Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces an immediate psychological reward, despite substantial harm and other negative consequences. Repeated substance use produces long-lasting changes in brain networks involved in reward, executive function, stress reactivity and mood. These changes underlie both the intense drive to use a substance and the reduced capacity to control that urge. It is therefore understood as a brain disorder arising from a complex mix of psychosocial and neurobiological factors.Nestler EJ (December 2013). "Cellular basis of memory for addiction". Dialogues in Clinical Neuroscience. 15 (4): 431–443. doi:10.31887/DCNS.2013.15.4/enestler. . PMID 24459410. A number of researchers argue that this framing is incomplete, and that addiction is better understood as learned behavior shaped by choice and social context.
Addiction takes both substance and non-substance forms. Substance addictions include alcoholism, cannabis addiction, amphetamine addiction, cocaine addiction, nicotine addiction, and opioid addiction. The DSM-5-TR recognizes only gambling disorder as a behavioral (non-substance) addiction and lists internet gaming disorder as a condition for further study, while the ICD-11 additionally classifies gaming disorder as a disorder due to addictive behaviors. Other candidate behavioral addictions, and the question of whether food can be addictive, are debated in the research literature but are not recognized in either manual. Across these forms, addiction is defined less by any single symptom than by a pattern: impaired control over the substance or behavior, increasing priority given to it over other activities, and continued use despite harm, accompanied for many substances by tolerance and withdrawal. It carries a substantial risk of further illness and early death, most immediately from overdose, and co-occurring psychiatric conditions are common.
Roughly half of the risk of developing an addiction is genetic: twin and adoption studies estimate the heritability of alcohol use disorder at about 50%, with comparable figures across other substances. Genetic vulnerability is polygenic, reflecting the small combined effects of many common variants rather than any single gene. Environmental contributors include adverse childhood experiences, chronic stress, family and peer influences, socioeconomic constraint and the availability of substances, and adolescence in a period of heightened vulnerability. At the level of mechanism, addiction is described as a recurring cycle in which dopaminergic signaling gives a drug and its associated cues a strong pull on attention and behavior, brain stress systems become overactive as ordinary pleasures are muted, and reduced prefrontal cortex control leaves craving poorly restrained.
Addiction is diagnosed clinically. The DSM-5-TR grades substance use disorder as mild, moderate, or severe and treats severe substance use disorder as synonymous with drug addiction. The ICD-11 instead distinguishes a harmful episode of use, a harmful pattern of use, and dependence. Prevention approaches with the strongest supporting evidence include family skills programs, school-based personal and social skills education, and policies that limit availability and raise price. Addiction is managed as a chronic, relapsing condition, usually combining medication, where an effective one exists, with psychological and social support. Effective medications are available for opioid, alcohol, and tobacco use disorders, but none is approved for stimulant use disorder, for which psychosocial treatment remains the mainstay. Harm reduction measures address the damage associated with continued use. Outcomes vary widely: an estimated 35–54% of people with a substance use disorder reach remission, though typically only after many years. About 163 million people worldwide were estimated to be living with a substance use disorder in 2021, most commonly alcohol use disorder, and drug use was one of only three risk factors whose age-standardized attributable burden rose between 2010 and 2023. Addiction carries substantial economic and social costs, and anthropological and structural accounts situate heavy drug use within cultural norms and unequal distributions of power.
Signs and symptoms Impaired control over the substance or behavior is the core feature. It appears as using more or for longer than intended, persistent unsuccessful attempts to cut down, and a great deal of time spent obtaining, using, or recovering. Social impairment follows, with failure to meet obligations at work, school, or home, and the abandonment of former activities. Risky use (continuing despite knowledge of physical or psychological harm) and, for many substances, tolerance and withdrawal, complete the picture.
Complications
Addiction carries a substantial risk of further illness and of early death. The most immediate danger is overdose, which for opioids and other sedatives acts by suppressing breathing. Injecting drug use also carries a risk of blood-borne infection, including HIV and hepatitis C. Long-term use damages particular organ systems depending on the substance, with liver cirrhosis and cognitive impairment following sustained heavy drinking and lung disease following tobacco smoking.
Psychiatric conditions frequently co-occur with addiction, and each worsens the outlook for the other, so current guidance is that both be treated at the same time rather than one after the other. People with substance use disorders also die by suicide considerably more often than the general population; a systematic review and meta-analysis of 47 cohort studies estimated the rate at roughly five times that expected, with raised risk found for alcohol, tobacco, opioid, cannabis, and amphetamine use and a stronger association in women than in men, although estimates varied widely between the studies pooled. Loss of pleasure in ordinary activities (anhedonia) is common and is associated with mood disorders.
Types Addiction is described in two broad forms: substance use disorders, which involve psychoactive drugs, and behavioral addictions, which involve activities that produce reward without a drug. Whether some patterns of eating meet the criteria for addiction remains disputed.
Substance use disorder
The DSM-5 discourages using the term drug addiction because of its "uncertain definition and its potentially negative connotation" and prefers 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.
Substance use disorder is one of the substance-related disorders. It is a long-term, relapsing condition in which a person continues seeking and taking a substance despite the harm it causes. Repeated use alters the brain circuits that handle reward, stress and self-control, which is why cutting down becomes harder over time. The substances most often involved are alcohol, nicotine, cannabis, opioids, cocaine and amphetamines. Use may begin socially, or follow from a prescribed medication. No single theory accounts for substance use disorder on its own. Phenomenological, operant and classical conditioning, cognitive, and cue reactivity models each explain part of it.
Behavioral addiction
The term behavioral addiction refers to a compulsion to engage in a natural reward despite adverse consequences.
Addiction can exist without psychotropic drugs, an idea that was popularized by psychologist Stanton Peele. These are termed behavioral addictions. Such addictions may be passive or active, but they commonly contain reinforcing features, which are found in most addictions. Sexual behavior, eating, gambling, playing video games, and shopping are all associated with compulsive behaviors in humans and have been shown to activate the mesolimbic pathway and other parts of the reward system. Diagnostic manuals recognize only some of these as disorders. Gambling disorder is the only behavioral addiction classified as a clinical disorder in the DSM-5-TR, which lists internet gaming disorder as a condition requiring further study; the ICD-11 classifies both gambling disorder and gaming disorder as disorders due to addictive behaviors. Compulsive sexual behavior disorder, compulsive buying–shopping disorder, and problematic use of social media are discussed in the research literature as candidate addictive disorders, but are not classified as addictions in either manual.
Food addiction
Whether food can be addictive is disputed. Neither the DSM-5-TR nor the ICD-11 recognizes a food or eating addiction, and researchers disagree about whether the concept is best framed as an addiction to specific foods, a pattern of disordered eating, or neither. Proponents argue that ultra-processed foods high in refined carbohydrate and fat meet the criteria conventionally used to identify an addictive substance, because processing delivers these nutrients faster and in higher concentrations than they occur in nature. Critics respond that no single constituent has been isolated as the addictive agent, unlike the case for a drug. Most research uses the Yale Food Addiction Scale, which applies the DSM-5 criteria for substance use disorder to eating. Food addiction as measured this way overlaps with, but is not the same as, binge eating disorder: not everyone with an eating disorder screens positive, and not everyone screening positive has a diagnosed eating disorder.
Causes
Several genetic and environmental risk factors exist for developing an addiction. Genetic and environmental risk factors each account for roughly half of an individual's risk for developing an addiction; the contribution from epigenetic risk factors to the total risk is unknown. Even in individuals with a relatively low genetic risk, exposure to sufficiently high doses of an addictive drug for a long period of time (e.g., weeks–months) can result in an addiction.
Genetic factors
Genetic factors, along with socio-environmental (e.g., psychosocial) factors, have been established as significant contributors to addiction vulnerability. Addiction is substantially heritable. Twin and adoption studies estimate the heritability of alcohol use disorder at approximately 50%, with comparable estimates across other substances. This risk is polygenic: it reflects the combined small effects of many common variants rather than any single gene.
Genome-wide association studies (GWAS) are used to examine genetic associations with dependence, addiction, and drug use, and have begun to map this architecture, and distinguish loci associated with a broad general liability to addiction across substances from loci conferring risk for a specific drug. Individual common variants each contribute only a small increment of risk, so genetic vulnerability is best understood as an aggregate rather than as the effect of any identified gene.
Environmental factors 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 their vulnerability to addiction. Several environmental factors have been implicated as risk factors for addiction, including various psychosocial stressors. The National Institute on Drug Abuse lists early aggressive behavior, lack of parental supervision, peer substance use, the availability of substances, and poverty as risk factors for substance use among children and adolescents.