Addiction: the story on HearLore

Addiction

Addiction is not a moral failing but a neuropsychological disorder that hijacks the brain's reward system, creating a persistent and intense urge to use a drug or engage in a behavior despite substantial harm. This phenomenon begins when repetitive drug use alters brain function in synapses, mimicking natural rewards like food or falling in love in ways that perpetuate craving and weaken self-control. For decades, scientists believed addiction was simply a choice, but research on mice given cocaine revealed the compulsive and involuntary nature of the condition, showing that the brain's circuitry can be reshaped to prioritize the substance over survival itself. The disorder changes brain circuitry such that the brain's reward system is compromised, causing functional consequences for stress management and self-control that can persist throughout a lifetime and cause death if untreated. While classic signs include compulsive engagement in rewarding stimuli and preoccupation with substances, the underlying mechanism involves a complex variety of psychosocial and neurobiological factors that are implicated in the development of addiction. The brain's reward system, known as the mesolimbic pathway, is characterized by the interaction of several areas, including the ventral tegmental area and the nucleus accumbens, which release dopamine to signal pleasure. Virtually all drugs causing addiction increase dopamine release in this pathway, leading to receptor downregulation and a decrease in sensitivity to natural reinforcers. This process creates a state where the individual's wanting or desire for the stimulus increases, often at pathologically high levels due to reward sensitization. The disorder is not limited to substances; behavioral addictions such as gambling, shopping, and video gaming activate the same mesolimbic pathway, proving that the brain's response to natural rewards can become pathological when overstimulated. The term addiction derives from the Latin addico, meaning giving over, with both positive connotations of devotion and negative ones of enslavement, reflecting the dual nature of the condition that has persisted through history. In the 19th century, addiction was seen and acknowledged in the Western world as a disease, being both a physical condition and mental illness, yet the understanding has evolved to recognize it as a biopsychosocial and neurological disorder that negatively impacts those who are affected by it. The DSM-5 discourages using the term drug addiction because of its uncertain definition and its potentially negative connotation, preferring the term substance use disorder to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive pattern of drug taking. The ICD-11 offers three diagnostic possibilities for substance use: an episode of harmful psychoactive substance use, a harmful pattern of psychoactive substance use, and substance dependence, moving away from the binary of abuse and dependence used in past editions. The disorder affects millions globally, with the United States reporting that 43.7 million people aged 12 or older needed treatment for an addiction to alcohol, nicotine, or other drugs, yet only about 10% receive any form of treatment. The economic cost of addiction is greater than the cost of diabetes and all forms of cancer combined, yet most doctors in the United States lack the training to effectively address a drug addiction. The disorder is not confined to substances; behavioral addictions such as gambling, shopping, and video gaming activate the same mesolimbic pathway, proving that the brain's response to natural rewards can become pathological when overstimulated. The term addiction derives from the Latin addico, meaning giving over, with both positive connotations of devotion and negative ones of enslavement, reflecting the dual nature of the condition that has persisted through history. In the 19th century, addiction was seen and acknowledged in the Western world as a disease, being both a physical condition and mental illness, yet the understanding has evolved to recognize it as a biopsychosocial and neurological disorder that negatively impacts those who are affected by it. The DSM-5 discourages using the term drug addiction because of its uncertain definition and its potentially negative connotation, preferring the term substance use disorder to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive pattern of drug taking. The ICD-11 offers three diagnostic possibilities for substance use: an episode of harmful psychoactive substance use, a harmful pattern of psychoactive substance use, and substance dependence, moving away from the binary of abuse and dependence used in past editions. The disorder affects millions globally, with the United States reporting that 43.7 million people aged 12 or older needed treatment for an addiction to alcohol, nicotine, or other drugs, yet only about 10% receive any form of treatment. The economic cost of addiction is greater than the cost of diabetes and all forms of cancer combined, yet most doctors in the United States lack the training to effectively address a drug addiction.

What is the definition of addiction according to the script?

Addiction is a neuropsychological disorder that hijacks the brain's reward system, creating a persistent and intense urge to use a drug or engage in a behavior despite substantial harm. This phenomenon begins when repetitive drug use alters brain function in synapses, mimicking natural rewards like food or falling in love in ways that perpetuate craving and weaken self-control.

How does the DeltaFosB gene contribute to addiction development?

DeltaFosB is a critical gene transcription factor that serves as a common factor in the development of virtually all forms of behavioral and drug addictions. Overexpression of DeltaFosB in the D1-type medium spiny neurons of the nucleus accumbens is necessary and sufficient for many of the neural adaptations and behavioral effects seen in drug addiction.

What percentage of addiction risk is attributed to genetic factors?

Genetic factors account for 40 to 60% of the risk factors for alcoholism, and similar rates of heritability for other types of drug addiction have been indicated. Twin studies provide evidence that if one twin is affected by addiction, the other twin is likely to be as well, and to the same substance.

What are the diagnostic possibilities for substance use in the ICD-11?

The ICD-11 offers three diagnostic possibilities for substance use: an episode of harmful psychoactive substance use, a harmful pattern of psychoactive substance use, and substance dependence. This framework moves away from the binary of abuse and dependence used in past editions.

How many people in the United States needed treatment for addiction in the reported statistics?

The United States reported that 43.7 million people aged 12 or older needed treatment for an addiction to alcohol, nicotine, or other drugs. Only about 10% of these individuals receive any form of treatment.

The Genetic And Environmental Roots

Genetic factors account for 40 to 60% of the risk factors for alcoholism, and similar rates of heritability for other types of drug addiction have been indicated, specifically in genes that encode the Alpha5 Nicotinic Acetylcholine Receptor. Twin studies have provided some of the highest-quality evidence of this link, with results finding that if one twin is affected by addiction, the other twin is likely to be as well, and to the same substance. Family studies suggest that if one family member has a history of addiction, the chances of a relative or close family developing those same habits are much higher than one who has not been introduced to addiction at a young age. However, the data implicating specific genes in the development of drug addiction is mixed for most genes, and many addiction studies that aim to identify specific genes focus on common variants with an allele frequency of greater than 5% in the general population. When associated with disease, these only confer a small amount of additional risk with an odds ratio of 1.1 to 1.3 percent, which has led to the development of the rare variant hypothesis, which states that genes with low frequencies in the population less than 1% confer much greater additional risk in the development of the disease. Genome-wide association studies are used to examine genetic associations with dependence, addiction, and drug use, and these studies rarely identify genes from proteins previously described via animal knockout models and candidate gene analysis. Instead, large percentages of genes involved in processes such as cell adhesion are commonly identified, and the important effects of endophenotypes are typically not capable of being captured by these methods. Environmental risk factors for addiction are the experiences of an individual during their lifetime that interact with the individual's genetic composition to increase or decrease his or her vulnerability to addiction. Adverse childhood events are associated with negative health outcomes, such as substance use disorder, and childhood abuse or exposure to violent crime is related to developing a mood or anxiety disorder, as well as a substance dependence risk. The Adverse Childhood Experiences Study by the Centers for Disease Control and Prevention has shown a strong dose-response relationship between ACEs and numerous health, social, and behavioral problems throughout a person's lifespan, including substance use disorder. Children's neurological development can be permanently disrupted when they are chronically exposed to stressful events such as physical, emotional, or sexual abuse, physical or emotional neglect, witnessing violence in the household, or a parent being incarcerated or having a mental illness. As a result, the child's cognitive functioning or ability to cope with negative or disruptive emotions may be impaired, and over time, the child may adopt substance use as a coping mechanism or as a result of reduced impulse control, particularly during adolescence. Vast amounts of children who experienced abuse have gone on to have some form of addiction in their adolescence or adult life. This pathway towards addiction that is opened through stressful experiences during childhood can be avoided by a change in environmental factors throughout an individual's life and opportunities of professional help. If one has friends or peers who engage in drug use favorably, the chances of them developing an addiction increases, and family conflict and home management is a cause for one to become engaged in drug use. The brain disease model of addiction posits that an individual's exposure to an addictive drug is the most significant environmental risk factor for addiction, yet many researchers, including neuroscientists, indicate that the brain disease model presents a misleading, incomplete, and potentially detrimental explanation of addiction. The psychoanalytic theory model defines addiction as a form of defense against feelings of hopelessness and helplessness as well as a symptom of failure to regulate powerful emotions related to adverse childhood experiences, various forms of maltreatment and dysfunction experienced in childhood. In this case, the addictive substance provides brief but total relief and positive feelings of control. The National Bureau of Economic Research found that there is a definite connection between mental illness and the use of addictive substances, and a majority of mental health patients participate in the use of these substances, with 38% using alcohol, 44% using cocaine, and 40% using cigarettes. The disorder is not confined to substances; behavioral addictions such as gambling, shopping, and video gaming activate the same mesolimbic pathway, proving that the brain's response to natural rewards can become pathological when overstimulated. The term addiction derives from the Latin addico, meaning giving over, with both positive connotations of devotion and negative ones of enslavement, reflecting the dual nature of the condition that has persisted through history. In the 19th century, addiction was seen and acknowledged in the Western world as a disease, being both a physical condition and mental illness, yet the understanding has evolved to recognize it as a biopsychosocial and neurological disorder that negatively impacts those who are affected by it. The DSM-5 discourages using the term drug addiction because of its uncertain definition and its potentially negative connotation, preferring the term substance use disorder to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive pattern of drug taking. The ICD-11 offers three diagnostic possibilities for substance use: an episode of harmful psychoactive substance use, a harmful pattern of psychoactive substance use, and substance dependence, moving away from the binary of abuse and dependence used in past editions. The disorder affects millions globally, with the United States reporting that 43.7 million people aged 12 or older needed treatment for an addiction to alcohol, nicotine, or other drugs, yet only about 10% receive any form of treatment. The economic cost of addiction is greater than the cost of diabetes and all forms of cancer combined, yet most doctors in the United States lack the training to effectively address a drug addiction.

The Molecular Switch

DeltaFosB, a gene transcription factor, is a critical component and common factor in the development of virtually all forms of behavioral and drug addictions. Two decades of research into DeltaFosB's role in addiction have demonstrated that addiction arises, and the associated compulsive behavior intensifies or attenuates, along with the overexpression of DeltaFosB in the D1-type medium spiny neurons of the nucleus accumbens. Due to the causal relationship between DeltaFosB expression and addictions, it is used preclinically as an addiction biomarker. DeltaFosB expression in these neurons directly and positively regulates drug self-administration and reward sensitization through positive reinforcement, while decreasing sensitivity to aversion. Chronic addictive drug use causes alterations in gene expression in the mesocorticolimbic projection, and the most important transcription factors that produce these alterations are DeltaFosB, cAMP response element binding protein, and nuclear factor kappa B. DeltaFosB is the most significant biomolecular mechanism in addiction because the overexpression of DeltaFosB in the D1-type medium spiny neurons in the nucleus accumbens is necessary and sufficient for many of the neural adaptations and behavioral effects seen in drug addiction. DeltaFosB has been implicated in mediating addictions to many different drugs and drug classes, including alcohol, amphetamine and other substituted amphetamines, cannabinoids, cocaine, methylphenidate, nicotine, opiates, phenylcyclidine, and propofol, among others. DeltaFosB plays an important role in regulating behavioral responses to natural rewards, such as palatable food, sex, and exercise. Natural rewards, like drugs of abuse, induce gene expression of DeltaFosB in the nucleus accumbens, and chronic acquisition of these rewards can result in a similar pathological addictive state through DeltaFosB overexpression. Consequently, DeltaFosB is the key transcription factor involved in addictions to natural rewards as well; in particular, DeltaFosB in the nucleus accumbens is critical for the reinforcing effects of sexual reward. Research on the interaction between natural and drug rewards suggests that dopaminergic psychostimulants and sexual behavior act on similar biomolecular mechanisms to induce DeltaFosB in the nucleus accumbens and possess bidirectional cross-sensitization effects that are mediated through DeltaFosB. This phenomenon is notable since, in humans, a dopamine dysregulation syndrome, characterized by drug-induced compulsive engagement in natural rewards, specifically sexual activity, shopping, and gambling, has been observed in some individuals taking dopaminergic medications. DeltaFosB inhibitors, drugs or treatments that oppose its action, may be an effective treatment for addiction and addictive disorders. The release of dopamine in the nucleus accumbens plays a role in the reinforcing qualities of many forms of stimuli, including naturally reinforcing stimuli like palatable food and sex. Altered dopamine neurotransmission is frequently observed following the development of an addictive state. In humans and lab animals that have developed an addiction, alterations in dopamine or opioid neurotransmission in the nucleus accumbens and other parts of the striatum are evident. Use of certain drugs, such as cocaine, affect cholinergic neurons that innervate the reward system, in turn affecting dopamine signaling in this region. A recent study in Addiction reports that GLP-1 agonist medications, such as semaglutide, which are commonly used for diabetes and weight management, may also reduce the risk of overdose and alcohol intoxication in people with substance use disorders. The study analyzed nearly nine years of health records from 1.3 million individuals across 136 U.S. hospitals, including 500,000 with opioid use disorder and over 800,000 with alcohol use disorder. Researchers found that those who used Ozempic or similar medications had a 40% lower risk of opioid overdose and a 50% lower risk of alcohol intoxication compared to those not using these drugs. The disorder is not confined to substances; behavioral addictions such as gambling, shopping, and video gaming activate the same mesolimbic pathway, proving that the brain's response to natural rewards can become pathological when overstimulated. The term addiction derives from the Latin addico, meaning giving over, with both positive connotations of devotion and negative ones of enslavement, reflecting the dual nature of the condition that has persisted through history. In the 19th century, addiction was seen and acknowledged in the Western world as a disease, being both a physical condition and mental illness, yet the understanding has evolved to recognize it as a biopsychosocial and neurological disorder that negatively impacts those who are affected by it. The DSM-5 discourages using the term drug addiction because of its uncertain definition and its potentially negative connotation, preferring the term substance use disorder to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive pattern of drug taking. The ICD-11 offers three diagnostic possibilities for substance use: an episode of harmful psychoactive substance use, a harmful pattern of psychoactive substance use, and substance dependence, moving away from the binary of abuse and dependence used in past editions. The disorder affects millions globally, with the United States reporting that 43.7 million people aged 12 or older needed treatment for an addiction to alcohol, nicotine, or other drugs, yet only about 10% receive any form of treatment. The economic cost of addiction is greater than the cost of diabetes and all forms of cancer combined, yet most doctors in the United States lack the training to effectively address a drug addiction.

The Adolescence Trap

Adolescence represents a period of increased vulnerability for developing an addiction, and in adolescence, the incentive-rewards systems in the brain mature well before the cognitive control center. This consequentially grants the incentive-rewards systems a disproportionate amount of power in the behavioral decision-making process, and therefore, adolescents are increasingly likely to act on their impulses and engage in risky, potentially addictive behavior before considering the consequences. Not only are adolescents more likely to initiate and maintain drug use, but once addicted they are more resistant to treatment and more liable to relapse. Most individuals are exposed to and use addictive drugs for the first time during their teenage years, and in the United States, there were just over 2.8 million new users of illicit drugs in 2013, with 7,800 new users per day, among them 54.1% were under 18 years of age. In 2011, there were approximately 20.6 million people in the United States over the age of 12 with an addiction, and over 90% of those with an addiction began drinking, smoking or using illicit drugs before the age of 18. Adolescence is a critical developmental period in which the prefrontal cortex, which is responsible for planning, inhibitory control, and evaluating long term consequences, experiences significant maturation. During this period, limbic reward circuits mature earlier than prefrontal cortex regulatory networks, creating a developmental imbalance in which reward sensitivity is high, but cognitive control is not fully developed yet. This mismatch contributes to higher experimentation with substances and vulnerability to addiction. Neuroimaging studies show that adolescents exhibit reduced prefrontal cortex activation during decision making tasks, risk taking behavior, and heightened dopamine reactivity compared with adults. Exposure to substances during this early period of their life can disrupt synaptic pruning and myelination, which can produce long term alterations in executive functioning and reward processing that increase the chance of developing a substance use disorder. The disorder is not confined to substances; behavioral addictions such as gambling, shopping, and video gaming activate the same mesolimbic pathway, proving that the brain's response to natural rewards can become pathological when overstimulated. The term addiction derives from the Latin addico, meaning giving over, with both positive connotations of devotion and negative ones of enslavement, reflecting the dual nature of the condition that has persisted through history. In the 19th century, addiction was seen and acknowledged in the Western world as a disease, being both a physical condition and mental illness, yet the understanding has evolved to recognize it as a biopsychosocial and neurological disorder that negatively impacts those who are affected by it. The DSM-5 discourages using the term drug addiction because of its uncertain definition and its potentially negative connotation, preferring the term substance use disorder to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive pattern of drug taking. The ICD-11 offers three diagnostic possibilities for substance use: an episode of harmful psychoactive substance use, a harmful pattern of psychoactive substance use, and substance dependence, moving away from the binary of abuse and dependence used in past editions. The disorder affects millions globally, with the United States reporting that 43.7 million people aged 12 or older needed treatment for an addiction to alcohol, nicotine, or other drugs, yet only about 10% receive any form of treatment. The economic cost of addiction is greater than the cost of diabetes and all forms of cancer combined, yet most doctors in the United States lack the training to effectively address a drug addiction.

The Stigma And The Art

Stigma can lead to feelings of shame that can prevent people with substance use disorders from seeking help and interfere with provision of harm reduction services, and it can influence healthcare policy, making it difficult for these individuals to access treatment. For designing and implementing effective and evidence-based stigma prevention and intervention, it is important to identify persons who are more likely to be stigmatized, such as male or those addicted to drugs believed to be stronger, and target those more likely to stigmatize, such as those with lacking or limited familiarity with addiction or more conservative individuals. Artists attempt to change the societal perception of addiction from a punishable moral offense to instead a chronic illness necessitating treatment, and this form of advocacy can help to relocate the fight of addiction from a judicial perspective to the public health system. Artists who have personally lived with addiction or undergone recovery may use art to depict their experiences in a manner that uncovers the human face of addiction, and by bringing experiences of addiction and recovery to a personal level and breaking down the us and them, the viewer may be more inclined to show compassion, forego stereotypes and stigma of addiction, and label addiction as a social rather than individual problem. According to Santora, the main purposes in using art as a form of advocacy in the education and prevention of substance use disorders include: addiction art exhibitions can come from a variety of sources, but the underlying message of these works is the same, to communicate through emotions without relying on intellectually demanding or gatekept facts and figures. These exhibitions can either stand alone, reinforce, or challenge facts, and a powerful educational tool for increasing awareness and understanding of addiction as a medical illness. Exhibitions featuring personal stories and images can help to create lasting impressions on diverse audiences, including addiction scientists and researchers, family and friends of those affected by addiction, highlighting the humanity of the problem and in turn encouraging compassion and understanding. A way to destigmatize substance use disorders and shift public perception from viewing them as a moral failing to understanding them as a chronic medical condition which requires treatment. Provide those who are struggling with addiction assurance and encouragement of healing, and let them know that they are not alone in their struggle. The use of visual arts can help bring attention to the lack of adequate substance use treatment, prevention, and education programs and services in a healthcare system, and messages can encourage policymakers to allocate more resources to addiction treatment and prevention from federal, state, and local levels. The Temple University College of Public Health department conducted a project to promote awareness around opioid use and reduce associated stigma by asking students to create art pieces that were displayed on a website they created and promoted via social media. Quantitative and qualitative data was recorded to measure engagement, and the student artists were interviewed, which revealed a change in perspective and understanding, as well as greater appreciation of diverse experiences. Ultimately, the project found that art was an effective medium for empowering both the artist creating the work and the person interacting with it. Another author critically examined works by contemporary Canadian artists that deal with addiction, and the arts can be used in a variety of ways to address issues related to addiction. Art can be used as a form of therapy in the treatment of substance use disorders, and creative activities like painting, sculpting, music, and writing can help people express their feelings and experiences in safe and healthy ways. The arts can be used as an assessment tool to identify underlying issues that may be contributing to a person's substance use disorder, and through art, individuals can gain insights into their own motivations and behaviors that can be helpful in determining a course of treatment. Finally, the arts can be used to advocate for those suffering from a substance use disorder by raising awareness of the issue and promoting understanding and compassion, and through art, individuals can share their stories, increase awareness, and offer support and hope to those struggling with substance use disorders. Addiction treatment is complex and not always effective due to engagement and service availability concerns, so researchers prioritize efforts to improve treatment retention and decrease relapse rates. Characteristics of substance abuse may include feelings of isolation, a lack of confidence, communication difficulties, and a perceived lack of control, and in a similar vein, people suffering from substance use disorders tend to be highly sensitive, creative, and as such, are likely able to express themselves meaningfully in creative arts such as dancing, painting, writing, music, and acting. Further evidenced by Waller and Mahony in 2002 and Kaufman in 1981, the creative arts therapies can be a suitable treatment option for this population especially when verbal communication is ineffective. Primary advantages of art therapy in the treatment of addiction have been identified as: assess and characterize a client's substance use issues, bypassing a client's resistances, defenses, and denial, containing shame or anger, facilitating the expression of suppressed and/or complicated emotions, highlighting a client's strengths, providing an alternative to verbal communication via use of symbols and conventional forms of therapy, providing clients with a sense of control, and tackling feelings of isolation. Art therapy is an effective method of dealing with substance abuse in comprehensive treatment models, and when included in psychoeducational programs, art therapy in a group setting can help clients internalize taught concepts in a more personalized manner. During the course of treatment, by examining and comparing artwork created at different times, art therapists can be helpful in identifying and diagnosing issues, as well as charting the extent or direction of improvement as a person detoxifies. Where increasing adherence to treatment regimes and maintaining abstinence is the target, art therapists can aid by customizing treatment directives, such as encouraging the client to create collages that compare pros and cons, pictures that compare past and present and future, and drawings that depict what happened when a client went off medication. Art therapy can function as a complementary therapy used in conjunction with more conventional therapies and can integrate with harm reduction protocols to minimize the negative effects of drug use. An evaluation of art therapy incorporation within a pre-existing Addiction Treatment Programme based on the 12 step Minnesota Model endorsed by the Alcoholics Anonymous found that 66% of participants expressed the usefulness of art therapy as a part of treatment. Within the weekly art therapy session, clients were able to reflect and process the intense emotions and cognitions evoked by the programme. In turn, the art therapy component of the programme fostered stronger self-awareness, exploration, and externalization of repressed and unconscious emotions of clients, promoting the development of a more integrated authentic self. Despite the large number of randomized control trials, clinical control trials, and anecdotal evidence supporting the effectiveness of art therapies for use in addiction treatment, a systematic review conducted in 2018 could not find enough evidence on visual art, drama, dance and movement therapy, or arts in health methodologies to confirm their effectiveness as interventions for reducing substance misuse. Music therapy was identified to have potentially strong beneficial effects in aiding contemplation and preparing those diagnosed with substance use for treatment. The Formal Elements Art Therapy Scale is an assessment tool used to evaluate drawings created by people suffering from substance use disorders by comparing them to drawings of a control group consisting of individuals without substance use disorders. The Formal Elements Art Therapy Scale consists of twelve elements, three of which were found to be particularly effective at distinguishing the drawings of those with substance use disorders from those without: Person, Realism, and Developmental. The Person element assesses the degree to which a human features are depicted realistically, the Realism element assesses the overall complexity of the artwork, and the Developmental element assesses developmental age of the artwork in relation to standardized drawings from children and adolescents. By using the Formal Elements Art Therapy Scale assessment tool, clinicians can gain valuable insight into the drawings of individuals with substance use disorders, and can compare them to those of the control group. Formal assessments such as the Formal Elements Art Therapy Scale provide healthcare providers with a means to quantify, standardize, and communicate abstract and visceral characteristics of substance use disorders to provide more accurate diagnoses and informed treatment decisions. Other artistic assessment methods include the Bird's Nest Drawing, a useful tool for visualizing a client's attachment security, and this assessment method looks at the amount of color used in the drawing, with a lack of color indicating an insecure attachment, a factor that the client's therapist or recovery framework must take into account. Art therapists working with children of parents suffering from alcoholism can use the Kinetic Family Drawings assessment tool to shed light on family dynamics and help children express and understand their family experiences. The Kinetic Family Drawings can be used in family sessions to allow children to share their experiences and needs with parents who may be in recovery from alcohol use disorder, and depiction of isolation of self and isolation of other family members may be an indicator of parental alcoholism. The disorder is not confined to substances; behavioral addictions such as gambling, shopping, and video gaming activate the same mesolimbic pathway, proving that the brain's response to natural rewards can become pathological when overstimulated. The term addiction derives from the Latin addico, meaning giving over, with both positive connotations of devotion and negative ones of enslavement, reflecting the dual nature of the condition that has persisted through history. In the 19th century, addiction was seen and acknowledged in the Western world as a disease, being both a physical condition and mental illness, yet the understanding has evolved to recognize it as a biopsychosocial and neurological disorder that negatively impacts those who are affected by it. The DSM-5 discourages using the term drug addiction because of its uncertain definition and its potentially negative connotation, preferring the term substance use disorder to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive pattern of drug taking. The ICD-11 offers three diagnostic possibilities for substance use: an episode of harmful psychoactive substance use, a harmful pattern of psychoactive substance use, and substance dependence, moving away from the binary of abuse and dependence used in past editions. The disorder affects millions globally, with the United States reporting that 43.7 million people aged 12 or older needed treatment for an addiction to alcohol, nicotine, or other drugs, yet only about 10% receive any form of treatment. The economic cost of addiction is greater than the cost of diabetes and all forms of cancer combined, yet most doctors in the United States lack the training to effectively address a drug addiction.

The Future Of Treatment

Potential vaccines for addiction to substances have been investigated as a possibility since the early 2000s, and the general theory of a vaccine intended to immunize against drug addiction or other substance abuse is that it would condition the immune system to attack and consume or otherwise disable the molecules of such substances that cause a reaction in the brain, thus preventing the addict from being able to realize the effect of the drug. Addictions that have been floated as targets for such treatment include nicotine, opioids, and fentanyl, and vaccines have been identified as potentially being more effective than other anti-addiction treatments, due to the long duration of action, the certainty of administration and a potential reduction of toxicity to important organs. Specific addiction vaccines in development include NicVAX, a conjugate vaccine intended to reduce or eliminate physical dependence on nicotine, which is being developed by Nabi Biopharmaceuticals of Rockville, Maryland, with the support from the U.S. National Institute on Drug Abuse. NicVAX consists of the hapten 3'-aminomethylnicotine which has been conjugated attached to Pseudomonas aeruginosa exotoxin A. TA-CD, an active vaccine developed by the Xenova Group which is used to negate the effects of cocaine, is created by combining norcocaine with inactivated cholera toxin, and it works in much the same way as a regular vaccine. A large protein molecule attaches to cocaine, which stimulates response from antibodies, which destroy the molecule, and this also prevents the cocaine from crossing the blood-brain barrier, negating the euphoric high and rewarding effect of cocaine caused from stimulation of dopamine release in the mesolimbic reward pathway. The vaccine does not affect the user's desire for cocaine, only the physical effects of the drug. TA-NIC, used to create human antibodies to destroy nicotine in the human body so that it is no longer effective, and as of September 2023, it was further reported that a vaccine has been tested against heroin and fentanyl and is on its way to being tested against OxyContin. To be effective, treatment for addiction that is pharmacological or biologically based need to be accompanied by other interventions such as cognitive behavioral therapy and dialectical behavioral therapy, individual and group psychotherapy, behavior modification strategies, twelve-step programs, and residential treatment facilities. The transtheoretical model can be used to determine when treatment can begin and which method will be most effective, and if treatment begins too early, it can cause a person to become defensive and resistant to change. The disorder is not confined to substances; behavioral addictions such as gambling, shopping, and video gaming activate the same mesolimbic pathway, proving that the brain's response to natural rewards can become pathological when overstimulated. The term addiction derives from the Latin addico, meaning giving over, with both positive connotations of devotion and negative ones of enslavement, reflecting the dual nature of the condition that has persisted through history. In the 19th century, addiction was seen and acknowledged in the Western world as a disease, being both a physical condition and mental illness, yet the understanding has evolved to recognize it as a biopsychosocial and neurological disorder that negatively impacts those who are affected by it. The DSM-5 discourages using the term drug addiction because of its uncertain definition and its potentially negative connotation, preferring the term substance use disorder to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive pattern of drug taking. The ICD-11 offers three diagnostic possibilities for substance use: an episode of harmful psychoactive substance use, a harmful pattern of psychoactive substance use, and substance dependence, moving away from the binary of abuse and dependence used in past editions. The disorder affects millions globally, with the United States reporting that 43.7 million people aged 12 or older needed treatment for an addiction to alcohol, nicotine, or other drugs, yet only about 10% receive any form of treatment. The economic cost of addiction is greater than the cost of diabetes and all forms of cancer combined, yet most doctors in the United States lack the training to effectively address a drug addiction.