intense satisfaction is likely to instill a powerful habit. This pattern is known as getting begets wanting (Baumeister & Nadal, 2017). For instance, some individuals, perhaps without access to mental health services, who suffer from depression, anxiety, or PTSD from childhood abuse self-medicate to soothe their psychic pain. The struggling individuals find the drugs the ultimate escape.
2. Tolerance. With regular use at the same dose, the body adapts so that the drug delivers a progressively diminishing effect. For example, alcohol is well known to be associated with increasing tolerance, so that a given dose of alcohol will produce less intoxication among regular users than among light drinkers. Tolerance can also explain the phenomenon of overdose upon relapse. An overdose occurs when a toxic amount of a drug overwhelms the body, which can lead to coma, seizures, and death. This can explain why addicts exiting prison can be prone to overdose death due to reduced tolerance.
3. The transition from casual to problematic use. The activity, which initially served only as a means to a goal, becomes an end in itself. For example, a drinker who started drinking to cope with social anxiety may continue to drink even outside the socializing contexts because drinking became valuable. Sometimes misers (hoarding of money for the sake of having it) can be thought to fall victim to this deception.
4. Maintenance phase. During this phase, the pleasures of indulging become associated with various cues, and these cues promote indulgence. Through Pavlovian learning, temptations are triggered by situational cues (e.g., smelling beer at a ball game) that promise immediate satisfaction.
5. Trying to quit. The difficulties begin if the addict tries to quit. There are several factors that sustain an already learned behavior. First, resistance takes self-control effort. And, when the self-control is weak, automatic responses become increasingly common. Second, to resist is to do without the pleasure that one anticipates. Third, the external cues remind the addict of the possible pleasure.
6. Withdrawal. The uncomfortable withdrawal symptoms make it hard to kick the habit. Withdrawal creates unpleasant feelings that could be solved by indulging. Accompanying every withdrawal syndrome is an intense craving for the drug that was withdrawn. Cravings narrow attention such that current desire, thoughts, and urges would be given extra weight, whereas future goals, ambitions, or plans seem less consequential.
7. Relapse. Lapse refers to a single indulgence (brief failure), whereas relapse means a return to regular use. For example, for a cigarette smoker trying to quit, there could be several lapses before a complete relapse. Stress can play a pernicious role in relapse. Daily stress can cripple the prefrontal cortex, the brain’s executive function, such as concentration, planning, and judgment. As a result, addicts lose the ability to be reflective (reg­ulate behavior), and impulses take a stronger hold over their behaviors. Thus, relapse under certain circumstances is perhaps tragic but not surprising.

Viewing addiction as a failure in decision making leads to a number of solutions for treating addiction. An effective way to quit an addiction is to develop alternative sources of joy and reward (Wood and Runger, 2016). For example, when the individual knows that he or she could spend time with friends and family or go to the gym to release stress (or feel good), the chance of drug use as an emotional coping strategy decreases (Kopetz et al., 2013).