An addiction is a health disorder in which a person loses control over their use of a substance or over a behaviour and keeps repeating it even though it is harming them. It is not a lack of willpower or a vice: continued use changes the way the brain works, which is why stopping is so hard even when you genuinely want to. Addiction can be treated, and asking for help early usually makes the road easier.
Addiction: what the word means
If you look up the meaning of addiction in a dictionary, you will find something along these lines: dependence on substances or activities that damage health or mental balance. The term comes from the Latin addictus, which in ancient Rome referred to someone who, unable to pay their debts, was handed over to their creditor. The image fits what many people describe: the feeling that using has taken charge.
In clinical settings professionals speak of substance use disorder or addictive disorder, and rate its severity as mild, moderate or severe. A situation does not have to be extreme to deserve professional attention.
What is addiction and how can you recognise it?
More than the amount or how often, what defines an addiction is the relationship a person develops with the substance or behaviour. Professionals look above all at these features:
- Loss of control: using more, or for longer, than intended, and attempts to cut down do not work.
- Intense desire (craving): very strong urges to use, triggered by certain places, people or emotions.
- Tolerance: needing a larger amount to feel the same effect.
- Withdrawal: physical or psychological discomfort when cutting down or stopping.
- Shifting priorities: using takes up more and more time and pushes aside work, studies, family or hobbies.
- Carrying on despite the harm: it continues even when there are already health, money, legal or relationship problems.
They do not all have to be present at once. If you recognise several in yourself or in someone close to you, that is reason enough to seek advice. In how to detect an addiction you will find more specific signs, including those that families often notice.
Why addiction happens
There is no single cause. An addiction develops when factors of different kinds come together.
What happens in the brain
Drugs, and also some behaviours such as gambling, activate the reward system, the circuit that drives us to repeat whatever we find pleasurable. With repetition, the brain adapts: everyday things become less rewarding, the substance becomes necessary to feel ‘normal’, and the areas that help us curb impulses and foresee consequences grow weaker. This explains why someone can sincerely want to stop and still go back to using.
What using does for the person
Use often starts or continues because it serves a purpose: easing anxiety, getting to sleep, forgetting pain, feeling more confident around other people or keeping up with a demanding pace. The relief is real, but it is short-lived, and over time the underlying problems tend to grow. When there is also a mental health condition, such as depression or an anxiety disorder, this is known as dual diagnosis.
Personal history and environment
Other factors also play a part: the age at which use begins, how easy it is to get hold of, use among people close to you, stress, loneliness, traumatic experiences and genetic predisposition. None of these factors condemns anyone, but they do increase the risk.
Substance and non-substance addictions
The best known are those linked to substances: alcohol, cocaine, cannabis, psychotropic medication such as benzodiazepines, opioids and synthetic drugs. There are also behavioural addictions, in which nothing is taken but the mechanism is similar: gambling, problematic internet use, shopping or sex. You can read about each one in our guide to types of addictions.
Stages of addiction
When people talk about the stages of addiction, they may mean two different processes: how the problem develops and how people get out of it.
How use usually develops
- Experimental or occasional use: trying it out of curiosity or in specific social situations.
- Regular use: use becomes routine and is linked to certain moments or moods.
- Problematic use: negative consequences appear, but use continues.
- Dependence: control is lost, using becomes a need and stopping causes discomfort.
Not everyone who tries a substance follows this path, nor in the same order or at the same pace.
The stages of change
To understand how people become aware of the problem, treatment teams often use the model developed by psychologists Prochaska and DiClemente, which divides change into five stages:
- Precontemplation: the person does not yet see that they have a problem.
- Contemplation: doubts arise; part of them wants to change and part resists.
- Preparation: they decide to do something and start planning how.
- Action: they put specific changes into practice, often with professional support.
- Maintenance: the changes become established; a person is considered to have reached this stage when they have lasted more than six months.
Relapses are common along the way and do not mean starting from scratch: they provide information for adjusting the treatment. The model also helps families understand why insisting or arguing achieves little while the person does not see the problem, and why each stage calls for a different kind of support.
When to ask for help
You do not need to hit rock bottom. It is worth seeking advice if:
- you have tried to cut down or stop and have not managed to;
- the substance use or behaviour is causing you problems at home, at work or with money;
- you need to use in order to sleep, relax or face the day;
- someone close to you has told you they are worried;
- you are a family member and do not know what to do.
At Fundación Salud y Comunidad (FSC) we offer a free first appointment in Barcelona to assess your situation calmly and give you guidance, including if you are calling about a family member. You can contact us on +34 93 424 04 00. If there is an immediate risk to health, call 112, the European emergency number.
Frequently asked questions
Is addiction an illness?
Yes. Medicine regards it as a health disorder with biological, psychological and social components. Seeing it this way helps to remove blame and to address it with treatment, as with other long-term health problems.
What is the difference between a habit and an addiction?
A habit can be changed without great difficulty when you set your mind to it. In an addiction there is loss of control, intense craving and discomfort when stopping, and the behaviour continues even when it causes obvious harm.
Can you have an addiction without taking drugs?
Yes. These are behavioural addictions, such as gambling or problematic internet use. They work through brain mechanisms similar to those of substances, and they can also be treated.
Can an addiction be overcome?
Addiction can be treated, and many people manage to stop using and rebuild their lives. It is approached as a medium- and long-term process, with support to prevent relapse and support for the family. We explain this in how addiction is treated.
How can I help a family member with an addiction?
Find out more, speak from concern rather than reproach, and avoid covering up the consequences of their use. Seek guidance for yourself too: family members can ask for advice even if the person does not yet want treatment.
A drug addiction, or drug dependence, is an illness with serious physical, psychological and social consequences. It is characterised by a maladaptive pattern of behaviour in which the person prioritises the use of drugs – alcohol, cocaine, cannabis, prescription drugs, etc. – over things that used to matter more to them, causing significant impairment or distress. People can also become addicted to certain behaviours, such as gambling, the internet, sex or shopping, which are known as behavioural addictions or non-substance addictions.
In general, all drugs act by releasing substances called neurotransmitters, which upset the balance of the central nervous system, so that when the person stops using, they need the drug to keep functioning. Their body loses the ability to produce its own substances and its natural balance is disrupted.
On a psychological level, drugs usually work either by relieving the person of a negative feeling or pain, or by offering an apparent, momentary solution to their needs (disinhibition, euphoria, feeling able to take on anything…). The person feels that they need to keep using the substances in order to be well.
A person with an addiction cannot control their use of the substance, however hard they try and even though they are aware of its harmful consequences. One of the characteristics of this illness is that someone who uses a drug continuously undergoes changes in their brain that weaken self-control and the ability to resist the urge to use; so they no longer use voluntarily, but because they cannot stop.
Becoming aware of an addiction
Becoming aware of an addiction and the process of stopping use go through different stages, described by the psychologists Prochaska and DiClemente:
Precontemplation stage:
The person uses without being aware of the negative consequences of their use.
Contemplation stage:
The person begins to consider that their use is a problem and that they should make some changes. Dissonance arises, that is, a discrepancy between what the person does and what they believe they should do.
Preparation stage:
The person begins to think seriously about the changes they need to make in their life to change their substance use.
Action stage:
The person begins to put these changes into practice.
Maintenance stage:
The person makes these changes part of their lifestyle. They are considered to have reached the maintenance stage when the new behaviours have lasted for more than 6 months.
Despite these changes, there may be relapses that lead the person to start the cycle again. This model shows how complex the process is and why it is so difficult for a person to become aware of their addiction, however much the people around them warn them. Each stage involves a different mindset and calls for a specific type of intervention to help the person move on to the next stage and progress through the process of change. That is why it is important to have professionals who design the treatment, both for the person themselves and for their family.