Addiction: Characteristics, Theories and Therapies
Addiction and Substance Misuse
People sometimes use the terms “addiction” and “substance misuse” interchangeably, but they have distinct clinical meanings. Addiction (or dependence) is a condition involving a loss of control over substance use, strong cravings, continued use despite harm, and physical or psychological withdrawal when stopping. Substance misuse (or abuse) refers to using a substance in a harmful or problematic way — for example drinking alcohol to excess — without necessarily being dependent. A person may misuse a substance without being addicted, but addiction always involves misuse.
Diagnosing Addiction: Dependence Syndrome
Like depression, addiction is diagnosed using the International Classification of Diseases (ICD). The ICD identifies a cluster of criteria for diagnosing dependence syndrome. The spec identifies three key criteria that students must know.
A strong desire to use substances despite harmful consequences. The person continues to use the substance even when they are aware it is harming their health, relationships or work. The craving overrides rational assessment of the consequences.
Difficulty in controlling use. The person finds it very hard to stop using the substance or to limit how much they use, even when they want to. Attempts to cut down often fail or are short-lived.
A higher priority given to the substance than to other activities or obligations. Over time, the substance takes precedence over relationships, work, hobbies and responsibilities. The person’s life becomes increasingly organised around obtaining and using the substance.
The three ICD criteria for diagnosing addiction: (1) strong desire to use despite harmful consequences; (2) difficulty controlling use; (3) substance given higher priority than other activities and obligations.
Biological Theory: The Influence of Nature
The biological explanation of addiction focuses on hereditary factors and genetic vulnerability. It argues that some individuals are biologically more susceptible to addiction due to their genetic make-up. Evidence for this comes from research comparing identical and non-identical twins and from family studies that show addiction clusters in families even when shared environment is controlled for.
Kaij’s twin study of alcohol abuse is the named study for this topic. Kaij studied male twins in Sweden where at least one twin had a history of alcohol abuse. He found that identical (monozygotic, MZ) twins showed a higher concordance rate for alcohol abuse than non-identical (dizygotic, DZ) twins. Because identical twins share 100% of their DNA while non-identical twins share around 50%, this pattern suggests a genetic contribution to the risk of alcohol addiction.
Kaij’s twin study: MZ (identical) twins showed higher concordance for alcohol abuse than DZ (non-identical) twins. Because MZ twins share 100% DNA vs DZ at ~50%, higher MZ concordance suggests a genetic component to addiction vulnerability.
Psychological Theory: The Influence of Nurture
The psychological explanation of addiction emphasises the role of peer influence as a key environmental factor. According to this view, people begin using substances largely because of their social environment — especially the attitudes and behaviour of their peer group. If substance use is normalised within a friendship group, the social pressure to conform can be powerful. Social learning theory suggests that observing peers use substances and seeing them rewarded (socially or through pleasure) increases the likelihood of imitation.
Aversion therapy is a biological/behavioural treatment. It pairs the substance with an unpleasant stimulus — for example, a medication that causes nausea when alcohol is consumed — to create a conditioned aversion. Over time, the person learns to associate the substance with discomfort rather than pleasure. This is a reductionist approach that targets the learned behaviour directly, without exploring the reasons behind it.
Self-management programmes take a more holistic approach. They help individuals identify triggers for substance use, develop coping strategies and set goals for reducing or stopping use. Examples include self-help groups, where people with shared experiences support each other, and 12-step recovery programmes such as Alcoholics Anonymous (AA). These approaches treat the whole person — addressing social, psychological and sometimes spiritual dimensions of recovery.
Reductionist and Holistic Perspectives on Addiction Therapies
Aversion therapy is a reductionist intervention: it targets the behaviour (substance use) through conditioning, without considering the psychological or social context. Self-management programmes and 12-step approaches are more holistic: they address the whole person, including their social environment, thought patterns and sense of identity.
Neither approach is universally effective. Aversion therapy can work quickly but may not prevent relapse if underlying reasons for use are not addressed. Self-management programmes are more comprehensive and can lead to sustained recovery, but they require significant personal commitment and social support. The most effective interventions often combine elements of both.