Addiction 101: Symptoms, Causes & Treatment

Addiction can come in many forms including substance and behaviour abuse. Learn more about the different types of addiction, its signs, differences between gender and treatment available in Malaysia.

by Ain Nadzirah

Addiction

Addiction is a chronic medical condition identified as being unable to control one’s urges to continuously depend on a substance or participate in an activity, despite being aware of the health consequences. This compulsive behaviour is influenced by changes in the level of dopamine hormones in your brain. Although addiction can disrupt one’s quality of life, the good news isthe disorder has been proven treatable with proper interventions and long-term treatments.  

Dopamine and brain reward system

In order to understand how dopamine hormones play a critical role in developing addiction, we first need to get to know the reward system in our brain. 

When you consume or do something that makes you feel good and rewarding, an area of your brain called the ventral tegmental area (VTA) is activated to produce dopamine hormones (which explains why dopamine is also known as one of the ‘feel-good’ hormones). These hormones then travel to various areas in the brain where different signals are triggered.

Let’s say, you are indulging a blueberry waffle. Here is how the reward system works:

  1. The delicious taste triggers your amygdala (which processes emotions), making you feel delighted. 
  2. Your hippocampus (which processes memory) then recognises having the waffle as pleasurable, thus helping to remember that exact feeling along with other related information like the flavour and the place you have the waffle at. 
  3. As a result, your nucleus accumbens (controls motivation and motor functions) motivates you to take another bite in order to experience the delicious taste repeatedly.
  4. At the same time, your prefrontal cortex (which controls attention) keeps you focused on savouring the waffle. 

The dopamine released naturally in our brain is only in small amounts. So you might wonder, how it can lead to addiction?

How Does Addiction Develop?

It starts to form when you cannot get enough of the feel-good emotion or ‘high’ feeling gained from using a substance or engaging in a pleasurable activity (‘rewards’). As a result, you keep going back to these rewards, thus creating repeated behaviour. 

Over time, your tolerance starts to build uptaking more doses or engaging in the pleasurable habit more frequently to achieve that same ‘high’ feeling. Such an increase causes the dopamine levels in your brain to exceed the healthy amount, thus creating an imbalance. Instead of enjoying the rewards like you used to, now it has become a need. 

If you fail to fulfil this need by quitting, there will be withdrawal symptoms such as anxiety, aches, and fatigue. As the urge to avoid these symptoms gets intense, your cravings for the rewards ultimately become uncontrollableleading to constantly relying on them in order to feel okay or normal again. 

The heavy dependence, how it manipulates your brain functions, and loss of self-control constitute an addiction. 

Misuse, Abuse, and Addiction

The terms misuse, abuse, and addiction are often used interchangeably to refer specifically to substance use or medications. Actually, each of them refers to different conditions, with slight similarities and correlations. Hence, let us learn how to distinguish one from the other.

Misuse: Taking a prescribed substance or medication improperly to enhance its effectiveness as a remedy to an ailment. For example, you still have coughs after ingesting a cap of cough syrup. Instead of following the recommended doses, you then gulp one whole bottle of cough syrup in one go as you assume the medicine will work more strongly. Other examples of misuse include not taking the prescriptions on time or forgetting them entirely, ingesting someone else’s prescriptions, and stopping medications without your doctor’s advice. 

Abuse: A substance, usually illegal and unprescribed, is abused to attain a state of ‘high’ or to self-harm. You can still manage to have self-control and are able to improve with the help of interventions by health professionals. However, if out of control, substance abuse can lead to addiction.

Addiction: A chronic form of substance abuse that is practised repeatedly over a long period of time, making it difficult to stop even after knowing the negative effects. It significantly impairs your cognitive functioning to the point of not being able to make rational decisions and control your desires, as well as displaying aggression which affects most or all aspects of life. 

Types of Addiction

Addiction consists of two types, which are:

  • Physical Addictions

Addiction is widely referred to as this type, whereby the physical substance is consumed. Physical addiction can be classified into 3 major categories as follows:

  • Alcohol addiction: Also known as alcoholism. Includes heavy drinking, inability to function in daily life without alcohol, and not being drunk despite having a great number of drinks. The cycle begins with a simple habit of drinking during a celebration or social occasion, which later becomes uncontrollable. 
  • Illicit drug addiction: Use of illegal substances or ‘street drugs’ that is not prescribed by a doctor or obtained from pharmacies. Common illegal drugs are cocaine, marijuana, amphetamines, hallucinogens, inhalants, and PCP. 
  • Prescription drug addiction: Regular misuse and abuse of medications prescribed by healthcare providers. Usually stemmed from taking a friend’s drug-like opioids, depressants, and stimulants.
  • Behavioural Addictions

Behavioural addiction is a lesser-known type of addiction. Instead of being addicted to a substance, a person is depending heavily on an action or a pattern of behaviour to experience the taste of brief pleasure.   

The most typical activities are:

  • Gambling
  • Internet
  • Sex and pornography 
  • Video games and the use of gadgets
  • Shopping 
  • Work (workaholism)
  • Food (overeating)

Both types deteriorate physical, psychological, and social well-being. A person who is undergoing recovery from drugs can later form behavioural addiction to cope with the absence of substance use.  

Causes of Addiction

Identifying specific causes would be oversimplifying a complex disorder, as there is a combination of various factors that come into play. We can take a look at how these factors increase a person’s urge for addiction.

Biological factors 

Natural aspects of a person like genetics, gender, and age affect the degree of sensitivity towards forming an addiction.

Genetics

Researchers suggest that it can be heritableespecially if you have a closer genetic relationship to the drug abuser like your parents and siblings. Although that does not mean the children will definitely succumb to addiction, family history does increase the probability by as much as 40% to 60%. Differences in genes may also affect the response of the dopamine system towards substance use; some get more easily addicted than others. 

Gender

Generally, the rates are much higher among men. However, women tend to get addicted much quicker than their counterparts. As women face more trauma and societal pressure, they have greater difficulty recovering from addiction and can easily slip back into relapse. 

In terms of behavioural addiction, certain types of addictive behaviour may be more prevalent in one gender than the other; video game addiction may be as common among men as shopping addiction among women.  

Age

Young adults and adolescents are more addicted to using of substances and illicit drugs, mainly alcohol, marijuana, and nicotine in cigarettes. On the other hand, older adults are more prone to develop an addiction to prescription drugs, such as opioid painkillers and benzodiazepines, possibly due to the influence of daily medications. 

Environmental pressure

We constantly face the following external influences in our everyday life, which may intensify our symptoms into developing a full addiction.

Dysfunctional home

The situation at home and upbringing are crucial in a person’s self-development; lifestyle, habits, routines, and manners will be emulated by the children. So if frequent alcohol consumption by the parents is normal, their children will have a higher tendency to follow suit. Distant relationships between family members and childhood abuse attributed to lack of communication, love, attention, and support can drive the children to indulge in unhealthy substances or activities.

Peer pressure

During adolescence, we often spend more time with friends than we do with the family. Therefore, it is not uncommon that you might be experimenting with new things including substance use and participating in addictive behaviour. Such early exposure is typically due to encouragement from peers and the desire to fit in. 

Stress 

Financial instability, social and cultural expectations, relationship problems, as well as conflicts at work and school can cause physical and mental stress. Stress is known to be a major trigger and as a way of coping in order to distract themselves from their worries. 

Mental health

We already know that addiction can lead to mental health disorders such as depression, anxiety, and bipolar due to its harmful effects on our brain chemicals. However, the opposite way is also possible—mental health illness can instead give rise to addiction through self-medication. Such individuals tend to misuse prescribed drugs or other substances as a relief for their mental health symptoms. 

Signs and Symptoms of Addiction 

Like any illness, each person may experience addiction differently. However, there are shared general signs and symptoms that make addiction more recognisable. 

Signs are the observable behaviours such as:

  • Denial or having problematic behaviours
  • Blaming others
  • Declining performance at school or at work
  • Social relationships getting strained
  • Personality becomes more aggressive and secretive

Symptoms are the physical and psychological discomfort experienced by the person with addiction:

  • Increased impulses 
  • Being occupied with the addiction and neglecting other aspects of life
  • Increased tolerance, resulting in additional doses or frequent addictive behaviour
  • Experience withdrawal when discontinuing the addiction
  • Difficulty to reduce and stop the addiction
  • Impaired judgement, memory, and decision-making ability
  • Lack or inability to control desires and urges
  • Feeling indifferent and disinterested
  • More sensitive toward stress
  • Fluctuating mood and energy levels
  • Having too much or too little sleep at irregular hours
  • Lack of appearance and hygiene care
  • Losing weight

Without immediate treatments, addiction can leave serious negative impacts on our life in the long run in terms of:

  • Physical complications, such as heart disease and brain damage, HIV due to needle sharing
  • Mental illnesses, such as stress, anxiety, depression, and suicide
  • Financial ruin, such as debt 
  • Social isolation due to damaged relationships

Treatment for Addiction

Overcoming addiction takes time as it is not a one-time fix but a lifelong process. The treatment plans vary depending on how severe their condition is. Addiction cannot be resolved merely with medications; their thoughts and behaviours need to be trained as well as rewired in order to improve self-control.

Detoxification

You may have heard the popular word ‘detox’ which means getting rid of unhealthy or toxic substances from our body. Detoxification is a common first step to combat addiction, by ‘forcing’ drug abusers to go through withdrawals safely. The purpose is to reduce dependency until their body is clean from the substance. Prescribed medications may be given from time to time to lessen the intensity of withdrawal symptoms. 

However, detoxification does not help address the behavioural problems caused by addiction—that is why it is often followed by rehabilitation and therapy. 

Rehabilitation

Rehabilitation aims to guide people with addiction in their process of recovery while being administered by relevant authorities and experts within a designated facility. In Malaysia, addiction rehabilitation centres are called ‘Pusat Serenti’ which are available nationwide with the usual duration of programmes ranging from 18 months to 2 years.

During rehabilitation, you might be introduced to a 12-Step Program as a guideline to keep your addiction in check through acceptance, being accountable for your behaviours, mindfulness practices, improving spirituality, and making active changes in your actions.  

Supervised follow-up care

The process of rehabilitation continues even after leaving the facility. In order to reduce the possibility of relapsing or returning to old habits of addiction when in public, a Drug Rehabilitation Officer will be in charge of monitoring your progress for 2 years. This follow-up care is intended to ease your adjustment into the community after recovery. 

Vocational training programmes are also conducted to equip the recovering individuals with necessary practical and professional skills for the purpose of employment. This initiative helps to boost their self-confidence and motivation to participate in the wider community.

Therapy

Behavioural therapy is crucial in learning to understand your thought process and how it affects your behaviours, thus developing the ability to control them. One of the most recommended therapy for addiction is Cognitive Behavioural Therapy (CBT), which helps to identify your behavioural patterns and learn the various ways of overcoming them through healthy coping skills.  

Family therapy can be considered to involve family members in creating bonds as well as fostering empathy and understanding towards the recovering person.  Examples of strategies are parental training, problem-solving skills, and communication practices.

Medications

Specific medications might also be prescribed during recovery to tone down cravings, boost mood, and reduce the feeling of getting ‘high’. These positive side effects will encourage you to decrease your dependency on substance use or addictive behaviour. 

Prevention of Addiction

Curbing addiction is not a one-man work; it takes a collaborative effort from the whole community including family, school, workplace, local neighbourhood, law enforcement, as well as the government.  

  • Educate the public, especially the youth. Expose them to the possible causes that lead a person to addiction, how addiction is developed through small unhealthy habits, how relapses can happen, and the dangers of addiction. 
  • Create awareness on ways to express negative emotions healthily. Organise programmes and workshops on how to redirect stress or aggression into something productive such as recreational activities, arts, and other hobbies. 
  • Supervision by parents and teachers in the child’s social circle to look out for good and bad influences. 
  • Encourage communication through group programmes between parent and child, teacher and student, employer-employer, partners, and friends. Establish a safe space to share personal problems and worries instead of keeping them suppressed. 
  • Provide counselling and support services at school and workplace to attend to mental health issues or poor performance. 
  • Promoting a healthy lifestyle through self-care, mindfulness, balanced diet, exercise, social interactions, and community engagement. 
  • Policies to reduce accessibility to illegal substances should be implemented by law enforcement authorities with the assistance of community leaders.  

Support Group for Addiction

In support groups, individuals who are recovering from addiction willingly get together to share and listen to similar experiences as well as struggles. Apart from finding a sense of belonging and comfort, the community is also a great hub for exchanging useful information, knowledge or insights. Family members of a person with the condition are encouraged to seek moral support from these groups as well. 

If you feel lost on where to start, discuss with your doctor the options of support groups available in your local community to determine which fits you best. Additionally, you might want to check out this free SMART Recovery Malaysia Meetup, a global platform available for online and face-to-face meetings conducted by a facilitator who will introduce you to techniques for managing your condition. 

The journey to recovery from addiction is a long winding road and that can be discouraging. Here is a list of organisations that specialise in providing a safe space for individuals who struggle with addiction:

Apart from support groups, there are plenty useful hotlines available to contact for assistance in regards to addiction, as well as mental health issues:

  • 03-8911 2233 or 019-626 2233 (National Anti-Drugs Agency or AADK)
  • 03-7627 2929 (Befrienders Malaysia/Mental Health and Suicide Prevention)
  • 03-2780 6803 (Malaysian Mental Health Association)

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References

4 Major Causes of Addiction: Beyond the Three-Factor Model. (n.d.). The Dawn Rehab. https://thedawnrehab.com/blog/major-causes-of-addiction/

Adept. (2020, August 19). Drug misuse, abuse, and addiction: What’s the difference? Meridian Psychiatric Partners. https://meridianpsychiatricpartners.com/drug-misuse-abuse-and-addiction-whats-the-difference/ 

American Psychiatric Association. (n.d.). What Is a Substance Use Disorder? https://psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder

American Psychological Association. (n.d.). Addictions. https://www.apa.org/topics/substance-use-abuse-addiction file:///C:/Users/SCSM11/Downloads/2768.pdf

Fuller, K. (2022, June 30). What Causes Addiction? Recovery.org. https://recovery.org/addiction/causes/ 

Gateway Foundation. (n.d.) What Causes Addiction? https://www.gatewayfoundation.org/addiction-blog/what-causes-addiction/

Guy-Evans, O. (2021, July 8). Brain Reward System. SimplyPsychology. https://www.simplypsychology.org/brain-reward-system.html 

Juergens, J. (2017, January 27). Treatment. Addiction Center. https://www.addictioncenter.com/treatment/ 

Khan Academy. (2014, June 25). Reward pathway in the brain [Video]. https://www.khanacademy.org/test-prep/mcat/processing-the-environment/drug-dependence/v/reward-pathway-in-the-brain

Malaysian Psychiatric Association. (n.d.). Treatment of Drug Addiction. https://psychiatry-malaysia.com/public/public-education/mental-disorders/drug-addiction/treatment-of-drug-addiction/

The Science of Addiction. (n.d.). Shatterproof. https://www.shatterproof.org/learn/addiction-basics/science-of-addiction 

Tracy, N. (2021, December 15). Types of Addiction: List of Addictions. HealthyPlace. https://www.healthyplace.com/addictions/addictions-information/types-of-addiction-list-of-addictions

Uloth, J. (n.d.). 5 Underlying Reasons for Addiction. Cliffside Malibu. https://www.cliffsidemalibu.com/blog/5-underlying-reasons-for-addiction/

What Are the Reasons for Addiction?. (2022, June 16). Sunrise House Treatment Center. https://sunrisehouse.com/cause-effect/reasons-addiction/

About the Writer
Ain Nadzirah
Ain is just another small-town film buff who treats her car rides as a stage to belt out show tunes and musicals. It is not a strange sight to spot her talking to her 14 cats at home, or arguing with her grandma over having too many (and counting) potted flowers.
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