Understanding Addiction As a Mental Health Condition

Addiction is a nonclinical term that refers to using a substance or repeating a behavior in a way that causes problems in many other areas of your life.

A key aspect of addiction is feeling like you can’t control how you use a substance or act on an urge.

Most diagnosable addictions involve substances, including:

• alcohol
• cannabis
• caffeine
• tobacco
• opioids
• stimulants, such as methamphetamine or cocaine
• sedatives, such as lorazepam (Ativan) or diazepam (Valium)
• hallucinogens, such as LSD
• inhalants such as aerosols or paint thinner

Gambling disorder is also clinically recognized as a behavioral addiction.

Read on to learn how addiction meets the criteria for a mental health condition, why addictions develop, and what treatment looks like.

Around 8% of people 12 and older meet the diagnostic criteria for having a substance addiction, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).

Keep in mind that, because the word “addiction” has a negative connotation and isn’t clinically specific, the American Psychiatric Association (APA) no longer uses that word in the DSM-5-TR to avoid stigmatizing people with the condition.

Instead, the official diagnosis for “addiction” is substance use disorder.

The DSM-5-TR sorts the behaviors that define a substance use disorder into four categories:

Lack of control

• difficulty controlling how much of the drug you consume or for how long you use it
• multiple past attempts to use less or quit
• spending a large part of the day getting more of, using, and dealing with the effects of the drug
• cravings, or urges to use the substance that you can’t ignore

Social effects

• negative effects on your ability to complete tasks at work, school, or home
• feeling like you can’t stop using the drug even when it hurts your relationships
• stepping back from aspects of work, relationships, or hobbies due to substance misuse

Risky use

• using the drug in situations that put you at higher risk of physical harm
• using the substance even though it causes and worsens symptoms of health issues, including mental health

Physical dependence

Drug dependence and substance misuse can exist independently, but developing dependence sometimes leads to a substance use disorder. Dependence involves:

• higher levels of tolerance for the drug
• withdrawal symptoms when you use less or try to quit

Substance use disorders can also be mild, moderate, or severe based on how many of the above behaviors you present.

What about behavioral addictions?

People often refer to behaviors like shopping or viewing pornography as addictions when they become hard to control, and some experts do suggest these behaviors could impact the brain in ways similar to substance use disorders.

Still, the DSM-5-TR doesn’t recognize most behaviors as addictions, outside of gambling disorder. When the APA released the DSM-5, which preceded the latest edition, they cited a need for more peer-reviewed research in order to categorize other behavioral addictions as official diagnoses.

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Sometimes other conditions, called co-occurring or comorbid conditions, exist alongside substance use disorders. According to the DSM-5-TR, these include:

• schizophrenia
• psychosis
• bipolar disorder
• depression
• anxiety
• obsessive-compulsive disorder
• sleep disorders
• sexual concerns
• neurocognitive issues such as delirium or dementia

These conditions might occur only while taking a drug, afterward as part of withdrawal, or both. A co-occurring condition can also exist longer-term or even contribute to the substance use disorder.

Recognizing mental health concerns that coexist with substance use disorders is important because support for any factors contributing to substance misuse could help make treatment more effective.

A complex combination of factors contributes to substance use disorders, so there’s no single cause.

Substance use disorders develop when ongoing drug use causes the brain to make high amounts of the neurotransmitter dopamine, overloading the areas responsible for reward and motivation. The brain tries to adapt by desensitizing dopamine receptors and producing less dopamine, leading to drug tolerance and dependence.

But substance misuse doesn’t always lead to substance use disorders. Instead, many factors will determine whether your brain responds to a drug in this way, including:

Genetics

Genes that control biological and brain differences determine about 50% of your chances of developing a substance use disorder when using a drug.

Exposure in early life

Teens are more susceptible to developing substance use disorders because their brains are in a stage of development that originally enabled risk-taking that helped with survival, according to 2020 research.

Trauma and other mental health concerns

Adverse childhood experiences are linked to higher chances of substance use disorder later in life.

Living with additional mental health concerns is also a risk factor, according to a Substance Abuse and Mental Health Services Administration (SAMHSA) survey.

Treatment for substance use disorders can involve different levels of support. Depending on your needs, it might include:

Medical support

The first step in treatment often involves tapering off the substance or working toward sobriety. For severe substance use disorder or withdrawal symptoms, this might involve inpatient care at a residential treatment facility or medical support with an outpatient clinic.

In some cases, a clinician might prescribe medication to help reduce cravings or withdrawal symptoms.

Mental health and emotional support

Therapy for substance use disorder often focuses on the psychological aspects of reducing your use or maintaining sobriety. It can also offer support and encouragement if you’ve had a recurrence of misuse, which is common during treatment.

In therapy, you might address any underlying factors that contribute to substance misuse such as trauma history or pre-existing mental health conditions.

Substance use disorder is the more accurate, clinical term for addiction. While some behaviors may fit into the category of addiction, further research is necessary for most of these to be considered official mental health diagnoses.

Substance use disorder is complex, with many contributing factors. Treatment might involve both medical and mental health care.

If you think you could be experiencing a substance use disorder, help is available. Consider finding treatment through the Substance Abuse and Mental Health Services Administration (SAMHSA), which also offers a free national hotline at 800-662-HELP (4357).

Last medically reviewed on April 11, 2023