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The causes of addiction are complex and generally rooted in some combination of biological, psychological, and social factors that vary for each person and substance. It is important to keep in mind that the development of addiction does not follow an established timetable. For example, one person might drink socially for years before abusing alcohol, and another person might become addicted to cocaine in a matter of weeks. Furthermore, newly developed substances powerfully target pleasure centers in the brain and, as a result, addictive substances have become more accessible and tempting. As scientists and professionals, we use our collective understandings to neutralize the powerful effects of society, technology, and marketing to help people recover from addiction.


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In 1964, a World Health Organization committee recommended the term addiction be replaced by the term dependence because dependence describes the physical or mental feeling related to use of a particular substance. However, most professionals continue to use the term addiction and define it as a shared experience of physical and mental dependence that causes a change in the brain. With addiction a person is compelled to use a substance even though the person realizes they face considerable harm by doing so.

The Research

The effects of particular drugs are usually studied under carefully controlled scientific conditions. To eliminate sources of research error, most researchers use the double-blind procedure, in which some research participants receive the active drug, and others take an inactive substance (placebo). Most drugs affect different people in different ways, which can complicate substance abuse research. More recently, neuroimaging procedures have proved useful, and can help researchers study brain differences between a person with an addiction and one without an addiction. Other investigators have focused on the role played by neurotransmitters in the addictive process and genetic markers,1 providing a better understanding of the biological basis of addiction, and potentially more effective treatments.

Categories of Drugs

Drugs, both legal and illegal, fall into the following three categories: depressants (e.g., alcohol and opiates), stimulants (e.g., caffeine and cocaine), and hallucinogens (e.g., marijuana and LSD). Depressants are chemicals that hinder behavior and thought by either accelerating or slowing nerve impulses. Stimulants generate feelings of optimism and unlimited energy. Hallucinogens often produce striking visual effects.

Cost of Addiction

According to a report released in 2009, U.S. government spending related to substnce abuse (including smoking, alcohol abuse, and illegal drugs) reached $468 billion in 2005, “accounting for more than one-tenth of combined federal, state and local expenditures for all purposes.”


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In 2005, 80 percent of American youth reportedly participated in school-based prevention programs; however, only 20 percent of these participants were exposed to effective programs.3 The U.S. Department of Health and Human Services reports that if “effective prevention programs were implemented nationwide, substance abuse initiation would decline for 1.5 million youth and be delayed for 2 years on average.”4 In addition, effective programs can help delay onset, thus reducing problems later in life.


“[Recovery from addiction] is a long-term process of internal change in which progress occurs in stages. In preparing a treatment plan, it is important to recognize that treatment takes place in different settings (e.g., residential and outpatient), over time, and that much of the recovery process typically occurs outside of, or following treatment (e.g., through participation in mutual self-help groups). Professionals often divide treatment into phases:



Primary treatment

Continuing care (or aftercare)”

Treatment planning begins with screening and assessment and depends on a qualified staff that is invested in continuing skills acquisition, values clarification, and competency attainment.

Some of the current evidence-based and successful treatment strategies include:

Motivational Interviewing (MI) – “a client-centered, directive method for enhancing intrinsic motivation to change (by exploring and resolving ambivalence)”6

Contingency Management (CM) – a method that “maintains that the form or frequency of behavior can be altered through the introduction of a planned and organized system of positive and negative consequences”7

Cognitive-Behavioral Therapy (CBT) – “a general therapeutic approach that seeks to modify negative or self-defeating thoughts and behaviors and is aimed at achieving change in both”8

Relapse Prevention (RP) – a method that develops the client’s/patient’s “ability to recognize cues and to intervene in the relapse process, so lapses occur less frequently and with less severity”9

Assertive Community Treatment (ACT) – a method that employs “extensive outreach activities, active and continuing engagement with clients, and a high intensity of services”10 including meeting basic needs.


Professionals agree that there are 10 very important things known about addiction:

In a fundamental sense, addiction is compulsive behavior.

The compulsive pursuit of drugs is initiated outside of consciousness.

Addiction is about 50 percent heritable and an extremely complex disorder.

Most people who seek help for their addiction also have a co-occurring psychiatric disorder.

Addiction is a chronic and relapsing disorder in the majority of people.

Most of the different treatment interventions produce similar treatment outcomes.

The professional is key in developing a client’s/patient’s motivation for change.

Customized “wrap-around” treatment produces better outcomes.

Epiphanies are unlikely when treating addiction.

Change takes time.

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