Understanding Addiction as a Mental Illness: Impact, Definition and Neurobiology

1. Introduction

   1. Addiction and Its Impact on the Society

      Addiction is a severe physical and psychological dependence on certain substances. It is a complex condition that is characterized by the use of complex or harmful drugs despite their harmful consequences.

      Addiction can also be called a severe form of substance use disorder. According to the Centers for Disease Control and Prevention 1 in 7 people in the United States of 12 years or older report experiencing substance use disorder ⁽⁴⁾.

      Addiction affects the brain’s rewards, motivation, and memory circuits. Over time addiction can bring in changes in the structure of the brain and make it difficult to control substance use.

      The impact of addiction on an individual and society is significant. It can lead to a range of physical and mental health problems including liver disease, heart disease, lung disease, depression, anxiety, and psychosis. It can also lead to social and economic problems including loss of job, financial instability, and legal issues.

      Addiction impacts society on a larger aspect. It increases the rate of crime, homelessness, and healthcare costs. It can also strain families, communities, and the healthcare system. It can lead to societal problems such as an increased rate of infectious diseases and accidents.

   2. Is Addiction a Mental Illness

      Many believe addiction to be a behavior disorder while others believe it to be a mental illness. It is argued to not be a mental illness as it is caused by a behavior rather than a biological or genetic condition. Many experts believe it to be a mental illness as they believe it involves changes in the brain chemistry and structure that are similar to those in other mental illnesses such as depression, anxiety, and schizophrenia. Also, there are many factors that contribute to substance use disorder including genetics ⁽¹⁾. The debate on whether or not addiction is a mental illness is complex, with valid arguments on both sides.

2. Definition of Mental Illness

   • Mental Illness and its Characteristics

     Mental illness refers to a range of mental health conditions that affect a person’s mood, thinking, and behavior. It can impact a person’s ability to function in their daily life affecting their relationships, work, and personal well-being.

     Common characteristics of mental illness include:

     Mood changes including feelings of sadness, anxiousness, and irritability.

     1. Distortion of thoughts, making it difficult for the person to think or make rational decisions.
     2. There can be changes in the behavior of a person including withdrawn, impulsive, engaging, or self-destructive behavior.
     3. Some mental illnesses can cause physical symptoms including headache, fatigue, and changes in appetite.
     4. Mental illness can make it difficult for a person to perform daily tasks and maintain social relationships.

     Mental illness manifests differently in different people. Everyone will not experience the same type of symptoms and behavior changes.

   • How Addiction Fits Within the Definition of Mental Illness

     Addiction is referred to as a type of mental illness as it involves changes in brain chemistry and behavior. This can impact a person’s overall health and well-being.

     As the brain-reward system is affected a person can get dependent on a particular substance or behavior. This can lead to changes in mood, behavior, or thinking. It also affects the person’s ability to function in daily life.

     Just like any other mental illness, addiction can have physical symptoms and may cause a person to experience severe distress or impairment in social or occupational functioning.

     Addiction often accompanies other mental conditions including depression and anxiety that can further complicate a person’s treatment and recovery.

     All these make addiction fit into the category of mental illness as it is observed to make changes in the brain chemistry and behavior and can impact a person’s health and well-being and also the ability to function.

3. Neurobiology of Addiction

   • How Does Addiction Affect the Brain?

     Addiction affects several parts of the brain, including those responsible for rewards, motivation, learning, memory, and decision-making.

     According to the National Institute of Drug Abuse alcohol and drugs can alter how the brain works ⁽³⁾. When a person consumes drugs or engages in addictive behavior there is a release of neurotransmitters including dopamine that activates the reward center of the brain. Over a period of time, this behavior may lead to the development of addiction.

     Addiction affects the brain in the following ways:

     • Addiction causes the brain to release large amounts of dopamine that reinforces the behavior and makes a person want to repeat it.
     • Prolonged drug usage can cause changes in the structure and functioning of the brain leading to altered memory and decision-making.
     • Addiction impairs the ability of the brain to control impulses and make rational decisions, resulting in continued usage of drugs despite negative consequences.
     • Addiction can create associations between addictive substances or behavior and environmental cues. This leads to powerful cravings or a desire to engage in a behavior.

     Addiction can have prolonged and long-lasting effects on the brain making it difficult for an individual to quit using drugs.

   • How is Addiction Similar to Other Mental Illnesses in Terms of Brain Activity

     Addiction like other mental illnesses brings about changes in brain chemistry and functioning. Addiction can impact several areas of the brain involved in reward, motivation, learning, and decision-making.

     A few ways in which it is similar to other mental illnesses include:

     • Addiction just like other mental illnesses brings in changes in the dopamine system. Repeated use of drugs and alcohol can bring in changes in the release and uptake of dopamine decreasing the ability to experience pleasure from natural rewards.
     • Just like other mental illnesses such as post-traumatic stress disorder and anxiety, addiction involves dysregulated stress response system, which can increase the risk of addiction
     • Most mental illnesses including addiction involve changes in the brain structure and function. Repeated drug use can bring in changes in the brain’s reward circuitry and the areas of the brain.
     • Genetics plays a role in many mental illnesses including addiction.

4. Who is at Risk for Addiction?

   The risk factors for addiction include:

   • Behavior issues since childhood
   • Experimenting drugs
   • Lack of supervision by parents
   • Lack of resources
   • Friends or peers taking drugs
   • Age when a person starts taking drugs
   • How is the drug taken, whether its injected or smoked

5. Diagnosis Criteria for Addiction

   Addiction is diagnosed by assessing the individual’s behavior and symptoms related to substance use disorder ⁽²⁾. The diagnosis of substance use disorder is based on at least two of the following criteria within a period of 12 months ⁽⁵⁾:

   • The person taking a substance in larger amounts.
   • Frequent desire or unsuccessful attempts to control or cut down substance use.
   • A desire to use the substance.
   • Spending time obtaining, using, or recovering from a substance.
   • Using substances in physically hazardous situations
   • Continuing the use of the substance despite knowing it to have persistent or recurrent physical or psychological problems due to its use.
   • Tolerance, which can lead to an increased intake of the substance to achieve intoxication or desired effects.
   • Withdrawal, characterized by withdrawal symptoms for the substance or another substance being taken to relieve or avoid withdrawal symptoms.
   • Giving up on social, occupational, and recreational activities because of substance use.

   The severity of substance use disorder is classified as mild, moderate, or severe depending on the symptoms present. The mild diagnosis may need 2-3 symptoms, moderate substance use disorder diagnosis may need the presence of 4-5 symptoms, and severe substance use disorder may need the presence of 6 or more symptoms.

6. Treatment Options for Addiction

   There are several treatment options available for addiction ranging from behavior therapies to medications. The treatment plan depends on the individual’s unique needs and circumstances and may involve a combination of approaches.

   The treatment options for addiction include:

   • Behavior therapy
   • Medications
   • Residential treatments
   • Outpatient treatment

   It is important for a person to work with a mental health professional and go ahead with the best treatment plan tailored according to individual needs.

7. Conclusion

   Addiction is widely considered a mental illness due to its impact on brain functioning affecting the well-being of an individual. Just like other mental illnesses, it involves a variety of biological, environmental, and social factors requiring a comprehensive treatment approach.

   Recognizing it as a mental illness can help reduce the stigma and promote access to appropriate treatment.

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