Addiction is a complex disorder that is multifactorial in origin. To begin, the term addiction is not part of the Diagnostic and Statistical Manual (DSM). The terms utilized are abuse and dependence. Both of these disorder have at the center the maladaptive use of a chemical that has negative consequences in various areas of functioning. Dependence is marked by inability to stop use, as well as, tolerance for the drug and withdrawal symptoms.
The are multiple factors that influence the development of the disorder. Historically there was the “moral” argument which stated that abuse/dependence was due to moral faults of the individual. With time the disease model of addiction took hold starting with the early work of AA. In this model the individual is afflicted with an illness which causes the compulsive misuse of a chemical. It removes the moral argument and creates the ability to “treat” the individual for the disease itself/ With the shift to the disease model a number of theories arose to explain the cause of the abuse/dependence.
A theory that was considered during the height of psychoanalytic influence, was the “self medication” hypothesis. Initially this theory dealt with unconscious issues that the individual faced and their use of psychoactive chemicals to alleviate the distress. At present, self medication refers to the use of psychoactive chemicals to “medicate” underlying psychiatric problems such as depression, anxiety and bipolar disorder. This point of view is often misused by individuals with a chemical dependency problem who rather than face their misuse diagnosis continue to look for a magical pharmacological “cure” for their psychiatric problem.
With the explosion of neurological and genetic research, we have been able to view addiction in a totally new way. Some of the initial work had to do with familial transmission of alcoholism, and the evidence supported the fact that sons of alcoholics had much higher rates of the disease. With the use of neuro-dynamics and neuro-imaging, researchers were able to show that these individuals had changes in their brain the existed prior to the use of psychoactive chemicals. This was some of the earliest evidence of changes in the brain that showed a predisposition to the development of the illness.
Researchers continue to find changes in the neurobiology of the addict. Much attention has been paid to the reward mechanism that is related to the neurotransmitter dopamine in the frontal regions of the brain. In addition, the ability of the addicted individual to “predict” negative consequences to the act of use is impaired. This all points to changes occurring in the brain over time that allows for the cycle of abuse and dependence.
Finally there is evidence to show how certain social and environmental factors play a part in the development of addiction. Some of the more robust evidence comes from the trauma literature in women.
Taken together, the evidence suggests that addiction is a complex disease with genetic vulnerabilities that is influenced by the environment. Psychoactive chemical use itself creates changes in the brain that foster the cycle of continued maladaptive use of the chemical. Given the complexity behind the creation of the addiction, we can see that the interventions to treat the disorder need to be equally as complex.