On Addiction: The Cycle of Addiction is Not Linear

Addiction is complex and it affects millions of individuals worldwide. Many of us, through our own experience or a loved one, have learned that addiction doesn't discriminate based on age, gender, or socio-economic status. While addiction is often portrayed as a straight line from initial use to dependence, the reality is far from this. The cycle of addiction ebbs and flows, marked by periods of euphoria, craving, and withdrawal.

This linear depiction of addiction can often mislead individuals into thinking they don’t have any issues with addiction. Many individuals can “successfully” use their substance(s) or behaviors of choice for a long period without it substantially impacting their day-to-day lives. Some never see any major, obvious repercussions, but they are still suffering in silence. Yes, some individuals use a substance or engage in a potentially addictive behavior and do follow a pretty straightforward path to addiction. The point is, we are all different. We all have different genetics, environmental factors, and experiences that impact us, including what addiction may look like.

The Initial Escape

In the beginning, many individuals turn to substances or behaviors as a means of escape. This could be due to depression, anxiety, trauma, or an otherwise upsetting feeling. A state of mind that the individual does not want to live with. The first use may be liberating, numbing, or exhilarating, providing a temporary reprieve from psychological or physical pain (Smith, 2016). This initial experience can create a powerful reinforcement loop, as the individual seeks to replicate those feelings of relief or pleasure. If this occurs in childhood or adolescence, when our brains are still developing, studies show this could increase the risk of addiction. We are much more vulnerable at this age as our cognitive decision-making and judgment skills have yet to be refined (Volkow, Koob, & McLellan, 2016).

The Spiral Begins:

However, for some individuals, what starts as a temporary escape can quickly spiral into a cycle of addiction. It is important to note that out of those who try drugs or addictive behaviors, many do not become addicted. I mention this because it is important to not shame someone for trying something. Instead, perhaps we should ask them “what made you want to try that?” or “why?”. This may lead to a more fruitful conversation, where perhaps the individual can obtain help in seeking healthier coping skills.

For those who continue in the use of the substance, tolerance will begin to build. That means the individual will require larger doses or more frequent engagement to achieve the same effects (Volkow & Li, 2005). This has become someone’s coping skill, their way of feeling better. Unfortunately, as tolerance builds, they will feel better less and less. Instead, it eventually escalates to cravings and withdrawal. Withdrawal can vary depending on the substance or behavior. It can be extreme physical symptoms (some deadly), and/or it can be painfully psychological in nature. Once an individual reaches this point, it can be quite hard to just stop. Without adequate resources and support, continuing the behavior may seem like the only logical option. At this point, adolescent or adult, the brains’ rational decision-making skills are compromised (Volkow et al., 2016).

The Non-Linear Nature of Addiction:

As previously mentioned, addiction is often characterized by periods of highs and lows, where the individual may go through cycles of abstinence, relapse, and recovery (Murray et al., 2019). Factors such as stress, environmental cues, and co-occurring mental health disorders can all influence this cycle, making it difficult to predict or control. This is why it is so imperative we treat one another with compassion, kindness, and support.

Helping our fellow humans, even in small ways, can go a long way. If someone relapses and is met with shame, they are less likely to continue seeking out help. They may remain in active addiction for a long time, if they even get out, because of how much shame they may be met with. In addition, meeting someone where they are at is so crucial. Perhaps they aren’t ready to fully stop, but they are engaging in safer alternatives or slowly reducing their use. We should encourage any movement towards a better, healthier life. Recovery is not just abstinence. It is an ongoing process, and it will have highs and lows.

Breaking the Cycle:

Breaking free from the cycle of addiction requires a multifaceted approach that addresses both the physical and psychological aspects of dependence. This may involve medical interventions to manage withdrawal symptoms, therapy to address underlying trauma or co-occurring disorders, and support groups to provide community and accountability (National Institute on Drug Abuse, 2020). A large part of this is also breaking the stigma of addiction, as briefly mentioned above. If we choose kindness in our approach, we may see more progress. A large piece of this is the acceptance and use of harm reduction, as well as changing how we view recovery (it is not always just abstinence).

Harm reduction comes in varying ways. It often involves meeting an addicted person where they are at and helping them live as healthy and safely as possible. For some, that may mean ensuring they have clean paraphernalia and Narcan. For others, it could be helping them get on medicated assisted treatment, in conjunction with therapy. Others may want to go into detox and live an abstinent-free lifestyle. Some may need assistance in the treatment of conditions such as hepatitis C, HIV/AIDS, or other medical health problems as a consequence of their addiction. It may even be financial counseling to help them work on their gambling debts. Use of religion, cultural practices, spirituality, community, 12-step programs, family, and friends are all possible sources of help and harm reduction. For many, it can be a combination of some or all of this. In varying periods of their recovery, some harm reduction is helpful, and in others, it is not. Again, addiction and recovery are not linear. The more we as a society understand this, the better we can help each other.

As always, these blogs are meant to be brief and educational, based on professional experience and research references. This blog is not meant to replace professional medical or mental health advice or treatment from your primary providers. If you have questions or comments, please feel free to contact me!

References:

Smith, J. (2016). The Cycle of Addiction: What You Should Know. Psychology Today. Retrieved from [link]

Murray, D. W., Blitstein, J. L., Dino, G. A., Emmons, K. M., & Federico, D. (2019). Abstinence and relapse among smokers who use cessation aids and those who do not: comparisons across a national sample. Nicotine & Tobacco Research, 21(4), 466-472.

National Institute on Drug Abuse. (2020). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved from [link]

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371. https://doi.org/10.1056/NEJMra1511480

Volkow, N. D., & Li, T. K. (2005). Drugs and alcohol: treating and preventing abuse, addiction, and their medical consequences. Pharmacology & Therapeutics, 108(1), 3-17.