What is Addiction? An Information Guide by CAMH

November 8, 2022

People use alcohol and other drugs for many reasons. Some use these substances to help them to relax, to feel more lively, to feel less inhibited or to feel pleasure. Some find the effects of substances make it seem easier to cope with problems. Some use substances for religious reasons or to fit in with the crowd. Others may be curious about the effects of a specific drug.

No one plans to become addicted. People may think that they can handle their substance use and that they only use when they want to. But when they want to change the way they use, they may find it’s not that simple.

Because substance use is common, it’s important to be able to see when a person’s use puts him or her at risk of developing a problem.

Jessie loves going out after work with her friends. Her job is stressful, and having a few drinks with her friends helps her to unwind and relax. Lately, Jessie’s regular “after-work drink” has turned into a whole evening of drinking. She often misses dinner and doesn’t get home until late. A couple of times Jessie hasn’t remembered how she got home the night before, and she’s been late for work. Her manager has commented that she seems tired and distracted, and wonders if anything is wrong.

This example shows how substance use problems can develop slowly, and how it can be easy to overlook some early warning signs that a person’s substance use is becoming a problem.

Next, we will look at some things that can signal when a person’s substance use might be a problem.

When is substance use a problem?

Two important signs that a person’s substance use is risky, or is already a problem, are harmful consequences and loss of control.

Harmful Consequences

The harms of substance use can range from mild (e.g., feeling hungover, being late for work) to severe (e.g., homelessness, disease). While each time a person uses a substance may seem to have little impact, the harmful consequences can build up over time. If a person continues to use substances despite the harmful consequences, he or she may have a substance use problem.

The harms of substance use can affect every aspect of a person’s life. Some examples are:

injuries while under the influence

• feelings of anxiety, irritability or depression
• trouble thinking clearly
• blackouts
• problems with relationships
• spending money on substances rather than on food, rent or other essentials
• legal problems related to substance use
• loss of hope, feelings of emptiness.

The harms of substance use can also extend to the person’s family, friends, co-workers and even strangers (e.g., when someone drives while under the influence of alcohol or other drugs).

Loss of Control

Some people may be aware that their substance use causes problems but continue to use, even when they want to stop. They may use more than they intended, or in situations where they didn’t want to use. Some may not see that their substance use is out of control and is causing problems in their lives. This is often referred to as being “ denial.” This so-called denial, however, might simply be a lack of awareness or insight into the situation. Whether people realize it or not, lack of control over use is another sign that substance use is a problem.

Dan started smoking marijuana three years ago, around the time his dad left for good. At first he only smoked it with friends after school, but gradually he smoked more often. Eventually he smoked every day, beginning first thing in the morning. He felt the drug helped to “mellow” him out, and thought that it was harmless. His marks in school, however, which were never great, were slipping. His mother nagged him about his schoolwork, and his girlfriend complained that he was always stoned. Dan tried to stop using, but he found that without marijuana he was irritable and tense. His cravings to get high were stronger than his will to quit.

In this example, Dan is showing some signs of addiction. He’s smoking marijuana regularly, is experiencing negative consequences of using (problems with his schoolwork and his relationship with his girlfriend), and is not able to stop using. He feels torn between wanting to quit and enjoying the effects of the drug and the relief it brings.

Defining addiction

The word “addiction” is often used to refer to any behaviour that is out of control in some way. People often describe themselves as being addicted to, for example, a tv show or to clothes shopping. The word is also used to explain the experience of withdrawal when a substance or behaviour is stopped (e.g., “I must be addicted to coffee: I get a headache when I don’t have my cup in the morning”).

However, neither enjoyment nor experiencing withdrawal, in themselves, necessarily implies addiction.

Because the term “addiction” is commonly used in such a vague way, there have been many attempts to define it more clearly. Here is one useful definition:

Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors. . . . It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving (Savage et al., 2003).

Another simpler way of describing addiction is the presence of the 4 C’s:

• Craving
• Loss of Control of amount or frequency of use
• Compulsion to use
• Use despite Consequences.

Consider a person who finds alcohol so pleasurable that he regularly goes to the bar after work (Craving). His drinking escalates to overcome tolerance, and he experiences withdrawal when he abstains. He tries and repeatedly fails to cut down (loss of Control). He begins to reorganize his life in order to maximize drinking opportunities, neglecting his work and family (Compulsion). Eventually his spouse leaves and he loses his job (Consequences).

Why do people keep using?

Substance use can be hard to change. One thing that makes change so difficult is that the immediate effects of substance use tend to be positive. People may feel good, have more confidence and forget about problems. In contrast, the problems from use might not be obvious for some time.

People may come to rely on the effects of substances to bring short-term relief from difficult or painful feelings. The effects of substances can make problems seem less important, or make it seem easier to talk and to be with others, and to enjoy sex. People may come to believe that they cannot function or make it through the day without drugs. When people use substances to escape or change the way they feel, using can become a habit, which can be hard to break.

Continued substance use, especially heavy use, can cause changes in the body and brain. If people develop physical dependence and then stop using, they may experience distressing symptoms of withdrawal. Changes to the brain may be lasting. These changes may be why people continue to crave substances and slip back into substance use long after they have stopped using.

When people who are addicted stop their substance use, they often compare the experience to leaving an important relationship.

Alex began using heroin more than 10 years ago. Getting money to buy drugs was always a problem. He grew tired of the stress of always needing to score, and of knowing that if he got arrested again, he’d go to jail. Still, deciding to leave heroin and try methadone  treatment was hard. Once the treatment became routine, he felt bored and didn’t know what to do with his time. He wished he could go back to using, but was afraid of what would happen if he did. His counsellor helped Alex to think about what he wanted from life. Alex enrolled in school and got a part-time job. Soon after, he started a new relationship with someone he trusted. Some days are still a struggle, but with time, and keeping busy, it gets easier.

Alex found it hard to stop using heroin and to continue with his treatment, especially at first. But just as substance use problems don’t start overnight, they don’t get better right away either. By staying in treatment and continuing to get support, Alex began to get his life back on track.

How common is addiction?

Addiction affects many people. Those who have not experienced a substance use problem first-hand are likely to have a family member, friend or colleague who has. Although addiction affects men and women of all ages, rates are:

• two to three times higher in men than women
• highest among people aged 15 to 24 (Statistics Canada, 2003).

A 2002 study of the rates of addiction found that 2.6 per cent of Canadians were dependent on alcohol and that fewer than one per cent were dependent on illegal drugs (Statistics Canada, 2003). These numbers, however, do not reflect the full impact of substance use problems in Canada. Substance use problems can occur even with low levels of alcohol or other drug use, and in people who are not  dependent. For example, estimates suggest that more than 25 per cent of men and nearly 9 per cent of women who drink alcohol are “high-risk” drinkers. These are people whose drinking can be said to be hazardous and harmful to themselves or others, even though these people may not be substance dependent (Adlaf et al., 2004).

The stigma of addiction

Stigma is another reason why the rates of substance use problems may be higher than studies suggest. Stigma marks substance use problems as shameful and makes people want to hide their addiction.

Stigma also affects the families of people with addiction. It makes them hide the problem or pretend it isn’t there at a time when families need support.

What can we do about stigma? One simple way you can help is to choose to talk about “people with substance use problems” rather than about “addicts,” “alcoholics,” “junkies” or “stoners.” Try this approach whether you are talking about another person or about yourself. When you do this, you put the person ahead of the problem. This helps to show that you know there is more to a person than a problem. You are also giving the person with an addiction the support and understanding it takes to recover.

Excerpted from: CAMH’s Addiction – An Information Guide