What is addiction? Diagnosis
Addiction is a pattern where a person keeps using a substance or doing an activity even though it causes harm, and finds it very hard to stop.
- Substance addictions: nicotine, alcohol, opioids, cannabis, caffeine (mild).
- Behavioural addictions: gambling, gaming, social media (gambling is officially recognised as a disorder).
Signs used in diagnosis
- Strong craving (urge).
- Loss of control: using more or longer than planned; failed attempts to cut down.
- Carrying on despite harm to health, study, money or relationships.
- Giving up other activities; much time spent getting or recovering.
Doctors use lists of such signs (from the WHO's ICD-11 and the DSM-5). The more signs, the more severe the problem.
Dependence, tolerance and withdrawal
- Tolerance: with repeated use, the body and brain adapt, so a bigger dose is needed for the same effect.
- Withdrawal: unpleasant symptoms when use stops: shaking, sweating, headache, anxiety, low mood, poor sleep.
- Physical dependence: the body needs the substance to avoid withdrawal.
- Psychological dependence: the person feels they need it to cope, relax or enjoy life.
Withdrawal creates a trap: using again takes away the bad feeling, which teaches the brain that using "works".
Explanations of addiction
Genetic explanation
Addiction often runs in families. Twin studies show identical twins are more alike than non-identical twins. Genes may affect how strongly the brain's reward chemical dopamine responds. Genes raise risk; they do not decide fate (a diathesis-stress idea: genes + stress).
Learning explanations
- Operant conditioning: positive reinforcement (the "high" or a win) and negative reinforcement (escaping withdrawal or stress) strengthen the habit.
- Classical conditioning: cues (a lighter, a friend, a betting app sound) get linked with the reward and trigger cravings.
- Social learning: copying parents, peers or celebrities who smoke, drink or bet.
Nicotine addiction
Brain explanation: nicotine makes the brain release dopamine quickly; receptors increase, causing tolerance and withdrawal. Learning: cues such as coffee or a break time trigger smoking.
Gambling addiction
Learning: wins come on a variable (partial) reinforcement schedule, which makes behaviour very hard to stop; near-misses feel like almost-wins. Cognitive: cognitive biases such as the illusion of control and the gambler's fallacy ("a win is due").
Risk factors
- Genetic vulnerability (family history).
- Stress: using as a way to cope.
- Personality: high impulsivity, sensation seeking.
- Family influences: parents' use and attitudes.
- Peers: friends who use; wanting to fit in.
- Age: teenage brains are more sensitive to reward and slower at self-control, so early use raises lifelong risk.
Protective factors work the other way: supportive family, hobbies, good coping skills, saying-no skills.
Reducing addiction
- Aversion therapy (classical conditioning): pair the habit with something unpleasant, e.g. a drug that causes sickness with alcohol, so a new link forms: alcohol = nausea. Weakness: effects can fade; ethical concerns.
- Self-management: set goals, record triggers, avoid cues, reward yourself for progress.
- Drug therapy: nicotine patches or gum, methadone for heroin, medicines that reduce craving. Can create a new dependence if not managed.
- Behavioural interventions: aversion therapy, covert sensitisation (imagining unpleasant results).
- Cognitive behaviour therapy (CBT): spot and challenge faulty thoughts ("I need it to relax"), learn coping skills and relapse prevention.
- Support groups and helplines; in India the national tele-helpline and de-addiction centres.
Models of behaviour change
Theory of planned behaviour (Ajzen)
Three things shape an intention to quit: attitude (Is quitting good for me?), subjective norms (What do people I care about think?) and perceived behavioural control (Can I do it?). Intention plus real control leads to behaviour. Weakness: people often intend but do not act (the intention-behaviour gap).
Prochaska's six-stage model
Change happens in stages: precontemplation (not thinking of change), contemplation, preparation, action, maintenance, termination. Help should match the stage; relapse is common and people may cycle back.
Try it: the 3D and at home
In the free-play step switch risk and protective factors on and off. Then keep a three-day urge diary for one habit: time, place, feeling, what you did instead.
Key formulas and definitions
- Addiction signs (C-C-C): Craving + lost Control + Continues despite harm
- Tolerance: same dose → smaller effect; more needed for the same effect
- Withdrawal: stop → unpleasant symptoms → urge to use again (negative reinforcement)
- Theory of planned behaviour: attitude + subjective norms + perceived control → intention → behaviour
- Prochaska: precontemplation → contemplation → preparation → action → maintenance → termination
Worked examples
1. Ravi used to feel relaxed after one cigarette. Now he needs four, and on a long train trip he becomes irritable and sweaty. Name the two processes.
Needing four for the same relaxation is tolerance. Irritability and sweating when he cannot smoke are withdrawal symptoms, showing physical dependence.
2. Explain gambling addiction using learning theory.
Wins are unpredictable: a variable reinforcement schedule. Because any bet might win, the person keeps betting and the habit resists extinction. Near-misses feel rewarding. Escaping stress through betting is negative reinforcement. Cues (app sounds, lights) become conditioned triggers for craving.
3. Use the theory of planned behaviour to plan help for a teenager who wants to stop vaping.
Attitude: show real health and money costs so quitting feels worthwhile. Subjective norms: involve friends and family who support quitting. Perceived control: give practical tools (avoid cues, replacement activity, helpline) so she believes she can. A strong intention plus these supports makes quitting more likely.
Common mistakes
- Thinking addiction is only about drugs. Gambling and gaming can be addictions too.
- Mixing up tolerance and withdrawal. Tolerance happens while using; withdrawal happens when stopping.
- Saying genes cause addiction. Genes only raise risk; environment and learning matter.
- Believing one treatment works for all. Matching help to the person and their stage of change works best.