Addiction is a brain disorder characterised by compulsive engagement in rewarding stimuli despite harmful consequences. Addiction to psychoactive substances such as alcohol, tobacco, weed, opioids and others is a complex process which develops slowly in an individual. However, once the addiction is established, the person takes a lot of time to get back to the premorbid state and unfortunately, the vulnerability to relapse stays lifelong. The better term to use in place of addiction is substance dependence as the latter is less derogatory and has more medical connotation to it.
When a person starts taking a psychoactive substance, there is a sudden rush of pleasure giving chemicals in the brain. Generally, the same chemicals are also released when a person indulges in any pleasurable activity such as being with his friends, pursuing his hobbies, consuming his favourite food etc. This brain circuit is called the reward pathway as this is the one which triggers pleasure on little rewards of our life. With the constant use of the substance, the brain circuitry is modulated in such a manner that the pleasure giving chemicals are exhausted over time and more and more substance is needed to give the same rush which the person was able to feel previously with a lower quantity. That is when we say the person is developing tolerance to the substance. A time comes when the individual is not able to derive any pleasure, neither from the substance nor from any of the previously pleasurable activities, but he continues to use the substance to avoid the withdrawals.
Gradually, with the continuous use of substance, not only the reward pathway is modulated but stress pathway and self-control pathway are also tempered with. Trivial stress (eg. argument with boss, critical comments by spouse) may trigger the craving for the substance. Besides, as the time passes by, it becomes extremely difficult for the individual to quit the substance despite wanting very hard to abstain from it. The social queues ( eg, watching someone taking a drink, passing by a tobacco selling kiosk) start to trigger an intense desire to consume the substance. These are the signs that an individual is getting dependent on the substance.
Furthermore, addiction too is genetically passed on to the next generations just as many other mental illnesses are. Social acceptance and easy access to substances for a child if his parents are consuming the same are also the reasons why substance dependence runs in the families. Besides, the psychoactive substance addiction, there are behavioural addictions as well. These include gambling, sexual addiction, digital media addiction and video games addiction to name a few.
The good news is that, though the quitting seems difficult to the individual, it is certainly possible to get completely out of the substance dependence. Please see a therapist at the earliest and sign up for the right therapy. We generally begin with lab tests to see the physical damage done by the substance and then correct the same. Then the drug therapy is initiated to treat the withdrawals. Finally, we work on motivation and relapse prevention through counselling and drug therapy.
It is very important to remain motivated throughout the therapy as the individual tends to relapse during the stressful times. Also important is the family support which pushes the individual when his own motivation seems to be shaking. No matter how hard it is, it is absolutely worthwhile to quit a substance considering the damage it does to physical and mental well being of the individual.
Wishing you the best of mental health today and always,
Dr Apala