What causes addiction? Why do some people become addicted, and yet others with the same experience do not? What do people who overcome addiction do that others who are still addicted do not? What works in the real world, according to experts by experience? How can you overcome your own addictions or help others to overcome theirs?
Addiction is a complex and multifaceted phenomenon that has perplexed researchers, healthcare professionals, and wider society for centuries. Addictions of all sorts have the power to grip people and can alter their behaviour, thoughts, and lives.
Understanding the causes of addiction
Any addiction develops as a result of a complex interaction of genetic, psychological, social, and environmental factors. Addictions come in all shapes and sizes, from alcohol to drugs, from gambling to gaming, from anorexia to bulimia, from… just about every human substance or behaviour can become the focus of an addiction.
Genetics. Some individuals may be genetically predisposed to addiction. Specific genes can affect how the brain responds to substances or behaviours, making some people more vulnerable.
Brain chemistry. Substance use and repeated behaviours can alter the brain’s reward system, leading to increased cravings and compulsions. Neurotransmitters like dopamine play a critical role in reinforcing addictive behaviours. Some people seem more vulnerable here, too.
Psychological factors. Underlying mental health conditions, such as depression, anxiety, or trauma, can increase the risk of addiction. Many addicts started with their chosen substance or behaviour being self-medication, an attempt to ameliorate some form of psychological pain.
Environmental influences. Exposure to addictive substances or behaviours can significantly impact addiction risk. This includes a family history of addiction, peer pressure, and societal norms. Children who grow up where addictive substances are within easy reach are more likely to become addicted. Role models, too, play a part. Children who see adults “solving their problems” by way of addictive substances are more likely to be addicts (although some see the negative role modelling and learn to avoid any such behaviour).
Neuroplasticity. The brain’s ability to adapt and change means that repeated exposure to addictive substances and addictive behaviours can reshape our brains to reinforce addictive behaviours.
Theories of addiction
The factors leading to addiction can interact in many possible ways. That has led to the creation of many different theories that seek to explain addiction. Here are just some of them:
The disease model of addiction. Views addiction as a chronic, relapsing brain disease characterised by changes in brain structure and function. It suggests that addiction is influenced by genetic factors and neurobiological changes that lead to compulsive behaviour or substance seeking and use.
Constructive use of theory: Seek professional help to address any neurological and genetic factors contributing to addiction.
The biopsychosocial model. Takes a holistic approach, considering biological, psychological, and social factors in addiction. It acknowledges that addiction is influenced by a combination of genetic predisposition, psychological vulnerabilities, and environmental stressors.
Constructive use of theory: Engage in a comprehensive approach that addresses biological, psychological, and social factors.
Social learning theory. Proposes that addiction is learned through observation, modelling, and reinforcement. People may develop addiction by observing the behaviour of others, especially if they perceive positive outcomes from the behaviour or substance use.
Constructive use of theory: recognise the role of learned behaviours and identify positive, alternative behaviours to replace addictive ones.
The cognitive-behavioural model. Focuses on the role of cognitive processes and behaviour in addiction. It suggests that individuals with addiction have distorted thought patterns and maladaptive behaviours, which contribute to their behaviour or substance use and maintain their addiction.
Constructive use of theory: challenge, reframe and replace disempowering thought patterns and develop healthier, empowering coping strategies.
The psychodynamic model. Suggests that addictive behaviour is a result of, or a means of dealing with, unconscious conflicts and unresolved issues. Since the unconscious is almost completely inaccessible to us, this theory is more philosophical than scientific.
Constructive use of theory: engage in self-reflection and introspection or psychotherapy to explore and address unconscious conflicts and unresolved issues that may be driving addictive behaviours.
The sociocultural model. Suggests that behaviour addictions or substance use are often shaped by social values, group norms, peer pressure and cultural factors.
Constructive use of theory: consider the cultural and societal influences on addiction and obtain support from groups or therapists who understand these influences.
The reinforcement model. Suggests that individuals become addicted because they experience pleasure or relief (reinforcement), from the addictive behaviour or used substances.
Constructive use of theory: identify and develop alternative sources of pleasure, satisfaction, and stress relief that do not involve addictive substances or behaviours.
The impulse control models. Suggests that addictive behaviours result from an inability to control impulses.
Constructive use of theory: develop self-awareness of impulsive control and reflective decision-making processes. Focus on strengthening the reflective, rational decision-making to counteract impulsivity.
The sensitisation and desensitisation theories. Suggests that addiction is driven by changes in the brain’s reward system. Repeated exposure to addictive behaviours or substances either sensitises or desensitises the brain’s reward pathways, leading to heightened craving and compulsive behaviour or substance-seeking.
Constructive use of theory: recognises that heightened craving can come from the brain needing more and more behaviour/substance to achieve the desired end, or more behaviour/use strengthens the link to perceived reward.
The self-medication hypothesis. Suggests that some individuals use substances to self-medicate underlying emotional or psychological distress. Substance use provides temporary relief from symptoms, leading to addiction.
Constructive use of theory: address the underlying emotional or psychological distress. Develop alternative strategies for coping with distress.
The interactional model. Suggests that there are multiple interacting factors, including biological, psychological, social, and environmental influences, to explain addiction.
Constructive use of theory: explore and address the role of the interacting factors.
The cycle of change model. Describes the stages of behavioural change in addiction: pre-contemplation, contemplation, preparation, action, maintenance, and relapse.
Constructive use of theory: recognise the stages of change and where one is in the cycle, and obtain the help appropriate to the current stage in the cycle.
The hedonic dysregulation model. Emphasises that addiction involves the dysregulation of the brain’s reward system, leading to a preference for addictive substances or behaviours over natural rewards such as activity, achievement, or social interactions.
Constructive use of theory: focus on obtaining reward and enjoyment from non-addictive activities.
Expectancy theory. Suggests that people’s positive beliefs and expectations about the effects of addictive behaviour or substance use can contribute to addiction.
Constructive use of theory: challenge and modify positive expectations about the addictive behaviour or substance.
Variation in susceptibility
Each of those models provides a different perspective on the complex phenomenon of addiction. With so many models, it may be clear that no single model, so far, has captured its complexity. One model may apply to one person and not another. As if that wasn’t complicated enough, there is even more variation in who is vulnerable to addiction and why.
Not everyone exposed to addictive substances or behaviours becomes addicted. Some people are more vulnerable for the following reasons:
Biological factors. Genetic predisposition can make some people more sensitive to the effects of addictive substances and behaviours, making them more likely to develop an addiction.
Psychological factors. People with certain dispositions, such as impulsivity or sensation-seeking, may be at a higher risk of addiction. Those with underlying mental health conditions are also more vulnerable.
Environmental factors. Exposure to environments where substances are readily available or where substance use is normalised can increase the likelihood of addiction.
Lack of social support. Weak social networks and unsupportive relationships can increase the risk of addiction.
The recovery process
Anyone who has recovered from addiction will tell you how tough that road is. What are the common success factors that distinguish those who overcome addiction from those who remain in its grip?
Acknowledgment. The first recovery step is recognising the addiction and its impact on one’s life. That moment of self-insight and self-awareness seems to be necessary for the person to seek help.
The decision. Almost everyone who has recovered from addiction makes a decision to change. Often, that moment is associated with, as many describe it, “rock bottom.” They find themselves in a situation of such self-revulsion that they decide to change.
Commitment to self-healing. Some people are able to “go cold turkey.” That is, they simply stop.
Professional assistance. Other people can recover with professional help, which may include therapy, medication, or rehabilitation programmes.
Understanding. Some people need to understand what is behind their addiction to be able to recover their health. Others find the reasons for their self-medication too painful to deal with and remove the addiction first, and then, once successful, address the underlying causes to prevent a relapse.
Removing triggers. Almost all addicts have triggers that start their addictive rituals. Identifying and removing those triggers is common to most successful recoveries. That may mean it is necessary to create a new group of friends and never revisit previous haunts.
Support system. Building a strong support network of friends, family, or support groups can be instrumental in recovery. It helps to be with people who provide encouragement, accountability, and understanding.
Coping mechanisms. Learning healthier ways to cope with stress, emotions, and triggers is crucial. That includes developing skills to manage cravings and avoid relapse.
Lifestyle changes. Adopting a healthier lifestyle, including regular exercise, balanced nutrition, and adequate sleep, can make recovery much more likely.
Reinforcing the new. People who reward themselves in ways that reinforce their new behaviours are more likely to recover. For instance, a person who successfully recovered from a food addiction may buy themselves clothing which now fits their slimmer body.
Overcoming addiction and helping others
Whether you’re struggling with addiction or want to help someone on their journey to recovery, here’s how real-world experts (by experience) have overcome addiction:
For people seeking recovery
Seek professional help. Reach out to healthcare professionals who specialise in addiction treatment.
Build a support system. Surround yourself with supportive friends and family members. Consider joining support groups like Alcoholics Anonymous or Narcotics Anonymous, or other mutual support groups that are run for and by experts by experience.
Develop coping strategies. Work with a therapist to develop healthy coping mechanisms for stress, triggers, and cravings.
Set realistic goals. Set achievable milestones in your recovery journey. Celebrate your successes, no matter how small.
Stay committed. Recovery is a lifelong process. Stay committed to your addiction-free life and seek help when you face setbacks.
For people supporting recovery
Educate yourself. Learn about addiction, its effects, and available help options to enable you to provide informed support.
Listen without expressing judgement. Create a safe space for open, honest communication. Avoid expressing criticism or judgment; it can hinder progress.
Be patient. Recovery can be a long and challenging journey. Seek to understand the person and their coping strategies and challenges.
Encourage professional help. Encourage seeking professional help and provide assistance in finding suitable resources. Help by checking out the success figures for any professional. If they can’t or won’t provide verifiable figures or a ‘no win, no fee’ arrangement, you may be looking at a charlatan.
Participate in their journey. Attend support group meetings or therapy sessions with your loved one to show your support in practical ways; merely saying that you are supportive is not enough.
The psychology of addiction is a complex field where the experts, by experience, seem to have the deepest level of real-world understanding.
Recovery is possible with the right combination of support, professional help, coping strategies, and above all, commitment.
By using the most effective techniques, those proven approaches used by experiential experts, the chances of becoming addiction-free are maximised.
In my experience, the biggest single predictor of whether someone will overcome their addiction is if they act on, and keep acting on, their commitment to be addiction free.
Professor Nigel MacLennan runs the performance coaching practice PsyPerform.
