Yes, Addiction Is a Mental Illness

There is an increasing awareness about the way addiction is connected to brain function and how it has a significant impact on well-being.

The National Institute on Drug Abuse (NIDA) characterizes addiction as a chronic and relapsing disorder, with substance use that persists despite adverse consequences. Because addiction involves neurological changes, NIDA considers it a brain disorder.

The American Psychological Association (APA) also defines addiction as chronic, with repeated exposure leading to brain changes.

The APA lists the following factors as responsible for developing and maintaining addiction:

• biological
• psychological
• social
• environmental

The APA publishes the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). This is a reference for healthcare professionals that helps them identify and diagnose mental health conditions.

In the DSM-5, healthcare professionals diagnose a level of SUD ranging from mild to severe based on the number of symptoms present from the following 11-item list:

• hazardous use
• interpersonal or social problems connected to use
• neglect of important roles connected to use
• cravings
• withdrawal
• tolerance
• use of larger amounts for longer
• repeated attempts to quit or control use
• much time spent using
• psychological or physical problems connected to use
• activities given up to use

Stigma remains a significant barrier to the treatment of SUD. Even though healthcare professionals know more about the brain differences associated with addiction, stigma persists.

Self-stigma makes a person living with SUD less likely to seek treatment. Structural stigma means that there may be fewer resources available to help. Meanwhile, social stigma isolates people living with SUD.

Unlike other diagnoses such as depression and HIV, where there is less stigma now than in the past, society still seems to blame people for their substance use disorders.

Anyone can develop addiction or SUD, but some factors increase your risk.

Genetics is a potent predictor of whether you may be more vulnerable to addiction. As much as half of your risk is accounted for in your genes.

Also, people with other mental health diagnoses may be more vulnerable to SUD. Examples of mental health conditions that can occur with substance use include:

• anxiety disorders
• untreated childhood attention deficit hyperactivity disorder (ADHD)
• depression
• bipolar disorder
• personality disorders
• schizophrenia
• post-traumatic stress disorder (PTSD)

A person’s environment can also influence whether they’ll develop an addiction. Social influence and the lack of available recreational activities for youths are two examples.

Your childhood experience is particularly significant. For example, children with aggressive behavior have a higher chance of developing SUD when they get older. Other factors include:

• lack of parent supervision
• drug experimentation
• community poverty
• the presence of drugs at school
• low ability to say no to peers
• poor academic performance
• household members with SUD or who break the law

The age at which a person first uses drugs or alcohol is a significant predictor. The teen years are an important window for brain development, including growth in the prefrontal cortex, which regulates decision making. Introducing substance use during this developmental period increases the chance of SUD.

How people try substances also matters. Those who smoke or inject them are more likely to repeat the experience. This may be because these methods produce a fast response that quickly fades, motivating people to use again.

Addiction is more than just risk factors that lead you to substance use. This use changes your brain in a way that makes stopping more difficult.

The changes to your brain last longer than the period of intoxication following use. Increased tolerance is one such change. This is when you need increasingly larger amounts of a substance to feel the same effects.

Your brain works by sending messages along cells called neurons, using chemicals called neurotransmitters. Drugs and alcohol affect this process.

Some drugs, such as heroin and cannabis, act as neurotransmitters and activate neurons. But they don’t do this precisely the same way as your natural neurotransmitters, so they send abnormal messages.

Other drugs like cocaine or amphetamine trigger the release of your neurotransmitters but in unnaturally high amounts. This also results in abnormal neuron messaging.

All this abnormal activity changes areas of your brain and how they function:

• Basal ganglia. Substance use interferes with your reward circuit so that it’s difficult to feel pleasure when you’re not using.
• Extended amygdala. This region processes emotions like anxiety and irritability, which increase after intoxication fades. This stress response becomes increasingly sensitive with repeated substance use, motivating even more use to get relief, not only intoxication.
• Prefrontal cortex. This is the area of the brain responsible for things such as impulse control and decision making. Substance-induced disruption to circuits result in lower impulse control.
• Brain stem. Breathing, heart rate, and sleep are brain stem functions that can change in response to certain drugs. This is why people could stop breathing while using drugs.

The increased action of a neurotransmitter called dopamine during substance use can result in cravings later. This is because the external cues linked to previous substance-induced dopamine surges can trigger those cravings. This can happen even after a long time has passed since you’ve last used a drug.

An important reason that stigma still exists is because of lack of education around two key principles:

• There are factors beyond a person’s control that lead to substance use.
• Brain changes result from substance use that make it difficult to stop.

Increased education about the importance of genetics and environment on SUD risk can help reduce the blame that society places on people living with addiction and the shame they feel.

When SUD is viewed as an illness rather than a moral failing, it’s easier for those who have it to self-advocate and seek the treatment and support they deserve.

When it comes to systemic changes that may help reduce stigma, more work needs to be done. According to a 2016 report of Human Rights Watch, someone is arrested for possessing drugs for personal use every 25 seconds in the United States — many of which are convicted.

But arresting people for having a medical condition like SUD that requires treatment may worsen their chances of receiving or seeking treatment. Plus, those who spend time in prison may not be given adequate tools to maintain recovery upon release, such as:

• housing in safe areas
• help finding a job with sustainable income
• access to medical treatment

Research shows that people who receive substantial support and treatment, including medications used to treat SUD, were less likely to experience relapse.

In their report, the Human Rights Watch and the American Civil Liberties Union outline recommendations to end the criminalization of personal use and drug possession. The aim is to reduce stigma and improve recovery outcomes for marginalized groups.

Addiction is not a type of weakness. It’s a mental illness resulting from genetic and environmental factors. People often develop SUD because of childhood situations over which they had no control.

SUDs are like other chronic health conditions — not just mental health conditions.

For example, a person with high blood pressure who can’t maintain a beneficial diet or exercise regimen and doesn’t have access to medications or other treatment options will continue to have high blood pressure.

Also, their condition could worsen over time and lead to additional health issues such as a heart attack.

The development of SUDs shares many similarities. But, like other chronic conditions, addiction can be treated successfully. Recovery means that you can manage your condition to keep yourself safe and improve the quality of your life.

Treatment strategies include:

• medication
• therapy to examine and change behaviors
• a plan for if your treatment isn’t effective

Additional support in the form of 12-step or other sobriety programs increases your chances of staying in recovery even more.

If you have addiction or SUD, remember that this is an illness, not a character flaw. Your health and safety are important, and treatment can give you a fresh start.