Science and research have expanded our understanding of addiction, but with a more nuanced view comes more debate and complexity. We’ve also adopted new words to explain the processes involved in addiction.
In addition, different groups have unique issues that surround their addiction, and these people require tailored treatments that take into account culture, gender, age, and socioeconomic factors.
This article reviews the current models used to explain addiction, parses some common addiction terms, and gives information about addiction in various populations of society.
Addiction is a complex subject, and the way we view it has changed over the past several hundred years.
Many viewed addiction as a moral failing in the 18th and 19th centuries.1,2 Consequently, addicts were whipped, beaten, fined, and ridiculed in public.1 As science uncovered more about how the brain was affected by drugs and alcohol, newer models emerged to explain addiction, which proposed that it was a disease and a learned behavior. Treatment, in turn, shifted to medication and helping the addict learn healthier behaviors to replace drug use.
These newer models, however, are not without criticism. The questions of what causes addiction and how best to treat it continue to be debated.
- Moral model: This is an older model of addiction rooted in religion. It assumes that there’s something morally wrong with people who use drugs. Addicts are “bad people” who decide to ingest substances or drink. They should be punished instead of rehabilitated. This model is criticized for not offering therapeutic value. But its focus on individual choice has been applied to interventions and understanding addiction.3
- Medical model: Under this model, addiction is a brain disease that has genetic and neurochemical components. This view is supported by both the National Institute on Drug Abuse (NIDA) and the American Society of Addiction Medicine (ASAM), who define addiction as a chronic, relapsing brain disease that leads a person to compulsively use drugs despite negative consequences.3,4,5 This model provides a lens through which addicted people, their families, and their treatment professionals can view the disorder, and it relieves some of the guilt and shame of addiction. However, it is believed to take the responsibility off the addict for solving their problems and can be stigmatizing.6,7
- Psychological model: This perspective asserts that a person uses drugs to fill some unmet psychological need or to escape reality. They “self-medicate” their suffering. One of the biggest issues with this model is the difficulty in determining whether psychiatric problems precede or are caused by drug and alcohol use.3
- Social model: According to this model, addiction is a behavior people learn from family members, peers, and the media.3 People who belong to disadvantaged groups or live in dysfunctional environments are more likely to abuse drugs, so the solution to addiction under this model is to treat societal problems, such as poverty and racism, rather than individuals.1 The problem with this model is that it ignores genetic and physiological factors.2
People often use the terms “addiction” and “dependence” interchangeably. And, though they may be conceptually related, they are not the same thing. Another more recent term, “substance use disorder,” is increasingly used to refer to addiction; it is a diagnostic concept and is mostly used in clinical settings.
- Dependence. According to NIDA, physical dependence can develop in anyone who regularly uses any substance, whether the substance is prescribed or illicit. The body becomes used to the frequent presence of the substance in a person’s system and has to adjust when the person stops using it. Withdrawal symptoms may arise as the body attempts to adapt to the substance no longer being present.4
- Addiction. A person is addicted when they cannot control their use of a substance even if they are suffering consequences from their use, such as the loss of a job or relationship. Physical dependence is part of the criteria used to diagnose addiction, but it is not the only factor considered.4
- Substance use disorder. This term first appeared in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which was published in 2013. The DSM is a common tool used to diagnose a substance abuse problem in treatment programs. The characteristic symptoms associated with substance use disorders can be categorized in 4 major groupings: impaired control, social impairment, risky use, and pharmacological criteria such as tolerance and withdrawal.4
DSM Criteria for Substance Use Disorder
As mentioned above, clinicians use the DSM to diagnose people with substance or behavioral addictions. To meet the criteria for a substance use disorder, a person must display at least 2 of the following behaviors over the course of a year:8
- The person uses more of the substance or uses it over a longer period than they intended.
- They want to stop using or try to quit but are unsuccessful.
- The person begins to spend more of their time getting the substance, using it, or recovering from using.
- They have powerful urges, or cravings, for the substance.
- Their substance abuse prevents them from taking care of responsibilities at work, school, or home.
- They keep using the substance even though they have social or personal problems that were caused or made worse by drug use.
- They stop engaging in activities they once enjoyed in favor of drug use.
- They use the drug in dangerous situations, such as while driving or operating machinery.
- The person continues to use the substance even though they are aware that they have a physical or mental problem that was probably caused or made worse by drug use.
- The person develops tolerance, in which they either need more and more of the substance to become intoxicated or experience less of an effect with the same dose they used before.
- The person has withdrawal symptoms when they stop using or uses to prevent withdrawal symptoms.
People who are addicted to drugs tend to share some features (compulsive use, tolerance). But the causes of and treatment for addiction can vary depending on the group. Below you can find more information about addiction in different populations based on gender, age, occupation, and demographics.
Men and women show differences in why they use drugs, what kind of drugs they use, and how they are affected by drug use. For example, men tend to have higher rates of substance use than women, but women may have more cravings to use drugs and may be more likely to relapse after rehab.9,10
- Drug abuse and women’s issues: There are different reasons women turn to drugs and specific health and relationship concerns for women that providers need to take into consideration during rehab.
- Pregnant women: Pregnant women and newborns face specific risks from using drugs and during the withdrawal process.
- Men and drug addiction: The consequences of addiction in men sometimes require unique therapeutic approaches used for this population, such as anger management.
Stage of Life
Addiction can be especially destructive for young people because their brains are still developing.11 Research has also found that 9 out of 10 people who abuse or are addicted to drugs began using before they were 18.12 Senior citizens are also at risk of substance abuse—particularly prescription drug abuse—and may not receive treatment because their symptoms may be misdiagnosed.
- Teenage drug abuse: The dangers of teenage drug abuse make knowing how to identify addiction in adolescents important.
- College students: Binge drinking on college campuses is a big problem that can harm college students and lead to alcoholism.
- Addicted senior citizens: The signs of addiction in the elderly are often difficult to detect, and certain factors need special attention for this population during withdrawal and rehab.
Addiction in the workplace causes problems for employees and employers. Employees can injure themselves or others, miss deadlines, and even lose their jobs. Employers can experience lost productivity, lower morale, and higher worker’s compensation costs.
- The working professional and substance abuse: Professionals abuse drugs and alcohol often due to the stress of the job or work environment.
- Lawyers, addiction, and abuse: Lawyers become addicted to drugs and alcohol more than almost any other profession. Fortunately, specific treatment options exist for this profession.
- Addiction and first responders: These high-stress occupations often lend themselves to substance abuse as first responders try to cope.
Certain populations or communities are prone to substance abuse due to discrimination, trauma, or lack of economic opportunity. These groups may also have a hard time finding treatment because they may feel stigmatized or lack access to adequate care in their communities.
- LGBT community and substance abuse: Drugs and alcohol tend to be abused in this community for specific reasons and they often face barriers getting into treatment.
- Native Americans and a history of addiction: The root causes of drug and alcohol abuse in the Native American population goes back hundreds of years, yet continues to impact modern-day tribes.
- Veterans, PTSD, and drug abuse: The connection between PTSD and addiction is real significant. Recognizing the symptoms of both conditions is an important step toward getting life-saving help.
- Trauma victims and substance abuse: Trauma is a frequent driver of drug and alcohol addiction and must be treated together to bring lasting healing and sobriety.
- Australian Government Department of Health. (2004). Models that help us understand AOD use in society.
- Ngo, V. Addiction According to Moral, Disease, and Learning Models. Simon Fraser University.
- Clark, M. (2011). Conceptualising Addiction: How Useful is the Construct? International Journal of Humanities and Social Science, 1(13), 55–64.
- National Institute on Drug Abuse. (2016). The Science of Drug Abuse and Addiction: The Basics.
- American Society of Addiction Medicine. (2011). Definition of Addiction.
- White, W. (2001). Addiction Disease Concept: Advocates and Critics. Counselor.
- Hammer, R. et al. (2013). Addiction: Current Criticism of the Brain Disease Paradigm. AJOB Neuroscience, 4(3), 27–32.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C: American Psychiatric Association.
- National Institute on Drug Abuse. (2016). Sex and Gender Differences in Substance Use.
- National Institute on Drug Abuse. (2017). Sex and Gender Differences in Substance Use.
- National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
- The National Center on Addiction and Substance Abuse. (2017). Teen Substance Use.