Addiction is a broad phenomenon that encompasses much more than just substance dependence. One can become addicted to prescription drugs, sweets, gambling, pornography, and more. What tells us that something is an addiction and not just a habit? It depends a bit on the context, but general criteria may include:

  1. Excessive time and resources are devoted to the addictive behavior, affecting other areas of life.
  2. There is strong reluctance to engage in activities or situations where one is prevented from engaging in the addictive behavior.
  3. Difficulty controlling the activity, with attempts to quit or limit it proving unsuccessful.
  4. Negative reactions from close individuals, such as family, partners, or friends, due to the behavior.
  5. Persistence in the behavior despite obvious negative consequences.
  6. Struggling with a constant ambivalence about quitting.

Examples of addiction can include a person who continues gambling even though it is ruining their finances, someone excessively playing video games instead of addressing crucial life issues, or continuing to drink despite threats from a spouse to leave if they don't stop, and so on.

Specifically for substances and medications, the following criteria apply:

a. Strong craving or a feeling of compulsion to use the substance.

b. Problems controlling intake in terms of frequency, quantity, and discontinuation.

c. Withdrawal symptoms when the intake ceases.

d. Development of tolerance, meaning an increased dose is needed to achieve the same effect.

e. Increasing indifference to other aspects of life; time and energy are largely spent acquiring, using the substance, and recovering from its use.

f. Continued use despite obvious negative consequences, socially, professionally, or physically.

Why do we become addicted?

Addiction is a complex phenomenon involving genetic, biological, social, and personality factors. Psychologically, addiction seems to serve a function for the addicted individual. It can be a tool to keep one's own emotions and anxiety in check, providing a false sense of control over one's experience. Over time, habits build up that further embed the addiction, such as using food or substances to reward oneself. When attempting to change this behavior, the brain activates a strong craving for what one is addicted to, making it very difficult to resist. For those carrying a vulnerable psyche, perhaps due to genetics and upbringing, or those in especially precarious situations, the pleasant feeling of escape into addiction can become very tempting. This doesn't mean that gambling or having a glass of wine is inherently wrong, but rather that some individuals are more vulnerable to addiction and should be cautious when crossing certain boundaries.

How to treat addiction?

Treatment for addiction must be tailored to the individual and the addiction in question; there is no one-size-fits-all approach. Additionally, the degree of addiction largely defines the interventions needed. In the beginning, it's simply about building a strong motivation for change. In this phase of addiction treatment, methods like 'motivational interviewing' are often used. It involves helping the individual face the negative effects of what they are doing and how life could be if they managed to stop. When the motivation for change is strong, the likelihood of maintaining the changes is greater. If there has been significant substance abuse or a similar issue, a gradual tapering may make the transition easier than quitting abruptly. It is essential to set achievable goals and be prepared for the possibility of relapse, understanding that it doesn't mean the entire treatment is wasted. We often develop a plan for what to do when one is about to relapse (or relapses) to avoid this. For those with severe addiction, especially to substances and medications, short-term hospitalization may be necessary to ensure optimal healthcare. Whether this is necessary or not must be assessed together by the client and therapist.

All or nothing?

In my experience, addiction treatment does not necessarily have to involve total abstinence for everyone. Those who have experienced over many years that they cannot maintain balanced consumption may benefit from choosing total abstinence. However, for many of those I meet in private practice, who may have developed an addiction over a shorter period, for example, only a couple of years, it is often realistic to establish balanced consumption again as long as one sets clear boundaries and guidelines for oneself."

The inhabitants of the Hungry Ghost Realm are depicted as creatures with scrawny necks, small mouths, emaciated limbs and large, bloated, empty bellies. This is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfillment. The aching emptiness is perpetual because the substances, objects or pursuits we hope will soothe it are not what we really need. We don't know what we need, and so long as we stay in the hungry ghost mode, we'll never know. We haunt our lives without being fully present.

Gabor Maté, In the Realm of the Hungry Ghosts