Addictions can be to a substance. Alcohol, Cocaine, Marijuana, Ice and prescription medications such as Valium and codeine are all examples of substances to which you can become addicted. These substances, when consumed frequently enough and/or in a great enough quantity can lead to neurobiological (brain circuitry) changes. If you are addicted to a substance, you will know that your neurobiology has changed, as you find yourself using more and more of the substance, and/or taking greater and greater risks to purchase or use the substance, and/or building a greater and greater tolerance for the substance.

But perhaps you won’t notice at all. Perhaps everyone else in your life will notice first. It is quite likely that, like a frog boiling in a pot, you will be oblivious to the trouble you are in. This failure to notice problematic behaviour despite evidence obvious to all others is called denial, and it is very common for people with addictive disorders to experience it. When in denial, you will form the habit of hiding the truth from yourself and others.

Addictions can be behavioural. For a long time, scientists thought that this was not true. Then, in 1980, psychiatric medicine recognised pathological gambling as a disorder of impulse control. Science had caught up with several thousand years of religious and philosophical thought. In the last 20 years the internet has become a daily tool for most humans. Many people recognise their own behaviour as compulsive and excessive. In 2018, the World Health Organisation of the United Nations added “internet gaming disorder” as a recognised addictive disorder. Other applications of screens and the internet, such as social media and pornography are yet to be recognised as specific disorders. Behavioural addictions occur when rewards are intermittently delivered. Examples of rewards are money, bargains, sexual pleasure, competitive winning and social approval (or even attention). In the case of gambling, the disorder often starts when the person has a big win.

Addictions can exist by themselves, or they can be a part of another disorder such as depression or anxiety disorders. Sometimes, rather than experiencing anxiety, or sadness, or anger, we can form a habit of disengaging from our emotions via an addictive behaviour or substance (see the anxiety tab about avoidance). When this is the case, sometimes treating the underlying emotional problem solves the addictive issue. In other cases, the addiction has taken on a life of its own and needs to be treated as its own condition first before dealing with underlying issues.

It can be very difficult to treat addictions by oneself. Denial means that you cannot always trust your own intentions. Many addicted people will find themselves sleep walking into relapse. Numerous support groups exist that stress integrity and accountability. Good psychological treatments for addiction involve the development of a plan to address addiction. This plan will involve methods of maintaining motivation, changing lifestyle patterns and addressing emotional issues.

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