The term addictive has been used for centuries, reportedly first appearing in the 12th century. But addiction itself has existed since man first began to crush grapes and consume the resulting wine. Alexander the Great, the king of Macedonia in 350 B.C., according to historical accounts, drank himself to death in a wine-drinking contest when he was just 33 years old. Wine-making and export of wine was the economic basis of the Roman Empire. Ancient Chinese smoked opium in dens. Native tribes have used hallucinogenic and addictive substances in religious ceremonies for centuries.
In the 18th century, according to scholars, addictive behavior was labeled as a disease of the will. A lot has changed since then, with addiction today being regarded as a complex psycho-bio-social disorder, a disease that, while progressive and potentially terminal, can be treated.
Criteria Applicable to Addiction
In order to understand what makes a person addicted to a particular substance or behavior, however, it is important to first look at the criteria most applicable to addiction.
• Withdrawal – This refers to the severity of the symptoms produced when the user stops using the drug.
• Reinforcement – This is the tendency of the drug to keep the user taking it over and over again.
• Tolerance – The user requires greater quantities of the drug in order to produce the same effect.
• Dependence – This is the difficulty in getting off or quitting the drug, and is usually measured by the number of users who eventually become dependent.
• Intoxication – This refers to the degree of intoxication produced by typical use of the drug.
Most Addictive Substances
Dependence is the most common measure for determining a particular drug’s addictiveness. Based on this, the most addictive substances, ranked in order from most to least addictive, are:
Addictive drugs can also be classified according to their addictive potential – or how easily it is to become addicted and how hard it is to quit. It’s referred to as potential because not everyone will become addicted who tries the drug or behavior, due to complex differences in individual makeup, heredity, preferences, backgrounds, and risk factors.
Nicotine - Not surprisingly, nicotine also tops the list of drugs with the most addictive potential. This includes all forms of nicotine, cigarettes, pipes, cigars, and chewing tobacco. Nicotine produces pleasurable and mood-altering effects that make the body and mind crave it more and more often. According to the American Cancer Society, the World Health Organization, and many other sources, smoking is the leading cause of preventable death in the world. According to the Centers for Disease Control and Prevention (CDC), each year, about 443,000 Americans die from smoking or from the effects of second-hand smoke. Another 8.6 million Americans have a serious disease caused by smoking. Despite the risks, about 46 million U.S. adults smoke cigarettes. Although quitting smoking at any time can result in health benefits, long-term smoking can take 10 to 15 years off a person’s life expectancy. Nicotine has also been described as the single-most difficult addiction to quit due to withdrawal symptoms ranging from headaches to anxiety to irritability and restlessness.
Heroin – Although only about 262,000 Americans (aged 12 and older) were considered to be dependent upon or abusers of heroin in 2008, according to the 2008 National Survey on Drug Use and Health (NSDUH), heroin is one of the most highly addictive substances. Derived from morphine, which itself is derived from the opium poppy, heroin can be injected, smoked, mixed in a marijuana joint, inhaled as smoke through a straw, or snorted through the nose. The effects are immediate, although they are short-lived, lasting only a few hours. Repeated use leads to increased desire for more, and withdrawal symptoms for chronic users can be severe. Numerous health risks occur over time, with addiction almost guaranteed in chronic users. Among heroin addicts in poor health, death can result from sudden withdrawal.
Methamphetamine – Smoked and Injected – Crystal meth (smoked) is considered to have a higher addictive potential than injected meth. Both cause an instant sense of euphoria in users, but threaten long-term effects including addiction, extreme mood swings, memory impairment, brain damage, hyperthermia, convulsions, and death. Treatment experts say that withdrawal from meth is physical agony, and relapse rates as high as 92 percent are reported.
Crack Cocaine and Cocaine – After it burst on the scene in 1985, crack cocaine, the rock crystal form of cocaine, quickly rose to the list of addictive substances posing great problems in America, particularly among the young. Smoked crack is listed of substances as having more addictive potential than inhaled cocaine. Crack delivers an instantaneous high in users that lasts only a few minutes, and users can become addicted with the very first hit. Long-term effects can include anxiety, bronchitis, heart disease, lung cancer, delusions, panic attacks and paranoia. The 2008 National Survey on Drug Use and Health (NSDUH) found that 1.4 million persons aged 12 and older were classified as dependent on or abusers of cocaine in 2008.
Alcohol – Not everyone that drinks alcohol becomes addicted, of course, but the addictive potential is there, nonetheless. Yet alcohol is one of the substances that is most addictive – given the right combination of factors. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about 18 million people have an alcohol use disorder (alcoholism and alcohol abuse). About 28 percent drink at heavy or high-risk levels, and 3 in 10 U.S. adults drink at levels that put them at risk for alcoholism, liver disease and other problems. Alcohol withdrawal symptoms can range from mild or moderate to severe. At the mild to moderate end are nausea, insomnia, loss of appetite, shakes, anxiety,depression and fatigue, among others, while at the severe end, fever, convulsion, blackouts, confusion and hallucinations (called delirium tremens) may result.
Caffeine – The morning wake-up beverage of choice for millions of Americans, caffeine is another highly addictive substance. The fact that caffeine perks us up, making us feel mentally more alert and awake is part of the overall appeal. Reportedly, more than 90 percent of Americans drink coffee every day, and most don’t think of the beverage as addictive – at least, not in the sense that nicotine and alcohol are addictive. Nevertheless, with some 400 billion cups of coffee consumed worldwide each year, caffeine (also present in teas and soft drinks) certainly holds us captive. Long-time coffee drinkers who attempt to quit experience withdrawal symptoms such as headache, loss of energy and alertness, increased fatigue, irritability, anxiety, and depression. Fortunately, most of these are short-lived.
Marijuana – Despite laws and societal perceptions of marijuana use (medical marijuana or otherwise), the fact of the matter is that chronic use can be viewed as addictive. The 2008 National Survey on Drug Use and Health (NSDUH) reports that marijuana was the illicit drug with the highest rate of past-year dependence or abuse in the U.S., affecting 4.2 million (1.7 percent of the population aged 12 and older). Tetrahydrocannabinol (THC), the main ingredient in marijuana is also more potent today than as short as a decade ago. With other additives (PCP, LSD, and others), marijuana is even more addictive. Long-term marijuana users who try to quit report withdrawal symptoms such as anxiety, decreased appetite, drug craving, irritability, and sleeplessness, all of which generally begin within a day after stopping use, peak at 2 to 3 days, and subside within 1 to 2 weeks after cessation.
Physical vs. Psychological Addiction
Many substances – and behaviors – can be both physically and psychologically addictive. As the body builds up tolerance to a particular substance or behavior, requiring more of it and more often, physical and mental side effects can be observed. Long after stopping drug use or addictive behavior, the psychological addiction continues in the form of cravings and urges. For some individuals who have been clean and sober (the general term referring to abstinence from addiction of any kind) for years, cravings may resurface. The danger is not that addicts in recovery have cravings, but that they will be unable to marshal and use proactive coping mechanisms to stave off relapse.
While physical addiction can be overcome in time with appropriate treatment, psychological addiction requires more time to overcome. Learning to adopt healthier behaviors generally involves some form of cognitive behavioral therapy (CBT), and may be long-term in nature before the individual is confident enough to effectively combat psychological addiction.
What About Process Addictions or Addictive Behaviors?
There are also process behavior addictions, including compulsive gambling, eating, spending, shopping, Internet addiction, video game addiction, and sexual activity. Some addicts are polydrug abusers, addicted to more than one substance or process, or have a co-occurring disorder, such as substance abuse and mental health disorder.
Using criteria developed by the American Psychiatric Association, the Problem Gambling website estimates that there are 2.5 million U.S. adults that are pathological gamblers, and another 3 million that are considered problem gamblers. But an estimated 15 million U.S. adults are at risk for problem gambling. Several studies of compulsive gamblers have shown that 50 percent of them also have drug or alcohol problems. Studies of people in treatment for substance abuse show that 10 to 30 percent also have a gambling problem.
The National Council on Sexual Addiction Compulsivity estimates that 6 to 8 percent of Americans are addicted to sex. That’s an astounding 18 to 24 million people. Sexual addiction results when a person’s preoccupation with sex leads to self-destructive behavior. The Internet has contributed to the explosion of addictive sex.
Recent studies have shown that Internet addiction disorder (failed impulse control without involving an intoxicant), of all addictions, is the closest to pathological gambling, although the effects that Internet addiction can have on the person’s life can be every bit as devastating as alcohol addiction.
Treatment for Addictive Behaviors and Addiction
Due to the progressive nature of addictive behaviors and addiction, without treatment, many individuals will continue in a downward spiral. Addiction treatment professionals agree that the most effective way to treat addiction is through a coordinated multidisciplinary approach. This may involve detoxification, active treatment (including various treatment modalities), and medication to alleviate withdrawal symptoms and reduce cravings, relapse prevention, post-treatment counseling, and 12-step group participation.
No single treatment works for every person, and treatment programs need to be tailored to the patient’s unique needs. In addition, there is no standard timetable for how long treatment takes. Some persons with single, short-term (in duration) addiction may complete treatment in months, whereas polydrug abusers or persons with co-occurring disorders may require much longer treatment and follow-up times. Danger of relapse remains high er for some individuals than others. While it is impossible to predict whether a person will relapse or not, certain factors weigh more heavily toward relapse than not. If a person quits treatment prematurely, relapse is very likely. Individuals lacking a solid support system or who go back to previous substance-using or behavior-addicted friends, have multiple addictions and/or a co-occurring mental health disorder, are highly likely to relapse within a short period of time (in 6 to 9 months).
As for type of treatment, residential, inpatient hospital or outpatient hospital treatment settings are available. Almost every addiction has a 12-step group for addicts committed to long-term sobriety. Groups include Alcoholics Anonymous, Narcotics Anonymous, Gamblers Anonymous, Cocaine Anonymous, Marijuana Anonymous, Sexaholics Anonymous, Overeaters Anonymous, Chemically Dependent Anonymous, Crystal Meth Anonymous, Debtors Anonymous, Spenders Anonymous, and others. There are also family groups for loved ones.
--Suzannekane 21:27, 27 May 2010 (UTC)