4.7 The unrestrained and addicted mind

The following section covers a group of phenomena that are similar in that they involve difficulties with self-control and behavioral regulation. They include more extreme expressions of some personality traits, such as sensation-seeking, impulsivity, unruliness, and emotional intensity. They are described as externalizing conditions because they tend to cause problems on the outside. They are distinguished from internalizing conditions, such as anxiety and depression, that tend to keep problems confined to the inside. Under the umbrella of externalizing conditions, we will cover substance abuse and impulse-control disorders. 

Substance abuse: Addiction is an intense feeling of craving for something, a loss of control over amount and frequency of its use, and continued involvement with it in spite of harmful consequences. The experience of intense pleasure has a powerful effect on the brain. A chemical rush creates an instant programming that makes us want to repeat the experience. At repeated exposure, a normal adaptive response sets in. As with any overwhelming stimulus, the brain tones down its response in order to keep its neural pathways from being flooded. However, the strong initial conditioning leads to a compulsive striving to repeat the intense initial experience.

The progression towards a state of addiction begins with experimentation. The initial exposure to the addictive agent may happen out of mere curiosity or reckless imprudence. The next stage in the progression is the development of a pattern of regular use and abuse as a coping strategy. Withdrawal symptoms set in whenever the addictive agent is being washed out of the system. As the organism adjusts to the continued exposure, it develops tolerance which leads to a craving for higher amounts to achieve the same effect. The organism is now dependent upon the continued presence of the addictive agent to maintain its capacity to function. Increasingly, there are tangible negative consequences as everyday functioning and relationships are impacted by the addition. This eventually leads to a “hitting-rock-bottom” experience where the addicted individual is forced to confront the extent of the problem.

Alcohol addiction: According to the 2019 National Survey on Drug Use and Health 66 million people in the U.S. reported engaging in binge drinking during the past month (1.2 million of these were adolescents between 12 and 17 years); 16 million people reported a pattern of heavy drinking over the past month and 14.5 million people aged 12 or above had an alcohol use disorder (2019 NSDUH).

In the 1940s and 50s, Morton Jellinek described a typical pattern in the progression of alcoholism and recovery.

Jellinek was the first one to describe alcohol addiction as a progressive and chronic disease rather than as a moral failure. A similar progression from recreational use to complete loss of control can be found with other addictive substances. How vulnerable a person is to become addicted to alcohol or drugs depends on a combination of genetic factors and environmental influences. A social environment where heavy drinking or substance use is common will have a more negative impact on people with a genetic disposition to develop an addiction. 

Behavioral addictions: In addition to substances certain behaviors can take on an addictive quality. Typical examples are gambling, excessive video gaming, shopping, or pornography. It is subject to debate whether these compulsive behaviors should actually be classified as addictions. However, studies show that behavioral addictions, such as a gambling addiction, involve very similar neurophysiological processes as addictions to substances. There is also no doubt about the pervasive negative effects of behavioral addictions. Again, a combination between a genetic disposition, a conducive environment, and emotional stressors (i.e. boredom, loneliness, exhaustion) determines the likelihood of occasional use deteriorating into a pervasive problem.

Impulse-control disorders: Other problem behaviors fall in the category of impulse-control disorders. These include a group of rare syndromes, such as kleptomania (compulsive stealing) and pyromania (a pervasive fascination with fire and compulsive fire starting) as well as more common problems such as explosive anger or oppositional-defiant tendencies in children.