Psychology of Addiction: Origins of Addiction
Addiction is considered to be a phenomenon as old as humankind. Though, with the centuries passing and numerous researches being carried out within various disciplines, we have more information about the ins and outs of this complex condition. The use of the term "addiction" to describe substance abuse is relatively new and started only one century ago as primarily it was used to describe self-imposed habits (Wise & Robble, 2020). Most commonly people understand addiction as abuse of substances such as drugs or alcohol, however, as it was already mentioned, addiction is complex and has many facets to it. Due to the fact that there are several causes of addiction and alongside to infamous gambling or sex addictions, it can even be masked as societally acceptable behaviors. Exercise, our daily use of social media and smartphones, even a delicious cup (or maybe several daily cups) of coffee—all of them indicate our everyday behaviors that rarely raise suspicion. However, it could be useful to pause and reflect on the possibility that these seemingly innocent daily actions can be indicators of an addiction. Due to raising awareness of addictive disorders and the need to aid people suffering from them, the psychology of addiction came into play. Its main goal goes beyond the understanding of addictive behaviors and includes more aspects such as addiction development, exploring motivation and reinforcement contributing to addictive habits, designing interventions and treatments. Hence, this article will focus on the origins of addiction and introduce the reader to the psychology of addiction.
What is the Definition of Addiction?
Addiction can be explained from several different perspectives: neurological, social and disease. From a neurological point of view, addiction is viewed as a dependence on a specific substance due to its direct pharmacological actions on the central nervous system (Kirschner et al., 2020). This perspective heavily relies on dopamine, a pleasure-inducing hormone, signaling theory. The theory states that some substances induce the feeling of pleasure or a sense of a reward, that is caused by dopamine, and, therefore, the substances act as accelerators of dopamine release, which in essence works as a motivational factor to seek for the addictive substances (Uhl et al., 2019). Numerous studies carried out with animals have also shown the importance of dopamine for their behavior. Wise and Robble (2020) describe an experiment showing that animals experiencing dopamine depletion rely on unconditioned reflexes only. Therefore, these animals, due to the damage done to their lesions are unable to learn and their behavior is based on behaviors learned before the damage occurred (Wise & Robble, 2020). Without a doubt, there is a direct connection between the central nervous system and how specific substances affect and interact with it. It has also been proven by a substantial amount of research and long-standing understanding that addiction is a disease of the brain. However, it is important to explore other perspectives that emphasize the complexity of addiction.
Looking into addiction from a social perspective, it can be described as a "disease of social ills" meaning that its causes stem from environmental pressure, unhealthy lifestyle and emotional distress (Editorial Staff, 2023). This perspective introduces an element of choice to the understanding of addiction. For decades it was believed that addiction is a brain condition and, as a consequence, it became overly medicalized. The element of choice is very well seen in the people who get sober, however, they do not thrive in their lives after recovery from addictive behaviors (Editorial Staff, 2023). Therefore, it is increasingly important to view addiction as both a disease of the brain and possibly a choice to fully embrace the role of psychology behind this complex issue. Therefore, even the psychology of addiction itself uses several theories as explanations for developing addictive behaviors. One of these theories is positive and negative reinforcement explanations. Positive-reinforcement explanation refers to drug use for pleasure or imposed by peer pressure, which later develops into habitual behavior (Bechara et al., 2019). Negative-reinforcement explanation refers to continuous drug use that is motivated by the discomfort inflicted by withdrawal symptoms (Bechara et al., 2019). Amongst many other theories explaining addiction from a social perspective, another important aspect is that of all the individuals taking substances recreationally, only a few of them actually become addicted (Bechara et al., 2019). This shows that addictive behaviors are motivated and need to be addressed beyond understanding addiction as a disease.
Among the changes of addictive substances and recognition of behaviors as addictive, the profile of a person who suffers from substance use disorder has also changed. In a particular case of heroin users, a typical profile 50 years ago constituted a young adolescent male in a minority group, living in a low-income household, however, as of recently this profile matches a white male or female in their early 20s, belonging to the middle-class (Bechara et al., 2019). This shows that addiction reaches beyond being a condition of the brain and it can be associated with socio-economic and cultural variables. Despite the change in the profile of a person who suffers from substance abuse disorder it is important to note that based on an individual’s socio-economic and cultural background general public continues to expect people having a particular profile to be more likely to suffer from addictive behaviors than others (Volkow, 2020). Moreover, a decision-making deficit vastly impacts an individual’s ability to recover from addiction (Verdejo‐Garcia et al., 2018). Despite several existing perspectives of addiction, they all have uniform definitions of addiction. Individual’s continuous and uncontrollable engagement with behaviors that are pleasurable and negatively affect their family, social life, work and finances are called addiction (Editorial Staff, 2023).
In conclusion, there are many different theories and models explaining addiction but what holds them together is their adherence to psychology (Bechara et al., 2019). These theories can be grouped into major categories. However, it is uncommon that addiction could be explained by only one theory and rather common that these theories may apply to only a certain degree. Furthermore, another uniting factor that is found throughout different perspectives of addiction is its definition that is agreed upon on neurological, social and disease perspectives on addictive behavior.
Causes of Addiction
As there are various types of addictions, the causes can also vary. In the case of internet addiction, lacking or bad social relationships serve as good predictors for possible addiction development (Baturay & Toker, 2019). In addition to that, it has been observed that commonly low self-confidence, self-esteem, self-efficacy and increased levels of loneliness are related to the prevalence of addiction development (Baturay & Toker, 2019). In the particular case of internet addiction among adolescents, there is comorbidity observed with anxiety disorders, developmental traits and depression (McNicol & Thorsteinsson, 2017). The aforementioned causes for addiction can also be classified as psychological causes, that are also occurrent in other types of addiction. Generally speaking, the psychological causes of addiction can be emotional stress, previously experienced trauma and other comorbid conditions of an individual.
Societal Stigmatization of Addiction
Unfortunately, even to this day addiction is heavily stigmatized. It is observed that commonly stigma attached to addiction is associated with a person’s own choice, weak willpower, and even moral failing (McGinty & Berry, 2020). Moreover, misconceptions of addiction persist today because people tend to overlook the complexity of addiction and evaluate the behavior of a person who suffers from addiction through their own lens of experience and as a result, they struggle to understand that a person having a strong urge to use drug substances or engage in addictive behavioral patterns has lost the capacity to control their behavior (Volkow, 2020). For this reason, it is very important that the public receives reliable information and education on such vulnerable topics.
The stigma attached to people suffering from substance use disorder, namely addiction, can have dire consequences as it can cause social isolation, discrimination and status loss (McGinty & Berry, 2020). Due to discrimination occurring among healthcare professionals, people who suffer from substance use disorder avoid seeking medical help when they need it and choose to put themselves in danger to avoid being mistreated due to their condition (Volkow, 2020). Moreover, the language that is used towards people suffering from addictive disorders also plays a very important role. As Dr. Volkow (2020) notes, certain terms such as ‘addict’, ‘drug habit’, ‘dirty’ and ‘substance abuser’ are derogatory, decrease people’s self-esteem and let the stigmatization persist. Therefore, it is encouraged to use ‘person-first’ language in order to reduce the stigma by more positive and less judgmental language (Volkow, 2020). Another interesting insight offered by Dr. Volkow (2020) is that the perspective stating that addiction is a disease causes a more pessimist views by the general public towards individuals suffering from addictive disorders, making the general public see these disorders as something of permanence. Therefore, the public is more likely to believe that the recovery is not as likely as it actually might be. One of the reasons for such belief could be that individuals suffering from addictive disorders engage in what are deemed to be societally unacceptable behaviors. Stealing, lying and behaving aggressively are commonly believed to be the main characteristics of someone who is suffering withdrawal symptoms and is trying to obtain the means to access substances (Volkow, 2020). Such misconceptions are negatively impacting the lives of persons suffering from addictions as they might increase social isolation and stigmatization, both of which play a vital role in recovery from addiction. In seeking to help people recover from addictive behaviors it is important that they are not punished for their drug use or exercising of other addictive behaviors. Social punishment is a strong negative reinforcement factor that can be compared to electric shock and can shy away people from seeking help and instead push them further into their addiction.
Other ways of reducing stigma are putting emphasis on the societal causes of addiction instead of putting the main focus on the individual causes. Social factors have an important impact on the likelihood of an individual engaging in addictive behaviors. Such factors can be a history of trauma, poverty or difficulty accessing necessary treatment (McGinty et al., 2020). Furthermore, the aforementioned use of language can be effectively used to reduce stigma and help increase the confidence of people with addiction to seek help. Negatively phrased language increases the bias and prejudice among the health care professionals which contributes to the unwillingness of individuals suffering from addictive disorders to seek help (Wakeman, 2019). Therefore, effective training of health professionals with the aim of reducing bias could serve as a great factor in reducing stigmatization. Such an approach should also include the general public to help create a supportive social environment.
Strategies to Combat Addictive Disorders
Addiction can be treated through a variety of successful practices such as cognitive behavioral therapy (CBT), medication-assisted treatments and contingency management (Bechara et al., 2019). Since addiction influences a person's physical and mental well-being, school or work, relationships, quality of life and life satisfaction multiple approaches might be necessary to be used in order to help someone get over an addiction (Malinauskas & Malinauskienė, 2019). Generally, strategies to cope with addiction can be categorized into five main categories. Those can be psychotherapies (e.g., interpersonal psychotherapy, CBT), vocational rehabilitation, community-based treatment, integrated care interventions and peer support services (Malinauskas & Malinauskienė, 2019). The effectiveness of the strategies to combat addiction, by large, depends on the individual differences and the type of addiction a person is suffering from. Therefore, to single out one method as the most effective is difficult and assessment of particular cases is needed.
Coming back to the stigma attached to addiction, Hanna Pickard (2017) expresses concern of framing addiction as someone’s personal choice, as it might further deepen the stigma attached to this condition. As a result, the scholar offers a Responsibility without Blame Framework, which is based on clinical practice and support to persons who can cause harm to themselves and others. Since addiction can be classified as a disorder of agency, it can only be broken by doing things differently. This means that it is important for a person to understand their responsibility, however, it is also important that there would not be any blame pressed upon this person from the environment (Pickard, 2017). Otherwise, it will come back to the beginning point, where a sense of judgment, prejudice, stigmatization and lack of support from the social environment will discourage the person with addiction to seek for help (Pickard, 2017). As a result, a prevalent theme has emerged throughout the topic of addiction and the help needed to overcome it—social support is vital for a successful recovery.
The Role of a Psychologist Working with Addiction
In the context of addiction psychology, the role of a psychologist is of high importance when working with addiction due to its multifaceted and complex nature. Psychologists in this field are needed to conduct thorough assessments to understand the psychological, emotional, and social factors contributing to an individual's addictive behaviors (Gifford & Humphreys, 2007). Through comprehensive evaluations, they identify underlying issues such as co-occurring mental health disorders, trauma or environmental stressors that may be facilitating the addiction. In addition to the assessment, treatment and intervention planning are other central aspects of the psychologist's role. Moreover, psychologists work together with individuals to develop personalized treatment plans. Such strategies as cognitive-behavioral therapy (CBT), contingency management and motivational interviewing are commonly employed to address the cognitive, behavioral and emotional aspects of addiction. Furthermore, psychologists play a crucial role in family therapy, helping to recognize the impact of addiction on their interpersonal relationships and involving the support network in the recovery process.
Prevention is another key component of a psychologist's role in addiction. They work in actively contributing to community education programs, developing prevention strategies, and identifying risk factors to mitigate the onset of addictive behaviors (Pačić–Turk & Bošković, 2010). Psychologists also collaborate with community organizations, schools and healthcare providers to implement evidence-based prevention methods to help people suffering from addiction disorders. In rehabilitation settings, psychologists can facilitate group therapy sessions, and provide a supportive environment for individuals to share their experiences, develop coping mechanisms and learn from each other. They also contribute to relapse prevention, helping individuals anticipate and manage triggers that potentially could lead to a return to substance use and other addictive behaviors. Besides the assessment, prevention and rehabilitation, psychologists also carry out research in the field of addiction. By conducting studies on the neurobiological, psychological, and social levels of addiction, psychologists contribute to the evolving understanding of substance use disorders. Their research informs evidence-based practices and shapes the continuous development of innovative treatment approaches.
Lastly, psychologists working in the area of addictions are involved in the advocacy dimension. They advocate for policy changes, the stigma that is surrounding addiction reduction, and increasing access to mental health services. By promoting awareness and understanding, they contribute to creating a supportive and compassionate environment for individuals seeking help for their addiction and increasing their quality of life and well-being.
In essence, psychologists working with addiction could be viewed as catalysts for change, offering a comprehensive and empathetic approach to address the intricate interplay of factors influencing the development of addiction. Their roles encompass assessment, research, treatment, prevention, and advocacy, collectively contributing to the ongoing effort to improve the lives of individuals affected by addiction.
The topic of addiction remains a rather delicate matter. In some countries, for example, the US, it is seen that not enough professionals in the field of psychology are interested in getting training related to addiction interventions and treatment (Dimoff et al., 2017). This causes concern due to addiction becoming a health crisis in the country. While other countries might not be suffering from such a heightened problem, the issue of addiction treatment and intervention remains important. Due to the complexity and many layers of addictive behaviors, the perspectives looking into this phenomenon are interdisciplinary varying across psychology, neuroscience, social factors and the traditional understanding of addiction as a disease. The psychology of addiction plays a vital role in aiding individuals suffering from addiction disorders. It not only offers mixed perspectives to help the people in need, but their individual cases are assessed, and appropriate strategies are offered for combating addiction. The psychologists working in this field, including clinical psychologists, also carry on a crucial role. They serve as spokespeople to the public trying to educate about the complexity of addiction, advocate for the people who are suffering from addictive behaviors, work in policy making and reduce stigma.
Bibliographical References
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