There are many things that can be addictive and result in potential negative results for health and wellness.  Addressing the potential for addiction early on will help young people to prevent negative outcomes.  Although there are a number of contributors to addiction, we know that some of the main factors involve individuals wanting to feel good and to fit in.  Using substances for coping with stress or mental/emotional distress can also be an issue.  Unhealthy coping methods become a habit. Some addictions develop over time, some can happen after the first time someone does something. Thus, teaching young people that there are many healthy ways that they can feel good and fit in will be critical for primary prevention.

What is Addiction?

The criteria for both substance and behavioral addiction include:

• a compulsion toward the substance or behavior
• loss of control
• negative consequences
• denial of addiction and negative consequences
• inability to stop

Behavioral or Process Addictions are similar to substance addictions in multiple ways, supporting the DSM category of Addiction and Related Disorders encompassing both substance use disorders and non-substance addictions.

Physiological dependence focuses on the responses of the physical body with physical withdrawal symptoms. Psychological dependence focuses on the mental craving and a psychological desire to carry out the behavior. In either case, the individual experiences a type of withdrawal without the substance or activity. Both substance and behavioral addictions can exhibit withdrawal, but only substance abuse withdrawal demonstrates physiological symptoms. Both types of addiction can also include tolerance.

Substance-related addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug/substance seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse drugs. The term addiction is regarded as equivalent to a severe substance use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Addiction can be a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful consequences, and are preventable and treatable, but if left untreated, can last a lifetime. Substances, such as alcohol/drugs, work because they resemble chemicals produced naturally in the body or result in a release of chemicals in the body that give an altered state of consciousness and euphoria.

As with substance-related addictions, non-substance addictions produce reward in the brain and can bring individuals to have decreased control despite negative consequences.  Behavioral addiction is a form of addiction that involves a compulsion to engage in a rewarding non-drug-related behavior despite any negative consequences. A number of behaviors are categorized as impulse control disorders and are similar to addictions with the repeated failure to resist an impulse or urge to perform an act that triggers the reward function in the brain, despite longer term consequences either to the individual or to others.

Non-Substance Related Process/Behavioral Addictions or Disorders

Addictions are not limited to substances.  There are behavioral addictions that can begin innocently enough.  An addiction may begin when an individual has stress or emotional pain and is looking for a way to cope.  In the absence of the practice of healthy coping, dysfunctional coping can lead to addiction.  In other cases, a seemingly harmless behavior becomes a habit and then an addiction that causes problems. The types of addiction vary greatly and have a variety of negative consequences. Gambling was one of the first non-substance related problems to be added to the Diagnostic Statistical Manual for evaluating disorders and addictions. Even something as simple as shopping can become an addiction with severe consequences. In addition to spending money, activities such as sex can also become addictions. Internet and gaming addictions are some of the most recent non-substance related addictions.  Compulsive cell phone use has also become a significant issue. The activities result in a good feeling, and therefore produce a desire for repetition of the activity. Exercise can even be an addiction, and can negatively affect health if done to excess.

As with substance-related addictions, non-substance addictions produce reward in the brain and can bring individuals to have decreased control despite negative consequences.  Behavioral addiction is a form of addiction that involves a compulsion to engage in a rewarding non-drug-related behavior despite any negative consequences. A number of behaviors are categorized as impulse control disorders and are similar to addictions with the repeated failure to resist an impulse or urge to perform an act that triggers the reward function in the brain, despite longer term consequences either to the individual or to others.

Why do some people become addicted to drugs, while others do not?

No single factor determines whether a person will become addicted to drugs. As with any other disease, vulnerability to addiction differs from person to person, and no single factor determines whether a person will become addicted to drugs. In general, the more risk factors a person has, the greater the chance that taking drugs will lead to abuse and addiction. Protective factors, on the other hand, reduce a person’s risk of developing addiction. Risk and protective factors may be either environmental (such as conditions at home, at school, and in the neighborhood) or biological (for instance, a person’s genes, their stage of development, and even their gender or ethnicity).

 What environmental factors increase the risk of addiction?

• Home and Family. The influence of the home environment, especially during childhood, is a very important factor. Parents or older family members who abuse alcohol or drugs, or who engage in criminal behavior, can increase children’s risks of developing their own drug problems.
• Peers and School. Friends and acquaintances can have an increasingly strong influence during adolescence. Drug-using peers can sway even those without risk factors to try drugs for the first time. Academic failure or poor social skills can put a child at further risk for using or becoming addicted to drugs.

What biological factors increase risk of addiction?

Scientists estimate that genetic factors account for between 40 and 60 percent of a person’s vulnerability to addiction; this includes the effects of environmental factors on the function and expression of a person’s genes. A person’s stage of development and other medical conditions they may have are also factors. Adolescents and people with mental disorders are at greater risk of drug

What other factors increase the risk of addiction?

• Early Use. Although taking drugs at any age can lead to addiction, research shows that the earlier a person begins to use drugs, the more likely he or she is to develop serious problems. This may reflect the harmful effect that drugs can have on the developing brain; it also may result from a mix of early social and biological vulnerability factors, including unstable family relationships, exposure to physical or sexual abuse, genetic susceptibility, or mental illness. Still, the fact remains that early use is a strong indicator of problems ahead, including addiction.
• Method of Administration. Smoking a drug or injecting it into a vein increases its addictive potential. Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense “high” can fade within a few minutes, taking the abuser down to lower, more normal levels. Scientists believe this starkly felt contrast drives some people to repeated drug taking in an attempt to recapture the fleeting pleasurable state.

Addiction is a developmental disease—it typically begins in childhood or adolescence. The brain continues to develop into adulthood and undergoes dramatic changes during adolescence. One of the brain areas still maturing during adolescence is the prefrontal cortex—the part of the brain that enables us to assess situations, make sound decisions, and keep our emotions and desires under control. The fact that this critical part of an adolescent’s brain is still a work in progress puts them at increased risk for making poor decisions (such as trying drugs or continuing to take them). Also, introducing drugs during this period of development may cause brain changes that have profound and long-lasting consequences.

Addiction in our society is a very expensive problem. Not only in terms of dollars, but also in terms of the quality and length of life for all individuals. One of the most recommended methods of deterring addiction is education. However, will knowledge alone keep people from becoming addicted or stop an addiction? Not necessarily.  Sure, there are a few people who will be deterred or changed by simply learning the facts, but this is a minority. Getting to the root of why individuals begin participating in behaviors that can lead to addiction is a critical factor.

How can addiction harm other people?

Beyond the harmful consequences for the person with the addiction, drug abuse can cause serious health problems for others. Three of the more devastating and troubling consequences of addiction are:

• Negative effects of prenatal drug exposure on infants and children.
  A mother’s abuse of heroin or prescription opioids during pregnancy can cause a withdrawal syndrome (called neonatal abstinence syndrome, or NAS) in her infant. It is also likely that some drug-exposed children will need educational support in the classroom to help them overcome what may be subtle deficits in developmental areas such as behavior, attention, and thinking. Ongoing research is investigating whether the effects of prenatal drug exposure on the brain and behavior extend into adolescence to cause developmental problems during that time period.
• Negative effects of secondhand smoke.
  Secondhand tobacco smoke, also called environmental tobacco smoke (ETS), is a significant source of exposure to a large number of substances known to be hazardous to human health. According to the Surgeon General’s 2006 Report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, involuntary exposure to secondhand smoke increases the risks of heart disease and lung cancer in people who have never smoked.
• Increased spread of infectious diseases.
  Injection of drugs such as heroin, cocaine, and methamphetamine currently accounts for about 12 percent of new AIDS cases. Injection drug use is also a major factor in the spread of hepatitis C, a serious, potentially fatal liver disease. Injection drug use is not the only way that drug abuse contributes to the spread of infectious diseases. All drugs of abuse cause some form of intoxication, which interferes with judgment and increases the likelihood of risky sexual behaviors. This, in turn, contributes to the spread of HIV/AIDS, hepatitis B and C, and other sexually transmitted diseases.

Children of Addiction/Substance Abusing Parents or Caregivers

Research demonstrates that children of substance abusing parents have an increased risk for poorer academic functioning; emotional, behavioral, and social problems; and an earlier onset of substance use, faster acceleration in substance use patterns, and higher rates of alcohol and drug use disorders. Research has also revealed that children of substance abusing parents are often subject to parenting deficits (less attention, warmth, responsiveness, engagement, in addition to harsher interaction styles), greater risk for child maltreatment, and less secure attachment patterns.

Teaching Children to Integrate Healthy, Natural Highs

One strategy for avoiding unhealthy addictions is to integrate healthy activities that make us feel good, into our lives.  One of the most important aspects of teaching children about healthy methods of feeling good, is modeling some examples of those behaviors.  It is very influential to demonstrate the use of activities that help us to feel good and don’t have potential negative side effects. As an adult, do you have some things that you do that are healthy and help you to feel good?  Also, are you able to provide ideas for other activities that might be useful for the young person, even if it is not something you do?

Recommended Free Resource for Caregivers – There are many helpful resources for parents and caregivers with regard to addressing the topics of substances and addiction with youth.  “Growing Up Drug Free – A Parent’s Guide to Prevention” is highly recommended.  It is a free and open resource.  https://www.dea.gov/sites/default/files/2018-06/growing-up-drug-free-2017.pdf