Addiction: What gets us hooked?

Some people have their lives destroyed by drugs or alcohol, while others can indulge and walk away. Now doctors are beginning to understand the reasons why.

"My destructive side has grown a mile wide," she sang on her first album in 2003. The cause of Amy Winehouse's death has not yet been confirmed, but her struggles with drug addiction, and more recently alcoholism, mean most people will be shocked if a link isn't found.

But have you ever wondered why one person can drink like a fish for years and never become an alcoholic, while for others, like Winehouse, a tipple or 10 can begin the slide into dependency? Why can one person take that first disgusting drag of a cigarette (for that first drag is always disgusting) and say never again, while for others it becomes the start of nicotine dependence, still the most common addiction in the world?

It's a question that has dogged professionals for decades. So what have they discovered? While addiction is naturally associated with drink and drugs, is that the whole story? Can, as the NHS claims, anything be addictive, from gambling to chocolate?

Addiction has to start with exposure, says Dr Gillian Tober, president of the Society for the Study of Addiction. "It's generally for social reasons – groups of friends or a boyfriend or girlfriend – and it's often not pleasant. The reward is merely social. It then becomes reinforced and casual use shifts to dependence."

Drugs directly feed the reward circuitry of the brain, she says, and the brain learns to look forward to the thrill. Tolerance occurs as you demand more each time. Physiological dependence – addiction – then emerges. "It is this area – the mechanisms involved in the addictive process – where research has been most progressive and this has meant we have a lot more effective medications to help people come off nicotine, alcohol and opiates," Ilana Crome, a professor of addiction psychiatry at Keele University, says. "But we still don't know what actually causes addiction."

Indeed, many people drink but few are addicted. During the Vietnam war, when many American soldiers took lots of heroin, there were concerns that they would have difficulty coping without it when they came home. In fact, when they returned to an environment where there wasn't the same availability and it wasn't part of their social lives, most were fine. Likewise, when opiates have been given to cancer sufferers for many years, studies show that only a few remain addicted.

"There is no single reason why this is the case," Dr Tober says. "There are not even any particular personality characteristics that predispose people to becoming addicted. There are risks involved in being outgoing, but equally there are risks involved in being introverted. Every sort of personality can become addicted."

Indeed, a long-term study of 500 men, which began in the 1940s, exploring why some people become addicts while others don't, found there were no consistent personality types, says Bob Adams, a consultant psychiatrist in York NHS Trust.

But the Faculty of Addictions at the Royal College of Psychiatrists claims there are three key risk factors – biological, psychological and social. Biologically, addicts may be wired differently, particularly in the brain's orbito-frontal cortex, the part of the brain involved in weighing up the pros and cons of a particular action, they say.

Meanwhile, scientists at the Neurocentre Magendie in Bordeaux recently found those who became addicts had brains incapable of returning to normal after regular drug abuse. Long-term drug binges change the way people's minds work, but they only become addicts if their brain cannot bounce back to normal when they stop, the French study found. Addicts lose the ability to produce a form of brain plasticity, known as LTD, crucial for developing and holding new memories and therefore in having flexible behaviour, they concluded.

"Scandinavian studies have shown that children of alcoholics – even those who were adopted – are more likely to become alcoholics themselves, suggesting there is a genetic component," Dr William Shanahan, a lead addiction consultant at Capio Nightingale Hospital in London, says. "It doesn't mean you're going to see the addiction through – you still have free will, after all, so you might, for example, recognise it in others around you early on and get frightened off, or something else, like religion, acts as your salvation. In fact, it's often the case that if you find a non-drinker, you can usually find a drinker somewhere in their lives."

The second risk factor is psychological trauma. Childhood neglect, abuse or bereavement is extremely common among addicts, Harry Shapiro from DrugScope, says. For others, the trauma comes later – a bereavement, loss of job or late-onset anxiety might make them turn to the bottle or cocaine. Research from the Nineties found there may be a biological link here, too. Levels of feel-good chemicals in the brain, mainly serotonin and dopamine, can be reduced by any traumatic event such as divorce or abuse. People who become addicted to certain substances are subconsciously trying to boost the levels of these feel-good chemicals.

Thirdly, social risks include the availability of the particular drug, being around others that take it and social deprivation. "Most of the people who come forward for heroin or crack use are pretty impoverished," Shapiro says.

Dr Farrukh Alam, consultant psychiatrist and clinical director at Central and Northwest London NHS Foundation Trust, believes the clues that we have about these, and other, risk factors mean that we may be able to identify a propensity towards addiction. You can spot some traits as early as late adolescence, he says. "We know, for instance, that among those most prone are people with compulsive or impulsive types of behaviour, an unwillingness to take responsibility for their own actions or who are stressed and anxious even in times of relative ease. The age of initiation is relevant, too – the earlier you start to misuse substances, the more likely you are to develop chronic dependence." Certain occupations have also been shown to be higher risk – media, entertainment, catering and the military among them.

Some even believe there's an "addictive personality", seen in people who have an addictive edge, that obsessive side to their personality that gets them practising at something until they're the best. It would certainly explain why so many people famous for their talents – Andre Agassi, Paul Gascoigne, and Winehouse among them – wind up in rehab.

Most addiction professionals talk about drugs and alcohol, but can you become addicted to anything? Gambling is accepted as a behaviour involving a thrill that the brain can become hooked on. And the NHS is reconsidering sex addiction as a genuine disorder after the American Psychiatric Association added it to its main diagnostic manual.

But not everyone is convinced. "I think the addiction has become a lazy word for a bit of an obsessive habit, which is not the same," Shapiro says.

"Put it this way – how many people do you know whose job has gone out of the window or they have neglected everyone in their lives because they want to buy more shoes, get a better tan or eat more chocolate?"

Warning signs

How to tell if you're an addict If you answer yes to three or more of these, it is probably time to seek help:

* Do you crave the substance or behaviour?

* Do you have difficulty controlling your intake?

* Have you become tolerant to it – ie, you need increased amounts in order to produce the same effects?

* Do you neglect other interests to feed your habit?

* Do you get physiological withdrawal symptoms upon cessation, such as sweating, anxiety and tremors?

* Do you persist in its use despite understanding the harmful consequences?

Suggested Topics
Life and Style
ebookNow available in paperback
ebookPart of The Independent’s new eBook series The Great Composers
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Ashdown Group: Senior VMware Platform Engineer - VMware / SAN / Tier3 DC

    £45000 - £55000 per annum + benefits: Ashdown Group: Senior VMware Platform En...

    Recruitment Genius: Purchasing Assistant

    £10000 - £16000 per annum: Recruitment Genius: A distributor of specialist ele...

    Recruitment Genius: Sales Ledger Assistant

    £17000 - £19000 per annum: Recruitment Genius: A distributor of specialist ele...

    Ashdown Group: Automated Tester / Test Analyst - .Net / SQL - Cheshire

    £32000 per annum + pension, healthcare & 23 days holiday: Ashdown Group: A gro...

    Day In a Page

    War with Isis: Iraq's government fights to win back Tikrit from militants - but then what?

    Baghdad fights to win back Tikrit from Isis – but then what?

    Patrick Cockburn reports from Kirkuk on a conflict which sectarianism has made intractable
    Living with Alzheimer's: What is it really like to be diagnosed with early-onset dementia?

    What is it like to live with Alzheimer's?

    Depicting early-onset Alzheimer's, the film 'Still Alice' had a profound effect on Joy Watson, who lives with the illness. She tells Kate Hilpern how she's coped with the diagnosis
    The Internet of Things: Meet the British salesman who gave real-world items a virtual life

    Setting in motion the Internet of Things

    British salesman Kevin Ashton gave real-world items a virtual life
    Election 2015: Latest polling reveals Tories and Labour on course to win the same number of seats - with the SNP holding the balance of power

    Election 2015: A dead heat between Mr Bean and Dick Dastardly!

    Lord Ashcroft reveals latest polling – and which character voters associate with each leader
    Audiences queue up for 'true stories told live' as cult competition The Moth goes global

    Cult competition The Moth goes global

    The non-profit 'slam storytelling' competition was founded in 1997 by the novelist George Dawes Green and has seen Malcolm Gladwell, Salman Rushdie and Molly Ringwald all take their turn at the mic
    Pakistani women come out fighting: A hard-hitting play focuses on female Muslim boxers

    Pakistani women come out fighting

    Hard-hitting new play 'No Guts, No Heart, No Glory' focuses on female Muslim boxers
    Leonora Carrington transcended her stolid background to become an avant garde star

    Surreal deal: Leonora Carrington

    The artist transcended her stolid background to become an avant garde star
    LGBT History Month: Pupils discuss topics from Sappho to same-sex marriage

    Education: LGBT History Month

    Pupils have been discussing topics from Sappho to same-sex marriage
    11 best gel eyeliners

    Go bold this season: 11 best gel eyeliners

    Use an ink pot eyeliner to go bold on the eyes with this season's feline flicked winged liner
    Cricket World Cup 2015: Tournament runs riot to make the event more hit than miss...

    Cricket World Cup runs riot to make the event more hit than miss...

    The tournament has reached its halfway mark and scores of 300 and amazing catches abound. One thing never changes, though – everyone loves beating England
    Katarina Johnson-Thompson: Heptathlete ready to jump at first major title

    Katarina Johnson-Thompson: Ready to jump at first major title

    After her 2014 was ruined by injury, 21-year-old Briton is leading pentathlete going into this week’s European Indoors. Now she intends to turn form into gold
    Syrian conflict is the world's first 'climate change war', say scientists, but it won't be the last one

    Climate change key in Syrian conflict

    And it will trigger more war in future
    How I outwitted the Gestapo

    How I outwitted the Gestapo

    My life as a Jew in wartime Berlin
    The nation's favourite animal revealed

    The nation's favourite animal revealed

    Women like cuddly creatures whilst men like creepy-crawlies
    Is this the way to get young people to vote?

    Getting young people to vote

    From #VOTESELFISH to Bite the Ballot