Addiction Myths and Facts

What Is Addiction?

The way that addiction is defined has been a source of controversy for decades, and there is no one universally accepted definition. Most authorities have settled on a definition of addiction that shares certain common features.

The following features appear in most formal definitions of addiction:⁹

• Repeated use of a substance to alleviate urges and cravings
• Preoccupation with the substance
• Temporary satisfaction after using the substance
• A loss of control over use of the substance
• The experience of negative consequences, effects, or impairments related to substance use

While historically, addiction has been a term used to describe the compulsive and problematic use of drugs, research is increasingly suggesting that it might be possible to become addicted to certain behaviors.⁴ In fact, Gambling Disorder became the first formally recognized behavioral addiction in 2010 when it was added to the DSM-5 (the ultimate reference guide for diagnosing mental illness).

In the future, it is likely that other behaviors like sex, pornography use, internet use, and gaming may also be recognized as behavioral addictions. These behaviors are thought to affect the brain in similar ways as drugs do, forming “addiction pathways.”

According to the DSM-5, any person who uses substances and reports two or more of the following symptoms may be struggling with an addictive disorder:¹

• Using more of a substance than intended, or for longer than intended
• A desire to cut back or stop and previous unsuccessful attempts to do so
• Spending a great deal of time thinking about, obtaining, using, or recovering from the effects of a substance
• Cravings or a strong urge to use the substance
• Recurrent use that may interfere with fulfilling major role obligations
• Persistent use despite experiencing problems in important relationships which are caused or exacerbated by substance use
• Reduction or withdrawal from important social, occupational, or recreational activities because of time devoted to substance use
• Use of the substance in situations that are potentially dangerous
• Continued use despite having knowledge of negative effects on health or mental health
• The development of tolerance to a substance (needing more to get the same effects)
• Experiencing symptoms of withdrawal (physical or psychological discomfort when stopping use of a substance)

Even with a formal set of criteria to diagnose addiction, misinformation about addiction is common. Read on for more information about common addiction myths and to learn the facts.

Myth 1: Addiction Means Being Physically “Addicted” to a Drug

One of the most common myths about addiction is that being “addicted” to something means a person has physical cravings and withdrawals. In many cases, this is not true. Some drugs are more likely than others to cause physical dependence (like alcohol and prescription pain medications like opiates), but others are less likely to (like tobacco and marijuana). Still, a person can develop a psychological dependence on a drug that results in cravings and even psychological withdrawal symptoms.

It is possible to have an addictive disorder without ever experiencing cravings or withdrawals. For example, a person might only drink occasionally but may have a pattern of drinking to the point of blacking out and has had multiple DUI charges.

Even though this person does not experience any physical or psychological cravings for alcohol and is able to stop without having withdrawals, their drinking has clearly become problematic. More than physical dependence, continuing to use after experiencing negative consequences like these is the true hallmark sign of addiction.

Myth 2: People Who Are Addicted Can’t Help Themselves; They Have a Disease

This one is tricky. Many researchers believe that addiction is a disease of the brain, while others have challenged the fact that addiction does not fully fit the typical pattern of disease compared to other diseases, and is “disease-like” because it persists despite the cost outweighing the benefits. Neuroimaging studies have found that the brains of those addicted to drugs show abnormalities not present in people without addiction issues. These brain changes have been found to persist even after drug discontinuation.

Over time, it is believed that dopamine (a brain chemical largely responsible for the “high”) causes the formation of a “reward pathway” (also called an addiction pathway) in the brain. This pathway creates strong urges to repeat the behavior, making it harder to stop. This is referred to as positive reinforcement. Drug addiction reward pathway also involves negative reinforcement where a negative emotional state (created by the absence of a drug chronically used) is alleviated by drug use leading to increased drug use.

Some people may be more susceptible to developing an addiction, like those with existing mental health issues, those with a family history of addiction, or even those who are naturally more impulsive.⁸ Even with evidence to suggest brain involvement in addiction, all hope is not lost for those who have developed these pathways.

Brain science research shows that the brain remains plastic (changeable) throughout the lifespan, constantly wiring and rewiring connections based on behavior changes. As people stop using drugs, the addiction pathways in the brain begin to be pruned out, and new default pathways can be formed.

While the existence of brain reward pathways does make it harder to stop, it does not make it impossible. This truth is underscored by the fact that the majority of people struggling with addiction are able to stop using, even without any formal medication or treatment.⁵

Also, those with existing predispositions to addiction are not “destined” to become addicts, especially if they avoid drugs and alcohol or are very intentional about moderating their use. While the disease model of addiction is helpful in understanding and having empathy for how difficult it is to break the cycle, it is evident that many individuals successfully do so.

Myth 3: People With Addiction Problems Are Unable to Function

In mainstream media, the stereotype of an addict often goes hand in hand with a person who is unable to work, has ruined their relationships, and even appears homeless or disheveled. While this reflects the reality of a small percentage of those living with addiction, it is far from the majority.

It was stated earlier that the hallmark of addiction is the continuation of behavior or substance after it has become problematic in some way. Problems related to addiction can show up in any area of life: A person’s physical or mental health, their work, their legal record, or their finances. Many people are able to hide or conceal these problems from others, even for several years.

Often, people with an addiction might even try to deny or minimize their problems, making excuses, and remaining in denial. Recovery usually begins when this is no longer possible or when a person feels unable to continue “living a lie.” Contrary to popular belief, this doesn’t always mean that a person has “hit rock bottom.” It is possible to make a decision to go into recovery even when the problems related to addiction are still relatively contained.

Myth 4: People With Addiction Problems Use Every Day

Many people believe that the most reliable indicators of addiction are how much and how often a person uses, but this isn’t always the case. While it is true that heavy, frequent use is more likely to lead to addiction, some occasional or light users are also struggling with an addiction. In fact, a more important indicator than how much and how often a person uses is what happens when they use and, to a lesser extent, why they use.

People who use drugs or alcohol infrequently but lose control when they do might also be struggling with an addiction, especially if their use often leads to problems or impairments. For instance, a person who uses cocaine infrequently but tends to go on “binges,” using high doses and losing money, or making poor choices when they do might also have an addiction.

There is also research to suggest that people’s reasons for using drugs or alcohol (or even engaging in a behavioral addiction like gambling) may also put them at greater risk for addiction. Specifically, those who use drugs or alcohol to cope with stress or difficult emotions are more likely to develop an addiction than those using for social or recreational purposes.⁶

When it comes to drinking alcohol, research also suggests that context is an important factor in problematic drinking. Those who drink alone are more likely to develop an addiction than those who drink with others,³ and this might also be true for other types of substance use as well.

Myth 5: Marijuana Is Safe and Non-Addictive

As marijuana is legalized in more states, societal attitudes towards its use also change. Marijuana is becoming more recognized for its medicinal value, but recreational use is also gaining more mainstream acceptance.

Many people mistakenly believe that marijuana is harmless, citing the fact that there have not been any documented cases of people overdosing on marijuana. While there is no known lethal dose for marijuana, it is not a harmless substance. Marijuana has become much more potent in the past few decades, increasing the risk of adverse effects.

Marijuana is an intoxicating, mind-altering substance. People who smoke marijuana have impaired thinking and motor functioning, and should not assume it is safe to carry out certain activities like using tools or driving. Marijuana use can also cause short term cognitive effects like slower response time, memory problems, and difficulty thinking. Research suggests that children and teens might even have more lasting cognitive effects, especially when exposed in-utero.⁷

There are both physical and mental health impacts of marijuana use, especially for chronic or heavy users. Marijuana use is associated with higher rates of respiratory problems and places additional strain on the heart. Marijuana can also exacerbate or cause mood changes and mental health issues, including paranoia and psychosis.

While marijuana may not be physically addictive, it is still possible to become psychologically dependent on it. Psychological dependence can result in cravings and even withdrawal symptoms. Heavy users are also more likely to report lower overall levels of life satisfaction, worse relationships, and more physical and mental health problems.⁷

Myth 6: Heroin Is the Most Dangerous Drug to Withdraw From

People who become addicted to heroin or other opioid drugs (like prescription pain medication) usually experience uncomfortable withdrawals when they stop using. Physical withdrawal symptoms include flu-like symptoms like chills, nausea, diarrhea, muscle spasms, and aches, and insomnia. Some people also spike fevers and break out into hot or cold sweats.¹

Psychological withdrawal symptoms are also common and include anxiety, mood swings, irritability, trouble focusing, and intense cravings.¹ In rare cases, some people in active opioid withdrawal may have hallucinations or other temporary psychotic symptoms. While the physical and psychological withdrawal symptoms are intense, they are not usually medically dangerous and are almost never fatal.¹⁰

While opioid withdrawal is not usually dangerous, it is very, very uncomfortable. Because of this, many people opt to detox in an inpatient facility or by using medications like Suboxone or Methadone to reduce their discomfort. These medications and treatments can be helpful in increasing the likelihood of successful detox, as the discomfort causes many to relapse before fully detoxing, which can take 4-20 days.¹⁰

Myth 7: Alcohol Is Safer than “Hard Drugs” Like Cocaine or Heroin

Many people downplay the dangers of drinking because it is legal and so socially accepted. Alcohol use, however, is one of the most dangerous substances, and also the most deadly. In the US, there are 88,000 alcohol-related deaths each year, exceeding the number of annual deaths related to all other substances combined.²

Alcohol use is known to increase the risk of serious chronic health conditions like cancer, cirrhosis, and hepatitis. It is also involved in the majority of deaths resulting from crime, suicide, and DUI’s. Many of these deaths are of people who have died early—an average of 30 years too early.²

People who drink heavily increase their risk for a host of physical and psychological problems, including diabetes, liver disease, high blood pressure, stroke, anxiety, and depression. They are also more likely to be unemployed and to have poor social relationships, suggesting that alcohol not only can reduce the length of a person’s life, but also their quality of life.²

For those who develop a physical dependence on alcohol, there are additional risks. Alcohol is one of the most dangerous drugs to withdraw from.¹⁰ While mild withdrawal symptoms like tremors, stomach upset, dehydration, anxiety and insomnia are more common, some people experience more severe symptoms of withdrawal. These include dangerous spikes in body temperature, extreme dehydration, psychosis, and even seizures. Without medical intervention, these withdrawal symptoms can lead to death.^1,10

Myth 8: Sobriety Is Always the Goal of Addiction Treatment

Historically, addiction has been regarded and treated in an all-or-nothing manner. Those entering addiction treatment were automatically enrolled in abstinence-only programs, where they were expected to completely give up alcohol and all other drugs. In recent years, addiction is more likely to be seen as a spectrum, and more individualized treatments are available.

In some cases, addiction is context-dependent. Some people might find that at certain times in their life (like after a breakup or during college), they develop a problem with drugs or alcohol, but that it naturally resolves once their situation changes.

What this means is that not all people who struggle with a diagnosable substance use disorder need to completely stop all drugs and alcohol. While many do, there are some people who are able to moderate, putting checks and balances into place which help keep them accountable.

Some might find they are unable to control their use of one type of substance but not others. For instance, a person who had an addiction to opioid pain medication might stop using these, but still occasionally drink alcohol. Addiction doesn’t look the same for everyone, so treatment shouldn’t either.

Myth 9: The Best Way to Confront an Addict Is Through an Intervention

The show “Intervention” popularized the myth that the best way to help a loved one struggling with addiction is to organize an intervention. For those unfamiliar with the term, an intervention is when a group of friends or family members confront a person about their drinking or drug use.

This emotionally-charged confrontation is often punctuated with an ultimatum given to the addict: get help or else. The “or else” usually involves being cut off in some way (financially or even just emotionally).

While well-intended, interventions are often problematic, and unfortunately, ineffective. One major problem with interventions is that the person is often unprepared and outnumbered, making it much more likely that they will feel attacked and become defensive. When people become defensive, they stop fully listening.

When relationships are used as leverage, people get the message that the people in their life will only be there for them if they stop using, causing them to feel more alone. The more isolated and alone people feel, the worse their addiction tends to become. Also, lasting change starts when a person becomes more aware and uncomfortable with the way things are. An intervention is an attempt to force this process to happen, sometimes before a person is ready or willing to make a change. It is, however, generally accepted that addiction treatment can still be effective even if not initiated voluntarily.

Myth 10: Addiction Is About the High

While drugs do cause pleasurable feelings, addiction is often more about pain than it is about pleasure. People who become addicted to drugs, alcohol, or even a behavior are typically using to avoid or escape physical or psychological pain.

There are high rates of comorbidity between addiction and other mental health issues like depression, anxiety, and trauma. Research tells us that people addicted to substances are much more likely to have begun using heavily in order to cope, rather than for enjoyment purposes.³

People who have been using heavily for long periods of time develop tolerance, meaning that drugs begin to have “diminishing returns.” Over time, they have to use more in order to get the same effects. In some cases, people no longer get high at all, and are using to avoid withdrawals or just to “feel normal.”

There is almost always a lot of sadness, pain, and loss behind addiction. As people spiral further into their addiction, this pain just worsens as people lose touch with themselves, people they love, and parts of their life that were important to them. For some, sobriety can even be scary because it means having to face the people they hurt and the opportunities they lost.

Final Thoughts

There are many misconceptions about addiction. These can make it harder for people struggling with addiction to come forward and get help. These also make it harder for people who love someone with an addiction to understand what the person is going through, why they don’t just stop, and what they can do to help. Luckily, there are many treatment options to support those wanting to recover from addiction, and also for loved ones wanting to help.