Drug Addicts

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, one of which is the usage of a drug, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens (but does not completely negate) self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological (and thus involuntary) factors that are implicated in addiction's development. Classic signs of addiction include compulsive engagement in rewarding stimuli, ''preoccupation'' with substances or behavior, and continued use despite negative consequences. Habits and patterns associated with addiction are typically characterized by immediate gratification (short-term reward), coupled with delayed deleterious effects (long-term costs).

Examples of drug (or more generally, substance) addictions include alcoholism, marijuana addiction, amphetamine addiction, cocaine addiction, nicotine addiction, opioid addiction, and eating or food addiction. Alternatively, behavioural addictions may include gambling addiction, internet addiction, video game addiction, pornography addiction and sexual addiction. The only behavioral addiction recognized by the DSM-5 and the ICD-10 is gambling addiction. With the introduction of the ICD-11 gaming addiction was appended. The term "addiction" is frequently misused when referring to other compulsive behaviors or disorders, particularly dependence, in news media. An important distinction between drug addiction and dependence is that drug dependence is a disorder in which cessation of drug use results in an unpleasant state of withdrawal, which can lead to further drug use. Addiction is the compulsive use of a substance or performance of a behavior that is independent of withdrawal. Addiction can occur in the absence of dependence, and dependence can occur in the absence of addiction, although the two often occur together.

Drug or substance addiction

Drug addiction, also known as substance use disorders, is a chronic and relapsing brain disorder that features drug seeking and drug abuse, despite their harmful effects. This form addiction changes brain circuitry such that the brain's reward system is compromised, causing functional consequences to stress management and self-control. Damage to the functions of the organs involved can persist throughout a lifetime and can cause death, if untreated. Substances involved with drug addiction include; alcohol, nicotine, marijuana, opioids, cocaine, heroin, methamphetamines, and even foods with high fat and sugar content. Drug addictions can begin experimentally in social contexts, can arise from use of prescribed medications or a variety of other measures.

Risk factors for Drug addiction includes:

* Aggressive behavior (particularly in childhood)
* Absent/lack of parental supervision
* Lack of peer refusal skills
* Drug experimentation
* Availability of drugs
* Community economic status
* Mental disorders
* Epigenetics
* Usage of drugs in youth
* Method drug is taken

Food addiction

Reviews of preclinical studies indicate that long-term frequent and excessive consumption of high fat or sugar foods can produce an addiction. Similarly to addictive drugs, foods high in fat and sugar trigger the brain's reward/pleasure centers, such that the individual may desire the same foods to an increasing degree over time. The signals sent when consuming highly palatable foods have the ability to counteract the body's signals for fullness, leading to persistent cravings. Those who show signs of food addiction may develop food tolerances, in which they eat more, despite the food becoming less satisfactory.

Chocolate is a food that can cause a food addiction. Chocolate's sweet flavor and pharmacological ingredients is known to create a strong craving or feel 'addictive' by the consumer. A person who has a strong liking for chocolate may refer to themselves as a chocoholic. Chocolate is not yet formally recognized by the DSM-5 as a diagnosable addiction.

The Yale Food Addiction Scale (YFAS), version 2.0, is the current standard measure for assessing whether an individual exhibits signs and symptoms of food addiction. It was developed in 2009 at Yale University on the hypothesis that foods high in fat, sugar, and salt have addictive-like effects which contribute to problematic eating habits. The YFAS is designed to address 11 substance-related and addictive disorders (SRADs) using a 35-item questionnaire, based on the diagnostic criteria for SRADs as per DSM-5. A potential food addiction diagnosis is predicted by the presence of at least 2 out of 11 SRADs and a significant impairment to daily activities.

Behavioral addiction

The term "behavioral addiction" refers to a compulsion to engage in a natural reward – which is a behavior that is inherently rewarding (i.e., desirable or appealing) – despite adverse consequences. Preclinical evidence has demonstrated that marked increases in the expression of ΔFosB through repetitive and excessive exposure to a natural reward induces the same behavioral effects and neuroplasticity as occurs in a drug addiction.

Addiction can exist in the absence of psychotropic drugs, which was popularized by Peele. These are termed behavioural addictions. Such addictions may be passive or active, but they commonly contain reinforcing features, which are found in most addictions. Sexual behavior, eating, gambling, playing video games, and shopping are all associated with compulsive behaviors in humans and have also been shown to activate the mesolimbic pathway and other parts of the reward system. Based upon this evidence, sexual addiction, gambling addiction, video game addiction, and shopping addiction are classified accordingly.

Sexual

Sexual addiction involves an engagement in excessive, compulsive, or otherwise problematic sexual behaviour that persists despite negative physiological, psychological, social, and occupational consequences. Sexual addiction may also be referred to as hypersexuality or compulsive sexual behavior disorder. The DSM-5 does not recognize sexual addiction as a clinical diagnosis. Hypersexuality disorder and internet addiction disorder were among proposed additions to the DSM-5, but were later rejected due to the insufficient evidence available in support of the existence of these disorders as discrete mental health conditions. Reviews of both clinical research in humans and preclinical studies involving ΔFosB have identified compulsive sexual activity – specifically, any form of sexual intercourse – as an addiction (i.e., sexual addiction). Moreover, reward cross-sensitization between amphetamine and sexual activity, meaning that exposure to one increases the desire for both, has been shown to occur preclinically and clinically as a dopamine dysregulation syndrome; ΔFosB expression is required for this cross-sensitization effect, which intensifies with the level of ΔFosB expression.

Gambling

Gambling provides a natural reward that is associated with compulsive behavior. There is evidence from functional neuroimaging that gambling activates the reward system and the mesolimbic pathway in particular. It is known that dopamine is involved in learning, motivation, as well as the reward system. The exact role of dopamine in gambling addiction has been debated. Suggested roles for D2, D3, and D4 dopamine receptors, as well as D3 receptors in the substantia nigra have been found in rat and human models, showing a correlation with the severity of the gambling behavior. This in turn was linked with greater dopamine release in the dorsal striatum.

Research has shown that gambling addictions are linked with comorbidities such as mental health disorders, substance abuse, or even personality disorders. There have been studies that show a high prevalence of alcohol use disorder and drug use disorder in compulsive gamblers.

Risk factors for gambling addictions include:

* Young age
* Substance use
* Antisocial behavior
* Male
* Impulsive personality, and
* Sensation seeking.

Gambling addiction has been associated with some personality traits, including: harm avoidance, low self direction, decision making and planning insufficiencies, impulsivity, as well as sensation seeking individuals. Although some personality traits can be linked with gambling addiction, there is no general description of gambling addicted individuals.

Internet

Internet addiction is not a medically recognized addictive disorder. Debate over the classification of problematic internet use considers whether it should be thought of as a behavioural addiction, an impulse control disorder, or an obsessive-compulsive disorder. Others argue that internet addiction should be considered a symptom of an underlying mental health condition and not a disorder in itself. Internet addiction is described as excessive use of the internet for nonessential reasons unrelated to occupational or academic requirements. Problematic internet use may include a preoccupation with the internet and/or digital media, excessive time spent using the internet despite resultant distress in the individual, increase in the amount of internet use required to achieve the same desired emotional response, loss of control over one's internet use habits, withdrawal symptoms, and continued problematic internet use despite negative consequences to one's work, social, academic, or personal life.

Studies conducted in the United States, Asia, and Europe have identified Internet addiction prevalence rates ranging in value from 1% to 18%, with the adolescent population having high rates compared to other age groups. However, prevalence rates have been difficult to establish due to a lack of universally accepted diagnostic criteria, a lack of diagnostic instruments demonstrating cross-cultural validity and reliability, and existing controversy surrounding the validity of labelling problematic internet use as an addictive disorder.

People with Internet addiction are likely to have a comorbid psychiatric disorder. Comorbid diagnoses identified alongside internet addiction include affective mood disorders, anxiety disorders, substance use disorders, and attention deficit hyperactivity disorder.

Video games

Video game addiction is characterized by the World Health Organization as excessive gaming behavior, potentially prioritized over other interests, despite the negative consequences that may arise, for a period of at least 12 months. In May 2019, the World Health Organization introduced gaming disorder in the 11th edition of the International Classification of Diseases. Video game addiction has been shown to be more prevalent in males than females, higher by 2.9 times. It has been suggested that people of younger ages are more prone to become addicted to video games. This may be due to video games being relatively new, hence the higher prevalence in younger groups. People with certain personalities may be more susceptible to gaming addictions, however, there have been conflicting results on this topic.

Risk factors for video game addiction include:

* Male
* Psychopathologies (e.g. ADHD or MDD)
* Social anxiety

Shopping

Shopping addiction, or compulsive buying disorder (CBD), is the excessive urge to shop or spend, potentially leading to unwanted consequences. These consequences can have serious impacts, such as increased consumer debt, negatively affected relationships, increased risk of illegal behavior, and suicide attempts. Shopping addiction occurs worldwide and has shown a 5.8% prevalence in the United States. Similar to other behavioural addictions, a study has found CBD can be linked to mood disorders, substance use disorders, eating disorders, and other disorders involving a lack of control.

Signs and symptoms

Signs and symptoms of addiction can vary depending on the type of addiction.

Symptoms of drug addictions may include:

* Urge to use drug regularly
* Needing more of the drug over time to achieve similar effects
* Ensuring a stable supply of the drug
* Disregarding financial status when it comes to drug purchases
* Social and work life impacted due to drug use
* Continuation of drug use despite the knowledge of consequences
* Unsuccessful attempts to stop drug use
* Experiencing withdrawal symptoms when stopping the drug
Observable signs and symptoms of drug addiction include:

Screening and assessment

Addictions neuroclinical assessment (ANA)

The addictions neuroclinical assessment is used to diagnose addiction disorders. This tool measures 3 different domains. The three neurofunctional domains include, executive function, incentive salience, and negative emotionality. The executive function domain includes processes that are involved in organizing behaviour towards future goals. Some of these processes include attention, response inhibition, behavioural flexibility, working memory, and planning. These are processes that would be disrupted in addiction. The second domain, incentive salience, is the psychological process which can change we perceive stimuli. In the case of addiction, making the stimuli attractive. The last domain involved in this assessment is negative emotionality. The increase in negative emotional responses has been commonly found with individuals with addictions. Researchers have considered that the excessive consumption of substances may be due to