# What are Addictions? Addiction—clinically termed _Substance Use Disorder (SUD)_—is a chronic pattern of compulsive substance use or behavior despite negative consequences, marked by craving and loss of control. Diagnostic frameworks (DSM‑5, ICD‑11) cluster symptoms into impaired control, social impairment, risky use, and pharmacological effects. Behavioral addictions (e.g., gambling, gaming) share the same compulsive cycle. ## Scope & Scale - **Global:** ~296 million people used illicit drugs in 2021; 39 million live with drug use disorders. Alcohol causes ~3 million deaths annually, tobacco ~8 million. - **Youth focus:** Initiation peaks in adolescence. In Southeast Asia, adolescent vaping and methamphetamine use are rising sharply. ## How Addiction Works All addictive stimuli hijack the brain’s reward pathway (dopamine in the nucleus accumbens), producing tolerance and withdrawal. Stress circuitry becomes over‑active, and the still‑maturing prefrontal cortex (decision‑making and impulse control) weakens, particularly in youth. Psychological conditioning (triggers, cues) and factors like trauma further entrench use. ## Addiction as a Symptom—A Socio‑Systemic Lens [[BioPsychoSocial]] Perspective [[Systemic Thinking]] Addiction often represents a _functional_ response to overwhelming stress, trauma, or unmet psychosocial needs. Removing the substance without addressing the underlying function leaves a vacuum. |**System Level**|**Key Drivers & Dynamics**|**Implications for Holistic Support**| |---|---|---| |**Individual**|Genetic vulnerability, early adversity, unaddressed mental illness, emotion dysregulation|Trauma‑informed therapy, emotion‑regulation skills, co‑treatment of comorbid disorders| |**Interpersonal / Family**|Modeling of substance use, conflict, insecure attachment|Family & couples therapy, parenting programmes, attachment repair| |**Peer / School / Workplace**|Peer norms, academic pressure, workplace stress, social identity|Positive peer groups, school wellbeing curriculum, workplace wellness policies| |**Community / Environment**|Retail density of vapes, advertising saturation, lack of safe recreation spaces|Licensing limits, youth clubs, sport & arts programmes, ad regulations| |**Societal / Policy**|Income inequality, stigma, punitive laws, algorithm‑driven marketing|Anti‑stigma campaigns, progressive taxation, harm‑reduction policy, restriction of targeted ads| ## Replacement Coping Toolkit When the "addiction" (or other substances) are removed, _functional alternatives_ must fill the gap: - **Physiological resets:** paced‑breathing, quick exercise bursts, cold‑water splash - **Emotion regulation:** mindfulness‑based urge‑surfing, expressive journaling, art/music creation - **Social connection:** community sport, LGBTQ‑affirming groups, peer recovery chat lines - **Meaning & mastery:** volunteering, micro‑skill courses, creative projects - **Environment hacks:** nicotine‑free oral substitutes, geofenced ad‑blocking, structured routines during high‑risk hours **Bottom line:** Sustainable recovery depends on aligning _personal agency_ with _collective scaffolding_ that makes the healthy choice the easy, socially reinforced choice. ## Substance Categories | **Category** | **Key Points** | | --------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Alcohol** | Most widely used; early onset increases dependence risk; withdrawal can be life‑threatening; medications include naltrexone & acamprosate. | | **Nicotine / Vaping** | Rapid reinforcement; flavoured vapes attracting new teen users; effective cessation tools: NRT, bupropion, varenicline. | | **Opioids** | High overdose lethality; 80 % of global drug‑related deaths; gold‑standard treatment is Medication‑Assisted Treatment (methadone, buprenorphine, naltrexone). | | **Stimulants** | Meth, cocaine, amphetamines; intense psychological dependence; no approved meds, but contingency management & CBT effective. | | **Cannabis & Others** | High‑THC products linked to cognitive impairment and psychosis risk; behavioural therapies primary treatment. | ### Behavioral Addictions Gambling Disorder (DSM‑5) and Gaming Disorder (ICD‑11) show loss of control, tolerance, and withdrawal‑like distress. Other compulsive behaviours—social media, pornography, shopping—may parallel this pattern. ### Screening & Assessment - **Brief screens:** AUDIT (alcohol), CAGE, DAST‑10, CRAFFT (teens). - **Comprehensive:** ASSIST, Addiction Severity Index. - **Behavioural tools:** PGSI, Internet Gaming Disorder Scale, Internet Addiction Test. - **SBIRT:** Integrates screening, brief motivational intervention, and referral. ### Evidence‑Based Interventions |**Approach**|**Purpose / Highlights**| |---|---| |**CBT & Relapse Prevention**|Identify triggers, build coping, plan for lapses.| |**Motivational Interviewing (MI)**|Resolve ambivalence, strengthen intrinsic motivation.| |**Contingency Management (CM)**|Immediate incentives for drug‑free tests; highly effective for stimulants & tobacco.| |**Family‑based Therapies**|MDFT, FFT improve communication & supervision in youth cases.| |**Medication‑Assisted Treatment**|Opioids: methadone, buprenorphine, XR‑naltrexone. Alcohol: naltrexone, acamprosate, disulfiram. Nicotine: NRT, varenicline, bupropion.| |**Adjuncts**|Mindfulness‑based relapse prevention, trauma‑informed therapy, exercise, peer support groups (AA, SMART).| ### Rehabilitation & Recovery Models - **Outpatient & Tele‑IOP/PHP** flexible integration with daily life. - **Residential / Therapeutic Communities** 24‑hour structured environments; effective for severe or chronic cases. - **Harm Reduction** needle exchange, supervised consumption sites, naloxone distribution, safer‑nicotine products. - **Aftercare & Recovery Capital** sober living, vocational support, peer coaching; continuity across the care continuum. ### Public Health & Policy Prevention programmes (school & family life‑skills), taxation & age limits to curb access, destigmatization campaigns, integration with criminal‑justice diversion and prison treatment.