Cycle of Addiction

Recovery Tools:  What is a Substance Use Disorder?

All addictive substances have powerful effects on the brain. These effects account for the euphoric or intensely pleasurable feelings that people experience during their initial use of alcohol or other substances, and these feelings motivate people to use those substances again and again, despite the risks for significant harms.
Effects on the brain
  • Well-supported scientific evidence shows that addiction to alcohol or drugs is a chronic brain disease that has potential for recurrence and recovery.

  • Well-supported evidence suggests that the addiction process involves a three-stage cycle: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. This cycle becomes more severe as a person continues substance use and as it produces dramatic changes in brain function that reduce a person’s ability to control his or her substance use.

  • Well-supported scientific evidence shows that disruptions in three areas of the brain are particularly important in the onset, development, and maintenance of substance use disorders: the basal ganglia, the extended amygdala, and the prefrontal cortex. These disruptions: (1) enable substance-associated cues to trigger substance seeking (i.e., they increase incentive salience); (2) reduce sensitivity of brain systems involved in the experience of pleasure or reward, and heighten activation of brain stress systems; and (3) reduce functioning of brain executive control systems, which are involved in the ability to make decisions and regulate one’s actions, emotions, and impulses.

  • Supported scientific evidence shows that these changes in the brain persist long after substance use stops. It is not yet known how much these changes may be reversed or how long that process may take.

  • Well-supported scientific evidence shows that adolescence is a critical “at-risk period” for substance use and addiction. All addictive drugs, including alcohol and marijuana, have especially harmful effects on the adolescent brain, which is still undergoing significant development.

Well-supported: when evidence is derived from multiple rigorous human and nonhuman studies; Supported: when evidence is derived from rigorous but fewer human and nonhuman studies.

As individuals continue to misuse alcohol or other substances, progressive changes, called neuro-adaptations, occur in the structure and function of the brain. These neuro-adaptations compromise brain function and also drive the transition from controlled, occasional substance use to chronic misuse, which can be difficult to control.

Moreover, these brain changes endure long after an individual stops using substances. They may produce continued, periodic craving for the substance that can lead to relapse: More than 60 percent of people treated for a substance use disorder experience relapse within the first year after they are discharged from treatment, and a person can remain at increased risk of relapse for many years.

However, addiction is not an inevitable consequence of substance use. Whether an individual ever uses alcohol or another substance, and whether that initial use progresses to a substance use disorder of any severity, depends on a number of factors. These include: a person’s genetic makeup and other individual biological factors; the age when use begins; psychological factors related to a person’s unique history and personality; and environmental factors, such as the availability of drugs, family and peer dynamics, financial resources, cultural norms, exposure to stress, and access to social support. Some of these factors increase risk for substance use, misuse, and use disorders, whereas other factors provide buffers against those risks. Nonetheless, specific combinations of factors can drive the emergence and continuation of substance misuse and the progression to a disorder or an addiction.

Addictive Pre-occupation is a cluster of symptoms which occurs when people are psychologically dependent on alcohol or drugs.  Most people who are physically addicticted are also psychologically dependent.   Symptoms include:

  • Euphoric Recall

    • When people remember the good experiences from use, and minimize or  deny bad experiences

  • ‘Awfulizing’ Abstinence

    • Identifying the negative aspects of abstinece

  • Magical Thinking about use

    • Creating positive fantasies about using alcohol and/or drugs in the future, with positive outcomes and benefits from use

  • Obsession

    • Cannot stop thinking about using alcohol and/or drugs

  • Compulsion to Use

    • Strong desires and/or urges for alcohol and/or drugs

  • Cravings

    • Physical cravings for alcohol and/or drugs

Addictive Pre-occupation can occur months or even years after use, underscoring the baffling qualities of the disease of addiction.  Some theories include that the rituals which accompany some forms of drug use (i.e., rigs, candles, etc.) contribute to this.  

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